Asthma, Author Interviews, NEJM, Pediatrics, Pharmacology / 01.09.2016

MedicalResearch.com Interview with: David A Stempel, MD Medical Affairs Lead US Medical Affairs GlaxoSmithKline MedicalResearch.com: What is the background for this study? What are the main findings? Response: Long-acting beta-agonists (LABAs) have been shown to increase the risk of asthma-related death among adults and the risk of asthma-related hospitalization among children. It is unknown whether the concomitant use of inhaled glucocorticoids with LABAs mitigates those risks. This trial prospectively evaluated the safety of the LABA salmeterol, added to fluticasone propionate, in a fixed-dose combination in children. (more…)
Author Interviews, Nutrition, Pediatrics, Vitamin D / 31.08.2016

MedicalResearch.com Interview with: Dr. Ben Wheeler MB ChB(Otago) DCH CCE FRACP Senior Lecturer / Paediatrician / Paediatric Endocrinologist Department of Women’s & Children’s Health : Te Tari Hauora Wāhine me te Tamariki Dunedin School of Medicine MedicalResearch.com: What is the background for this study? Response: Vitamin D is essential for calcium and bone metabolism. It is unique among vitamins in that it is mainly derived from synthesis in the skin after exposure to UV-B radiation. In the absence of fortification, few foods are rich in vitamin D, including human milk, which contains very low amounts. Breastfeeding infants in higher latitude countries such as New Zealand, much of North America and Central/Northern Europe are at risk of vitamin D deficiency. The most profound manifestation of vitamin D deficiency in growing children is rickets, characterized by bone deformities, impaired growth, biochemical abnormalities, and depending on the severity of deficiency, seizures. Studies also identified a number of common factors that potentially affect the risk of rickets, including darker pigmented skin, maternal vitamin D deficiency during pregnancy, season of birth, and age. A potential alternative strategy to improve the vitamin D status of breastfed infants is high-dose vitamin D supplementation to pregnant and lactating women. This would be attractive from a compliance perspective, promote exclusive breastfeeding, and treat both the mother and her infant. Thus, the primary aim of this randomized, placebo-controlled study was to determine the effect of two different monthly doses of maternal vitamin D supplementation on the vitamin D status of non–vitamin D–supplemented breastfed infants and their mothers. (more…)
Author Interviews, Cancer Research, Mammograms, PNAS, Radiology / 31.08.2016

MedicalResearch.com Interview with: Karla K. Evans, Ph.D. Lecturer, Department of Psychology The University of York Heslington, York UK MedicalResearch.com: What is the background for this study? Response: This research started after initially talking to radiologists and pathologists about how they search a radiograph or micrograph for abnormalities. They talked about being able to tell at the first glance if the image had something bad about it. Jokingly, they talked about “having the force” to see the bad. We wanted to know whether this hunch after the brief initial viewing was real and to systematically test it. We collected radiographic and micrographic images, half of them that had signs of cancer in them and half of them that didn't, and we briefly presented them (250 millisecond to 2000 milliseconds) to radiologists or pathologistsrespectively. They simply had to report whether they would recall the patient or not and try localize on the outline the location of the abnormality. We first reported these finding in the following paper. Evans et al. (2013) The Gist of the Abnormal: Above chance medical decision making in the blink of an eye. Psychonomic Bulletin & Review (DOI) 10.3758/s13423-013-0459-3 In addition to finding that radiologists and pathologists can indeed detect subtle cancers in a quarter of a second we also found that they did not know where it was in the image leading us to conclude that the signal that they were picking up must be a global signal (i.e. the global image statistic or the texture of the breast as a whole) rather than the result of a local saliency. This led me to start further exploring this signal in order to characterize it when I moved to University or York, UK to establish my own lab. (more…)
Author Interviews, Neurological Disorders / 31.08.2016

