Author: Marie Benz MD FAAD
12 Feb Identifying Gene Expression of Early Lung Cancer Exposes More Drug Targets
MedicalResearch.com Interview with: [caption id="attachment_21559" align="alignleft" width="180"]
Dr. Chiara Ambrogio[/caption]
Chiara Ambrogio, PhD
Experimental Oncology Group
CNIO-Centro Nacional de Investigaciones Oncológicas
(Spanish National Cancer Research Centre)
Melchor Fernández Almagro nº3
Madrid Spain
Medical Research: What is the background for this study?
Dr. Ambrogio: The majority of preclinical studies aimed at discovering new therapeutic strategies for lung adenocarcinoma have been conducted so far in full-blown tumors. We wanted to try a new approach by studying early lung lesions in a KRasG12V mouse model in order to bypass the problems imposed by tumor heterogeneity in later stages of the disease. We reasoned that the analysis of the first steps of lung adenocarcinoma development would help us in identifying valuable targets for therapeutic intervention.
Medical Research: What are the main findings?
Dr. Ambrogio:
1) We performed gene expression analysis of KRasG12V-driven mouse lung hyperplasias (≤ 500 cells) and we compared it to the gene expression profile of full-blown lung adenocarcinoma. We found that the aggressive nature of this tumor type is determined earlier than what predicted by histopathological criteria.
2) The analysis of transcriptional changes in early lesions allowed us to identify DDR1 as a drugable target in KRasG12V-driven lung adenocarcinoma. We validated its potential as a therapeutic target both genetically and pharmacologically by means of a selective DDR1 inhibitor. We demonstrated that the co-inhibition of DDR1 and NOTCH pathway, a key player in DDR1-mediated survival, exerted additive therapeutic effect.
3) We confirmed these results in human lung adenocarcinoma by reporting, for the first time, the development of an orthotopic Patient-Derived Xenograft (PDX) model as the ideal platform for the preclinical evaluation of new therapeutic strategies.
12 Feb Increased rates of incarceration may mean more sexual partners and STDs
MedicalResearch.com Interview with: [caption id="attachment_21643" align="alignleft" width="186"]
Dr. Andrea Knittel[/caption]
Andrea K. Knittel, MD, PhD
PGY-3, Department of Obstetrics, Gynecology, and Reproductive Sciences
University of California, San Francisco
Medical Research: What is the background for this study?
Dr. Knittel: The United States has the highest rate of incarceration in the world, and many studies have shown that involvement in the criminal justice system may be a risk factor for HIV/AIDS or other STDs. For example, some studies have found that in areas with high rates of incarceration, rates of STDs are higher, and others have shown that incarcerated individuals are more likely to have higher rates of concurrent sexual partnerships and a greater number of sexual partners. This may happen because of increased rates of partnership dissolution due to physical and emotional distance, as well as a desire on the part of formerly incarcerated men for an increased number of sexual partners to “make up for lost time,” which some studies have suggested. In addition, the female partners of incarcerated men may rely on other relationships, including new sexual partners, for emotional and financial support while their partners are incarcerated, whether their relationships end permanently or temporarily or they maintain their relationships through visits and calls.
Very few studies have been able to look at community level effects of incarceration, however, because it is difficult to gather data at this level. This study uses an agent-based model, a computational approach that provide a closed system in which to test hypotheses. An agent-based model is a computer simulation that creates a small community (250 “agents” or simulated people) in which the agents can date and have sexual relationships. The model used in this paper has been shown previously to be similar to young people in the US. The experiment in this study was to run the model without incarceration and see how many partners men and women in the community had, and then add incarceration into the model and see what happened. Based on data from other studies, when men in the model were incarcerated they had a slightly higher risk of ending a relationship and became slightly less desirable as partners.