MedicalResearch.com Interview with: Sanne Kikkert, DPhil student FMRIB Centre, University of Oxford Oxford, United Kingdom MedicalResearch.com: What is the background for this study? Response: One of the most mysterious questions about the brain’s ability to adaptively change to new circumstances is: what happens to the brain once a key input is lost (e.g. through amputation)? It has been thought that the hand representation in the brain, located in the primary somatosensory cortex, is maintained by regular sensory input from the hand. Indeed, textbooks teach that any sensory representation in the brain will be ‘overwritten’ if its primary input stops. Following this explanation, people who have undergone hand amputation would show extremely low or no activity related to its original focus in the brain area of the missing hand. However, we know that amputees often experience phantom sensations from their missing hand, such that when asked to move a phantom finger they can ‘feel’ that movement. We previously showed that we can trace some activity in the missing hand brain area when amputees move their phantom hand. In this study, we were interested in finding how the representation of a missing hand is stored in the brain. (more…)
Author Interviews, Biomarkers, Heart Disease, Kidney Disease / 31.08.2016

MedicalResearch.com Interview with: Xiaobing Yang, MD Division of Nephrology, Nanfang Hospital Southern Medical University MedicalResearch.com: What is the background for this study? Response: AKI is a common complication in patients with acute decompensated heart failure (ADHF) and associated with increased death and worse clinical outcomes. Early detecting which patients are going to suffer progressive AKI or proceed to death could help physicians to plan and initiate timely managements. We analyzed data and samples of 732 ADHF patients from a prospective, multicenter study in China. We demonstrated that kidney injury biomarkers, measured at the first time of AKI clinical diagnosis, could predict which patients were going to have AKI progression or worsening of AKI with death. Notably, three urinary biomarkers, including urinary angiotensinogen (uAGT), urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary IL-18 (uIL-18), were all able to forecast which patients with the earliest stages of AKI were most likely to suffer progressive AKI. (more…)
Author Interviews, Cost of Health Care, JAMA / 31.08.2016

MedicalResearch.com Interview with: Dr. Rachel O. Reid MD MS Associate Physician Policy Researcher RAND Corporation MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Waste in the US health care system is both common and expensive, estimated to be in the range of $750 billion annually. Contributing to this waste is over-treatment and use of low value services that offer little or no clinical benefit to patients. We studied 1.46 million adults from across the US with commercial insurance and found that spending on 28 low value services totaled $32.8 million in 2013, accounting for 0.5% of their medical spending or $22 per person annually. The most commonly received low-value services included hormone tests for thyroid problems, imaging for low-back pain and imaging for uncomplicated headache. The greatest proportion of spending was for spinal injection for lower-back pain at $12.1 million, imaging for uncomplicated headache at $3.6 million and imaging for nonspecific low-back pain at $3.1 million. Low-value spending was lower among patients who were older, male, black or Asian, lower-income or enrolled on consumer-directed health plans, which have high member cost-sharing. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pharmacology / 31.08.2016

MedicalResearch.com Interview with: Aaron S. Kesselheim, M.D., J.D., M.P.H. Associate Professor of Medicine at Harvard Medical School Director, Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women's Hospital Boston MA 02120 MedicalResearch.com: What is the background for this study? What are the main findings? Response: It has been previously reported that the number of new cardiovascular drugs approved by the U.S. Food and Drug Administration (FDA) has declined in recent years. So we sought to empirically assess trends in the development of new cardiovascular therapeutics. (more…)
Author Interviews, Lyme / 31.08.2016