12 Feb What Is the Ideal Aspirin Dose for Cardiac Health and Cancer Prevention?
MedicalResearch.com Interview with: [caption id="attachment_21364" align="alignleft" width="113"]
Dr. Biondi-Zoccai[/caption]
Giuseppe Biondi-Zoccai MD
Department of Medico-Surgical Sciences and Biotechnologies
Sapienza University of Rome
Corso della Repubblica
Latina, Italy
Medical Research: What is the background for this study?
Dr. Biondi-Zoccai: The main premise of our work is the historically established benefit of aspirin to reduce the risk of cardiovascular events in apparently healthy people, which is however substantially offset by the risk of bleeding. More recently, several pieces of evidence have highlighed the cancer benefits of aspirin, namely its capability of reducing the risk of cancer, in particular cancer in the colon and rectum, as well as deaths due to such cancer. Despite these potentially momentous benefits, there is uncertainty on which dose and preparation of aspirin is best suited to reduce cardiovascular and cancer events, while minimizing bleeding. Indeed, several dosages of aspirin have been tested and are commercially available (for instance from as little as 50 mg per day to more than 300 mg per day). In addition, aspirin is available in different pharmacologic preparations, for instance with specific gastro-protective coatings or controlled-release features, which may have impact on safety and efficacy.
Medical Research: What are the main findings?
Dr. Biondi-Zoccai: Our results, building upon the recent research work of the US Government sanctioned Preventive Services Task Force (USPSTF), suggest that a dosage of aspirin of 100 mg per day, combined with enteric-coating, is most likely to be beneficial to reduce the risk of cancer and minimize stomach bleeding. The results, as often in biomedical research, are not however 100% certain, and thus this increased likelihood of benefit must be viewed in the context of our study design, as well as other procedural and patient factors.
12 Feb Young Black MSM Account For Largest Number of New HIV Cases
MedicalResearch.com Interview with: [caption id="attachment_21546" align="alignleft" width="141"]
Dr. Laura Kann[/caption]
Laura Kann, PhD
Chief of the School-Based Surveillance Branch (SBSB)
Division of Adolescent and School Health (DASH).
CDC
Medical Research: What is the background for this study?
Dr. Kann: Young persons aged 13–24 years accounted for an estimated 22% of all new diagnoses of human immunodeficiency virus (HIV) infection in the United States in 2014. Most new HIV diagnoses among youths occur among males who have sex with males (MSM). Among all MSM, young black MSM accounted for the largest number of new HIV diagnoses in 2014 (4,398 among blacks, 1,834 among Hispanics, and 1,366 among whites). Although other studies have examined HIV-related risk behaviors among MSM, less is known about MSM aged <18 years.
Medical Research: What are the main findings?
Dr. Kann: Among male students who had sexual contact with males, black students had a significantly lower prevalence than white students of drinking five or more drinks of alcohol in a row; ever using inhalants, heroin, ecstasy, or prescription drugs without a doctor’s prescription; and drinking alcohol or using drugs before last sexual intercourse. Black students also had a significantly lower prevalence than Hispanic students of drinking five or more drinks of alcohol in a row and ever using cocaine, inhalants, methamphetamines, ecstasy, or steroids without a doctor’s prescription. However, among male students who had sexual contact with males, black students had a significantly higher prevalence than white students of ever having had sexual intercourse and using a condom during last sexual intercourse; black students also had a higher prevalence than Hispanic students of ever having sexual intercourse.
12 Feb Acetaminophen During Pregnancy Linked To Childhood Asthma
MedicalResearch.com Interview with: [caption id="attachment_21542" align="alignleft" width="133"]
Maria C. Magnus[/caption]
Maria C. Magnus
Norwegian Institute of Public Health
Oslo Norway
Medical Research: What is the background for this study? What are the main findings?
Response: Researchers have found that developing asthma can be linked to pregnant women and infants being exposed to paracetamol, (acetaminophen) by testing that the association was not simply linked to the complaint for which the person is taking paracetamol. The findings were published in the International Journal of Epidemiology
Using data from the Norwegian Mother and Child Cohort Study, researchers in Norway compared associations between several conditions during pregnancy (with and without the use of paracetamol) and asthma developing in the 114,500 children in the study. They examined asthma outcomes at ages three and seven and evaluated the likelihood of the association being as a result of the three most common uses of paracetamol in pregnancy: pain, fever, and influenza.