MedicalResearch.com Interview with: Audun Aase, PhD Department Director, Infectious Disease Immunology Norwegian Institute of Public Health Oslo, Norway MedicalResearch.com: What is the background for this study? Response: Controversies related to Lyme disease and tick transmitted diseases have gained much attention in the public media in Norway, both regarding treatment regimens and diagnostics. People with long-lasting disease may relate their symptoms to previous tick bite and/or suboptimal-treated Lyme disease and have adopted the diagnosis chronic Lyme disease. As many of these patients lack objective proof of Lyme disease, they look for alternative test to signify their suspicion. A modified microscopy method for detection of the Borrelia burgdorferi s.l. (the causative agent of Lyme disease) in human blood was published in 2013. The authors behind the method examined blood from suspected chronic Lyme disease patients, and the results showed presence of Borrelia spirochetes in most of the specimens. Using the same method, they also claimed to detect the Babesia parasites in many of the samples. The method gained much publicity and the patients advocated strongly for this method as most other laboratory tests had failed to prove their diagnosis. (more…)
Author Interviews, Heart Disease, Lancet, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Prof Lars Wallentin, MD PHD Senior Professor Cardiology Uppsala Clinical Research Center, Uppsala University  MedicalResearch.com: What is the background for this study? Response: The FRISC2 study was performed 1996 – 1998 and reported 1999 for the first time a significant reduction in death and myocardial infarction by early invasive compared to non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). The results at 6 months, 1, 2 and 5 years were published in The Lancet and pivotal in changing the treatment guidelines and thereby improving outcomes in patients with NSTE-ACS. These findings were within the next few years verified in the TACTICS-TIMI18 and RITA3 trials. However the later performed ICTUS trial, starting after these results were published and accordingly with a substantial early crossover to the invasive arm, showed neutral results. Recently the reduction in event rates by an early invasive strategy was again validated in patients above 80 years of age, which were less well represented in the initial trials. These benefits of an early invasive strategy have previously been shown sustained for at least five years based on results from the FRISC2, RITA3, and ICTUS trials. The FRISC2 and TACTICS-TIMI18 trials also showed that the benefits with an early invasive strategy seemed confined to patients with signs of myocardial necrosis as indicated by elevated troponin level at entry. In addition the FRISC2 trial found that the benefits were larger in patients with signs of inflammatory activity as indicated by a high level of growth differentiation factor 15 (GDF-15) at entry. These pivotal results have been the basis for the current international treatment guidelines recommending an early invasive treatment strategy in patients with NSTE-ACS and elevated troponin and/or other indicators of a raised risk. (more…)
Author Interviews, Nutrition, Pediatrics, Social Issues, Weight Research / 31.08.2016

MedicalResearch.com Interview with: Kai Ling Kong, PhD, MS Assistant Professor Division of Behavioral Medicine Department of Pediatrics School of Medicine and Biomedical Sciences State University of New York at Buffalo MedicalResearch.com: What is the background for this study? Response: Infant temperament, or individual behavior styles, can be reliably measured and is related to weight status. However, we know very little about the association of infants’ temperament and their motivation to eat versus engage in other activities (relative food reinforcement). Examining such associations is an important step given the need to use behavioral strategies in obesity prevention in early life. The purpose of our study was to determine if infant temperament, specifically the factors that have been linked with obesity risk, are associated with infant relative food reinforcement. (more…)
Author Interviews, Genetic Research, PLoS, University of Pittsburgh / 31.08.2016

MedicalResearch.com Interview with: Seth M. Weinberg, PhD Assistant Professor, Department of Oral Biology Assistant Professor, Department of Anthropology Director, CCDG Imaging and Morphometrics Lab MedicalResearch.com: What is the background for this study? Response: Scientists have long recognized that aspects of facial appearance have a genetic basis. This is most obvious when we look at the faces of people in the same family.  It is also well known that mutations in certain genes can result in syndromes where the face is affected.  However, very little is known about how specific genes influence the size and shape of normal human facial features.  To date, only a handful of studies have looked at this question, and while these studies have reported several interesting results, only a small number of genes have so far been linked to normal variation in facial features.  The primary goal of our study was to test for evidence of association between detailed facial measures derived from 3D images and common genetic variants spread across the entire genome.  We also attempted to independently replicate some of the findings from previous studies. (more…)
Author Interviews, Heart Disease, NEJM, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Dr. Kaare Harald Bønaa Principal investigator University of Tromsø, Norway MedicalResearch.com: What is the background for this study? Response: The NORSTENT study was designed shortly after the “Barcelona fire storm” in 2006 that raised severe safety concerns against drug-eluting stents (DES). At that time there was evidence for increased risk of stent thrombosis with DES. How this could influence long term results compared to PCI with bare metal stents (MMS) was not known. Accordingly, we designed the NORSTENT study with the primary composite endpoint of all-cause mortality and non-fatal spontaneous myocardial infarction at a medial of 5 years of follow-up. (more…)
Anesthesiology, Author Interviews, Emergency Care, JAMA, Pediatrics / 31.08.2016

MedicalResearch.com Interview with: Marc Auerbach, MD, FAAP, MSc Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education) Director, Pediatric Simulation Yale Center for Medical Simulation; MedicalResearch.com: What is the background for this study? What are the main findings? Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores. The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation. (more…)
Author Interviews, Breast Cancer, Genetic Research, Mental Health Research, Ovarian Cancer, Psychological Science / 31.08.2016

MedicalResearch.com Interview with: Mag. Dr. Anne Oberguggenberger PhD Medizinische Universität Innsbruck Department für Psychiatrie, Psychotherapie und Psychosomatik Innsbruck Austria MedicalResearch.com: What is the background for this study? Response: Genetic counseling and testing is increasingly integrated in routine clinical care for breast- and ovarian cancer (BOC). Knowledge on follow-up psychosocial outcomes in all different groups of counselees is essential in order to improve follow-up care and counselees’ quality of life. (more…)
AHA Journals, Author Interviews, Heart Disease, Hospital Readmissions, Surgical Research / 31.08.2016

MedicalResearch.com Interview with: Jason H. Wasfy, MD, MPhil Assistant Medical Director, Massachusetts General Physicians Organization Director of Quality and Analytics Massachusetts General Hospital Heart Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reducing preventable readmissions after PCI is a way to both improve the quality of care for our patients and improve value for patients with coronary artery disease. Through a variety of tactics, we were able to reduce the 30 day readmission rate for patients after PCI by nearly half. Keep in mind that this is only the readmission rate to our hospital, so we will need to confirm these results with data including patients who may have been readmitted to other hospitals after a PCI at Mass General. (more…)
Author Interviews, Education, JAMA / 30.08.2016

MedicalResearch.com Interview with: Daniel J. Morgan M.D., M.S Associate Professor Epidemiology & Public Health University of Maryland School of Medicine MedicalResearch.com: What is the background for this study? Response: Physicians are generally taught if a treatment is indicated, not how well the treatment works. Although this has been part of evidence based medical training, doctors still perform poorly with ability to understand risk and how treatment limits risk (Bayesian reasoning). Many publications focus on relative risk reduction which inflates the perception of an effect over the more accurate absolute risk reduction. (more…)
Addiction, Author Interviews, CDC, Opiods / 30.08.2016

MedicalResearch.com Interview with: Alexis B. Peterson, PhD (Epidemic Intelligence Service Officer) R. Matthew Gladden, PhD (Behavioral Scientist) MedicalResearch.com What is the background for this study? Response: In March and October 2015, the Drug Enforcement Administration and the Centers for Disease Control and Prevention (CDC) issued nationwide alerts identifying fentanyl, particularly illicitly manufactured fentanyl, as a threat to public health and safety. During 2013-2014, Ohio and Florida reported significant increases in fentanyl-involved overdose deaths (fentanyl deaths) and fentanyl submissions (drug products obtained by law enforcement that tested positive for fentanyl). Fentanyl is a synthetic opioid 50-100 times more potent than morphine. The University of Florida and the Ohio Department of Public Health with CDC assistance compared trends in fentanyl deaths, fentanyl submissions, and fentanyl prescribing during January 2013–June 2015. In-depth review of medical examiner and coroner reports of fentanyl deaths occurring in Ohio’s 14 high-burden counties were performed to identify circumstances surrounding fentanyl overdose death. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, Education / 30.08.2016

MedicalResearch.com Interview with: Deborah Blacker MD, ScD Director of the Gerontology Research Unit Department of Psychiatry Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings Response: Many observational studies have found that those who are cognitively active have a lower risk of developing Alzheimer's disease or any type of dementia. However, we and others have been concerned that these findings might be spurious due to two potential biases:
  • 1) “confounding,” meaning that those who are cognitively active have lower rates of Alzheimer’s disease for another reason, in particular the effect of greater education, which is associated with both lower risk of Alzheimer’s and higher levels of cognitive activity; and
  • 2) “reverse causation,” meaning that theassociation could be due to a reduction in cognitive activity among those already in the long preclinical phase of cognitive decline before Alzheimer’s dementia (rather than the lack of cognitive activity causing the Alzheimer’s). Our study performed a systematic review of the literature on the association, and then a set of bias analyses to assess whether confounding or reverse causation could account for the observed associations.
(more…)
Author Interviews, Heart Disease, NEJM, Obstructive Sleep Apnea, Sleep Disorders / 30.08.2016