The results showed that 5.7 per cent of the children had current asthma at age three, and 5.1 per cent had asthma at age seven. The research found that there was a strong link between children who had asthma at age three who had been exposed to paracetamol as during pregnancy or infancy. The strongest association was seen if the mother used paracetamol during pregnancy for more than one complaint with a child having asthma at three years old.
12 Feb Babies’ Intestinal Microbiome Affected By Family Diet
MedicalResearch.com Interview with [caption id="attachment_21538" align="alignleft" width="103"]
Prof. Tine Rask Licht[/caption]
Tine Rask Licht, Professor
Head of Research Group on Gut Microbiology and Immunology
Technical University of Denmark
National Food Institute Søborg
Medical Research: What is the background for this study? What are the main findings?
Response: During childhood, the intestinal microbiota is under establishment. This period thus represents a ’window’, where the microbiota is likely to be more susceptible to be affected by external factors such as diet. Currently, it is well known that breast feeding has a major impact on the microbiota of young infants, but only very few studies have addressed the effect of the ‘next step’ in diet exposure, represented by complementary feeding.
We studied two cohorts of children, born to normal-weight and obese mothers, respectively, and mapped the composition of bacteria in their fecal microbiota at age 9 months and 18 months. We found that at 9 months, the microbiota was clearly affected by the composition of the complementary diet, but not by maternal obesity.
12 Feb Online Health Portals Linked To Better Adherence To Preventive Care
Posted at 01:48h
in Author Interviews, Compliance, Electronic Records, Kaiser Permanente, Technology
MedicalResearch.com Interview with:
[caption id="attachment_21527" align="alignleft" width="133"]
Dr. Shayna Henry[/caption]
Shayna L. Henry, PhD
Postdoctoral Research Fellow
Department of Research & Evaluation
Kaiser Permanente Southern California
Medical Research: What is the background for this study? What are the main findings?
Dr. Henry: In this study, we analyzed the electronic health records of 838,638 Kaiser Permanente members in Southern California. We decided to conduct this study because Kaiser Permanente always strives to advance standards of excellence for care, and even with all the outreach resources available to health care providers and staff, gaps in preventive care still arise. It can be hard to get patients engaged in managing their preventive care, because there are so many tasks for them to keep track of – many of which don’t happen on a very regular basis. Online patient portals have been very useful at helping patients get more engaged in their care, but patients still have to make the first move, and put all the pieces together. Our tool, the Online Personal Action Plan (oPAP), puts our members’ health status and preventive and chronic care tasks in a single dashboard, and alerts them via email to their upcoming care needs, prompting them to log in, view their upcoming health care tasks such as annual vaccinations, tests and blood draws for chronic conditions, and routine cancer screenings, and make the necessary medical appointments to close those gaps in care. We wanted to better understand if having access to the oPAP tools was associated with a higher likelihood of taking care of those outstanding health care tasks in a timely manner.
We found that members who used oPAP were more likely to get a mammogram, Pap smear, receive colorectal cancer screenings, and more likely to complete HbA1c testing for diabetes within 90 days of their coming due compared to members who were not registered on our patient portal.
11 Feb Meditation May Improve Experience with Imaging-Guided Needle Breast Biopsy
MedicalResearch.com Interview with: [caption id="attachment_21522" align="alignleft" width="133"]
Dr. Mary Scott Soo[/caption]
Mary Scott Soo, M.D. FACR
Associate professor of Radiology
Duke Cancer Institute
Medical Research: What is the background for this study?