MedicalResearch.com Interview with: Prof. Craig Anderson, PhD Professor of Stroke Medicine and Clinical Neuroscience Medicine, The George Institute for Global Health University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wished to prove whether treatment of obstructive sleep apnea with continuous positive airway pressure (CPAP ) can modify the risk of cardiovascular disease. The is a lot of association data from epidemiological and clinical studies but no large scale international clinical trials assessing the effects of CPAP on the prevention of serious cardiovascular events like heart attack and stroke. Our study in nearly 3000 adults with prior heart attack or stroke and moderate to severe obstructive sleep apnea showed that CPAP treatment did not prevent recurrent cardiovascular events or major cardiovascular risk factors. However CPAP did improve wearers' sense of wellbeing, mood and work productivity. (more…)
Accidents & Violence, Author Interviews, CDC, Cost of Health Care, Frailty, Geriatrics / 30.08.2016

MedicalResearch.com Interview with: Elizabeth Burns, MPH Health Scientist, Division of Unintentional Injury Prevention National Center for Injury Prevention and Control CDC MedicalResearch.com: What is the background for this study? Response: Falls are the leading cause of both fatal and non-fatal injuries among Americans aged 65 and older. In 2000, the direct cost of falls were estimated to be $179 million for fatal falls and $19 billion for non-fatal falls. Fall injuries and deaths are expected to rise as more than 10,000 Americans turn 65 each day. Within the next 15 years, the U. S. population of older Americans is anticipated to increase more than 50%, with the total number of older adults rising to 74 million by 2030. (more…)
Author Interviews, Diabetes, Heart Disease, Stem Cells / 30.08.2016

MedicalResearch.com Interview with: Jolanta U Weaver, FRCP MRCS PhD CTLHE Senior Lecturer in Diabetes Medicine Honorary Consultant Diabetologist Newcastle MedicalResearch.com: What is the background for this study? What are the main findings? Response: Vascular stem cells, which are associated with an improvement of heart disease, are improved in type 1 diabetes by repurposing metformin, known to reduce heart disease in type 2 diabetes. We treated patients with type 1 diabetes with metformin for 8 weeks. The metformin dose varied between 500 mg a day to 2000 mg a day, depending on what patients were happy to take. Subjects were requested to keep diabetic control unchanged to study the direct effect of metformin on heart disease. Circulating endothelial progenitor cells (vascular stem cells) count, Hill’s colonies and pro angiogenic cells function (in test tube) improved in comparison to patients, who did not take metformin but remained on standard therapy. Endothelial cells associated with vascular damage, on the other hand, were reduced following metformin therapy confirming improved vascular health. The glycaemic control remained unchanged (as planned at the onset of the study) to allow us to examine the effect of metformin ALONE on vascular health. Patients did not suffer any serious side effects. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Transplantation / 30.08.2016

MedicalResearch.com Interview with: Dr. Laith Alshawabkeh MD ‎Senior Fellow Brigham & Women's and Boston Childrens Hospitals / Harvard Medical School MedicalResearch.com: What is the background for this study? Response: As the number of adults living with congenital heart disease continues to increase, there is paucity of evidence on the trajectories and patterns of their comorbidities. In all, heart failure is the leading cause of death in this group of patients. Unfortunately, landmark trials and advances in medical therapy which promoted increase survival in patients with the usual heart failure (non-congenital) has not been translated into those with congenital heart disease. Heart transplantation remains one of the (if not the only) sustainable option for many patients with congenital heart disease at the end stage of heart failure. Recent studies have shown that adults with congenital heart disease who underwent transplantation experienced higher risk of postoperative mortality compared to their non-congenital counterparts; however, patients with congenital heart disease who survived the first year post-transplantation enjoyed significantly better long-term survival, indicating that with careful selection those patients might benefit tremendously from transplantation. Much less is known about the outcome of these patients while they are waiting for an organ. As such, this study sought to examine the outcomes of patients with congenital heart disease while listed for heart transplantation and to investigate correlates of adverse outcomes (mortality and delisting due to clinical worsening). (more…)
Author Interviews, Heart Disease, Stem Cells / 30.08.2016

MedicalResearch.com Interview with: Javed Butler, M.D., MPH, FACC, FAHA Chief of the Cardiology Division and Co-Director of the Heart Institute at Stony Brook University Stony Brook Heart Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: It was previously assumed that stem cells must be delivered directly to the myocardium to improve patient outcomes. However, this delivery mechanism – either in the coronary artery or the myocardium – may not be feasible for millions of patients and for repeat injections. This study represents the first clinical trial to observe the effects of intravenous (IV) administration of ischemia-tolerant mesenchymal stem cells (itMSCs) in patients with chronic heart failure. Results show that an IV injection strategy is safe and well-tolerated.In addition, the data illustrate statistically significant improvement in 6-minute walk test, quality-of-life scores as assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ) and favorable immune modulatory benefits. (more…)
Author Interviews, Chemotherapy, Prostate Cancer / 30.08.2016

MedicalResearch.com Interview with: Prof. Ronald de Wit, MD, PhD Medical Oncologist Medical Oncology Erasmus MC University Medical Center, Rotterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mainsail is one of the largest phase 3 trials in the setting of  Metastatic Castration-Resistant Prostate Cancer (mCRPC)  in the past decade that investigated the addition of a second active biological drug to standard docetaxel every 3 weeks plus prednisone. In Mainsail the greater myelotoxicity caused by the addition of lenalidomide to docetaxel resulted in a reduction of the number of cycles of docetaxel that patients were able to tolerate – median of 6 cycles in the DPL arm vs. 8 in the DP arm. Median overall survival (OS) was shorter in patients receiving lenalidomide, which could have attributed to either a direct adverse effect of lenalidomide on OS, or, alternatively because of the reduction in the number of docetaxel treatment cycles. In this study we investigated the impact of the cumulative dose of docetaxel as reflected by the total number of cycles of docetaxel on median OS, in Univariate and Multivariate analyses on the ITT Population, both dependent upon the treatment arm, as well as irrespective of the treatment arm. In subsequent sensitivity analyses we addressed potential confounding factors on the eventual survival outcome. (more…)
AHA Journals, Anemia, Author Interviews, Hematology, Stroke / 30.08.2016

MedicalResearch.com Interview with: Raphae Barlas M.A 3rd year MBChB student The Institute of Applied Health Sciences Aberdeen MedicalResearch.com: What is the background for this study? What are the main findings? Response: Anemia and stroke are both common conditions. While previous studies have found an association between anemia on admission and increased mortality in stroke patients, this was not consistent throughout the literature. We aimed to comprehensively assess this association by conducting our own observational study, consisting of 8000 patients from UK regional stroke registry data. We then aggregated our findings into a systematic review and meta-analysis of the existing literature for a total study population of approximately 30,000 patients. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC, Surgical Research / 30.08.2016

MedicalResearch.com Interview with: Gennaro Giustino MD Resident Physician - Department of Medicine The Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: A period of dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention (PCI) with drug-eluting stents (DES). The pathophysiological rationale for DAPT after DES-PCI is predicated on the need to prevent stent-related thrombotic complications while vascular healing and platform endothelialization are ongoing, a process that seems to last between 1 and 6 months with new-generation DES. Whether to extend DAPT after this mandatory period in order to provide a broader atherothrombotic risk protection (for stent-related and non-stent-related atherothrombotic events) is currently a matter of debate. Current guidelines recommend at least 6 months of DAPT after PCI in patients with stable coronary artery disease (CAD) and at least 12 months of DAPT in patients presenting with acute coronary syndrome (ACS). While, several risk scores have been developed to guide clinical decision making for DAPT intensity and duration (namely the DAPT score and the PARIS risk scores) little attention has been payed so far to PCI complexity and the extent of CAD to guide duration of DAPT. In fact irrespective of clinical presentation, patients undergoing more complex PCI procedure (likely due to greater coronary atherosclerotic burden) may remain at greater risk for ischemic events and therefore may benefit of prolonged, or more intense, DAPT. (more…)
Author Interviews, Lyme / 29.08.2016