Dr. Soo: Imaging-guided needle breast biopsies for diagnosing suspicious breast lesions have been performed for many years and have definite advantages as a diagnostic tool over surgical biopsies. These biopsies are performed in outpatient settings, which decrease costs and reduce delays, and are highly accurate and less invasive than surgical procedures, requiring only local anesthesia. However, performing biopsies in this outpatient setting limits the use of intravenous sedation and pain medication that could address commonly experienced patient anxiety and occasional associated pain. Anxiety and pain can negatively impact the patient's experience and could possibly affect the biopsy outcome due to patient movement, and could potentially even alter patients' adherence to follow-up recommendations. Prior studies have explored methods to reduce anxiety, using interventions such as music, hypnosis and anxiolytics. Although hypnosis and anxiolytics are effective, these are a little more complicated to implement due to training costs for administering hypnotherapy, and costs, potential side effects, and need for an adult driver to take the patients home when anxiolytics are used. Other research has shown that meditation-based interventions can lead to positive psychological and physical outcomes, and may be helpful for decreasing anxiety, pain and fatigue.
Loving-kindness mediation is a type of mediation that focuses on relaxation and developing positive emotions, by silently repeating phrases encouraging compassion and goodwill towards oneself and others, while also reducing negative emotions. Previous studies have shown that even a 7-minute loving-kindness meditation can be effective for increasing positive emotions, so my co-authors Rebecca Shelby PhD, a clinical psychologist at Duke’s Pain Prevention and Treatment Research Program,clinical psychologist Anava Wrenn PhD, who has used loving-kindness meditation in a different practice setting, and breast imaging radiologist Jennifer Jarosz MD and I put together a team to study whether an audio-recorded, lovingkindness meditation could reduce anxiety, fatigue and pain during the imaging-guided breast biopsy time frame. We consulted with Mary Brantley, MA, LMFT, who teaches loving-kindness meditation at Duke's Integrative Medicine, to develop an audio-recorded loving-kindness mediation used specifically in the breast biopsy setting, and compared this to using music during biopsies or standard care (supportive dialogue) from the technologist and radiologist performing the biopsy.
11 Feb Home Saliva Test Can Assess Your Personal Circadian Cycle
MedicalResearch.com Interview with: [caption id="attachment_21518" align="alignleft" width="120"]
Prof. Helen Burgess[/caption]
Helen J. Burgess, Ph.D.
Professor, Departments of Behavioral Sciences & Internal Medicine
Director, Biological Rhythms Research Laboratory
Director, Center for Clinical Chronobiology
Rush University Medical Center
Chicago IL 60612
Medical Research: What is the background for this study? What are the main findings?
Dr. Burgess: The 24 hour circadian clock in the brain has a profound influence on mental and physical health. Circadian rhythm sleep disorders occur when the internal circadian clock’s timing is out of synch with the external social world, which often dictates when we should eat, work and sleep. One such disorder, delayed sleep phase disorder, occurs when the circadian clock runs too late relative to social time.
Patients with delayed sleep phase disorder can appear to simply have insomnia, but careful measurement of their circadian timing can reveal the underlying circadian cause. Also, the treatment of delayed sleep phase disorder with either bright light and/or melatonin can be optimized by knowing a patient’s circadian timing, because the effect of these treatments can vary widely depending on when they are administered.
A problem in the sleep and circadian field is that the gold standard marker of circadian timing in humans, the dim light melatonin onset (DLMO), is typically only measured in the clinic or laboratory. Many clinics do not even measure the DLMO. Our group recently developed a home saliva collection kit to assist people in measuring their DLMO at home. Previously, we found the home DLMOs compared very well to laboratory DLMOs in healthy controls. In this paper, we extended this work to show the kit also works well in patients with delayed sleep phase disorder.
11 Feb Fully Integrated Electronic Records Linked to Fewer Inpatient Adverse Effects
MedicalResearch.com Interview with: [caption id="attachment_21535" align="alignleft" width="147"]
Mr. Noel Eldridge[/caption]
Mr. Noel Eldridge
Center for Quality Improvement and Patient Safety
Agency for Healthcare Research and Quality
Medical Research: What is the background for this study? What are the main findings?