MedicalResearch.com with Senior Author: Tara Moriarty, Ph.D. University of Toronto, Canada Faculty of Dentistry, Matrix Dynamics Group Faculty of Medicine, Department of Laboratory Medicine and Pathobiology Lead Author: Rhodaba Ebady, Ph.D. student University of Toronto, Canada Faculty of Dentistry, Matrix Dynamics Group MedicalResearch.com: What is the background for this study? What are the main findings? Response: The spread of microbes via the bloodstream (dissemination) is responsible for most of the mortality associated with bacterial infection. Even though this is a clinically important step of many infectious diseases, and likely an important target for disease treatment, we don’t know how most microbes disseminate. One of the key steps in this process is adhesion of bacteria to the inner surfaces of blood vessels. This allows bacteria to slow down enough to grab onto vessel surfaces, then escape from the blood stream into tissues where it’s easier for them to live. It’s a bit like the problem faced by a person being carried down a fast-flowing river who needs to grab onto something on the banks to get out onto dry land. A big problem for bacteria, and any other cells which must stick to blood vessel walls (like white blood cells travelling to a site of infection or inflammation), is that they have to be able to stick to vessel walls without being ripped off by the flow of blood. They have to have adhesion mechanisms strong enough to overcome forces due to flow. It’s also really helpful to be able to hang on but keep moving along walls until they reach a good spot to get out. This is important for white blood cells too, which have to “sample” their environment to get to the right place to get out of blood flow. Even though the problem of how bacteria stick to blood vessel walls is so important clinically, the mechanisms bacteria use to do this are not widely understood. Part of this gap in our knowledge arises because we haven’t had good tools to study this process as it happens, and to understand how force affects bacterial interaction with vessel walls. The process of bacteria sticking to blood vessel walls is very fast, and hard to observe. The methods to observe this have already been developed, but the major technical innovations of our paper were to figure out how to identify and track the movement of the individual bacteria which stuck to vessel walls among millions flowing past, and to figure out how to set up a flow chamber system which replicated certain conditions in human blood vessels. Figuring out how to do this allowed us to figure out a lot about how the bacteria moved, and the forces and mechanisms involved in adhesion. It took a couple of years just to figure out the common patterns in the thousands of tracks of bacteria interacting with blood vessels, after the initial technical innovation. (more…)
Author Interviews, Neurology, Stroke / 29.08.2016

MedicalResearch.com Interview with: Dr. Ashkan Shoamanesh MD FRCPC Assistant Professor Division of Neurology, Department of Medicine McMaster University and Dr. Jose Rafael Romero, MD Associate Professor of Neurology Boston University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Framingham Heart Study is a population-based study of individuals residing in the community. Identifying people who are at risk for stroke can help us determine who would benefit most from existing or new therapies to prevent stroke. As inflammatory pathways are believed to contribute to vascular disease and stroke, we tested whether circulating biomarkers of inflammation and endothelial dysfunction could improve the predictive ability of the Framingham Stroke Risk Profile score, a model that contains classical vascular risk factors such as high blood pressure and diabetes. Our main observation was that inclusion of 4 biomarkers (C-reactive protein, tumor necrosis factor receptor-2, total homocysteine, and vascular endothelial growth factor) in the Framingham Stroke Risk Profile improved its ability to predict a stroke (net reclassification improvement of 0.34 [0.12–0.57]). (more…)
Author Interviews, Compliance, Cost of Health Care / 29.08.2016

MedicalResearch.com Interview with: Elizabeth Geneva Wood, MHPA Department of Health Policy and Administration College of Nursing Washington State University Spokane MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many people don’t fill prescriptions because they can’t afford them, which is risky for their health. The problem of cost-related nonadherence to prescriptions (CRN) was increasing in prevalence over time until several major policy changes in the 2000s that were intended to help prescription affordability and/or access to health insurance. We observed that each of these major policy changes corresponded with a decrease in CRN among the policy’s target population. For seniors, CRN dropped in 2006, when Medicare Part D came into effect. For younger adults (19-25), CRN dropped in 2010, when the Affordable Care Act began allowing them to stay on their parents’ insurance. Cost-related nonadherence rates also dropped for all non-elderly adults (including the younger ones) in 2014 and 2015, when the Medicaid expansion and the introduction of the health insurance marketplaces offered coverage to many previously-uninsured adults. (more…)