Mr. Eldridge: We used existing data on adverse events from the Medicare Patient Safety Monitoring System, which AHRQ, CMS, and Qualidigm have been analyzing for years, and focused on the question as to whether rates of the adverse event measures were higher or lower in patients whose charts indicated that they had been treated with a full electronic health record (EHR) or a partial EHR during their inpatient stay.
The main finding was that the adverse event rates were lower in the full EHR patients. We saw three different diagnosis groups of patients (cardiovascular, pneumonia, and major surgery), and looked at combined rates for all adverse event types, as well as for four combined subtypes separately: hospital-acquired infections, adverse drug events, post-procedural events, and falls and pressure ulcers combined. Not all of our findings were what people unfamiliar with our measures would have expected.
11 Feb Several Genes Identified as Potential Biomarkers For Glaucoma
MedicalResearch.com Interview with: Dr Shi Song Rong PhD and Guy Li-Jia CHEN MBBS, MMed, MRCSEd (Ophth), PhD Assistant Professor Department of Ophthalmology & Visual SciencesPrince of Wales Hospital Faculty of Medicine The Chinese University of Hong Kong Medical Research: What is the background for this study? What are the main findings? Response: Glaucoma is a leading cause of irreversible blindness worldwide. Primary angle-closure glaucoma (PACG) as a major form of glaucoma accounts for about half of the cases blinded from the disease. So far, more than 50 genes/loci have been assessed for their associations with PACG and a wider spectrum of relevant conditions, primary angle-closure disease (PACD). In the article, we summarize the statistical associations of individual genes varying across different study cohorts and conducted meta-analysis to evaluate the associations of 28 polymorphisms in 11 genes/loci with PACD and its subtypes, including PACG, primary angle-closure (PAC) and/or primary angle-closure suspect (PACS). Thus, we affirmed the association of PACG and combined PACS/PAC/PACG with 10 polymorphisms in 8 genes/loci as potential biomarkers. Among them 3 were identified in the genome-wide association study (COL11A1,PLEKHA7 and PCMTD1-ST18), and 5 (HGF, HSP70, MFRP, MMP9 and NOS3) in candidate gene studies.11 Feb Dementia Incidence Dropping In Those With At Least High School Education
MedicalResearch.com Interview with: [caption id="attachment_21408" align="alignleft" width="200"]
Dr. Claudia Satizabal[/caption]
Claudia L. Satizabal, PhD
Instructor in Neurology
Boston University School of Medicine
The Framingham Heart Study
Boston, MA 02118-2526
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Satizabal: Our societies are expected to face an increasing burden of dementia in the next decades due to increasing life expectancies and the aging of a big proportion of the population, the so called “baby boomers”. However, some studies conducted in high-income countries have suggested a decline in the total number of cases (prevalence) as well as new cases (incidence) of dementia at any given age. Yet the findings of these studies were not seen as definitive, either because results were of borderline significance or because they were based on survey data, and stronger evidence was lacking.
We used information collected since 1975 in the Framingham Heart Study to estimate the trends in dementia incidence. One of the strengths of this study is that investigators have been careful to use the same diagnostic criteria for over the past 30 decades, which allows us to provide more robust evidence of dementia trends over time.
We found that there has been a progressive decline in the incidence of dementia at any given age over the past 30 decades. Compared to the late 1970s, we observed a decline of 22% in the late 1980s, 38% in the 1990s and 44% in the 2000s. This beneficial trend was only seen among persons with at least a high school diploma. We also explored trends in vascular risk factors such as blood pressure, smoking, diabetes, and others; however, these trends did not completely explain the decline in dementia incidence. One interesting finding was that the risk of dementia associated with cardiovascular diseases, such as stroke or atrial fibrillation, decreased dramatically over the course of time from the late 1970s to the 2000s.
11 Feb Hospice Providers Paid Same Rate Regardless of Services Provided
MedicalResearch.com Interview with: [caption id="attachment_21304" align="alignleft" width="200"]
Dr. Joan Teno[/caption]
Joan M Teno, MD, MS
Professor of Medicine
Division of Gerontology and Geriatrics
Cambia Palliative Care Center of Excellence
University of Washington
Medical Research: What is the background for this study? What are the main findings?
Dr. Teno: Hospices in the US are paid a daily rate, regardless of the service delivered. Key to hospice patients dying comfortably is that the caregiver and dying person received the needed visits by hospice professional staff, such as a nurse or social worker. These staff are trained to assess the patient and make appropriate changes to care plan to ensure the comfort and safety of the hospice patient. Multiple studies attest to the finding that pain and other symptoms exacerbate in the last days of life - key is the primary caregiver, usually a close family member receives the need training in administering of medicine to ensure the dying person is comfortable in the last hours of life.
We studied visits pattern by professional staff in the last 2 days of life finding that one in eight hospice patients were not visited.
While we would not expect every patient to have visits, there was several key finding that raised concern.
- First, blacks were 30% less likely to receive visits compared to whites
- Second, 16% persons dying in a nursing home were not visited - historically, bereaved family members identify concerns with the quality of end of life care in NH, even when the person is on hospice services.
- Third, one in five persons who died on Sunday were not visited in the last 2 days of life - which raises a concern with how hospices are staffing weekend coverage. There is nothing that would suggest biologically that persons don’t experience pain while dying on sturdy.
11 Feb Partial Meniscectomy Doesn’t Reduce Mechanical Knee Symptoms Any Better Than Sham Procedure
MedicalResearch.com Interview with: [caption id="attachment_21378" align="alignleft" width="180"]
Dr. Teppo Järvinen[/caption]
Teppo L N Järvinen MD PhD
Sports Medicine, Orthopedic Surgery, Clinical Trials
University of Helsinki, Helsinki
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Järvinen: When the primary analysis of the FIDELITY trial was published in the New England Journal of Medicine (http://www.nejm.org/doi/full/10.1056/NEJMoa1305189), showing that arthroscopic partial meniscectomy (APM) is no better than sham/placebo surgery in relieving knee pain and improving knee function in patients with a degenerative meniscus tear and no knee OA, the study was met with unprecedented criticism, even hostility. The advocates of APM (which was at the time and probably still is the most common orthopedic procedure in the US and most other “western” countries) argued – despite the fact that our study only confirmed what several other high-quality RCTs had suggested – that arthroscopic partial meniscectomy is a highly beneficial procedure in the “right” patients. Among the subgroups of patients allegedly having a favourable response to APM, those experiencing “mechanical symptoms” — sensations of knee catching or locking — represented the most obvious group who would benefit from arthroscopic partial meniscectomy surgery. This assertion is plausible because knee catching or locking is believed to result from a mechanical blocking mechanism in the knee - a piece of the joint structure lodging between the articular surfaces. Because degenerative meniscal tears are very common pathologic alterations found by arthroscopy in the knee joints of patients with degenerative knee disease, trimming the torn meniscus should, in theory at least, improve the apparent mechanical derangement.
Against this background, it is somewhat unusual that no study has yet specifically tested whether arthroscopic partial meniscectomy is effective in alleviating these symptoms. Mechanical symptoms are usually thought to be a solid indication for arthroscopic knee surgery. This is what we set out to examine in our secondary analysis of our sham-surgery controlled FIDELITY trial.
Our key finding: arthroscopic partial meniscectomy (partial resection of a torn meniscus) does not reduce or alleviate mechanical symptoms any better than a sham surgical procedure.
11 Feb Nanobody is Potentially First Targeted Therapy for TTP
MedicalResearch.com Interview with: Dr. Filip Callewaert PhD Senior Clinical Scientist Clinical Development, Ablynx Zwijnaarde, Belgium Medical Research: What is the background for this study? What are the main findings? Dr. Callewaert: Acquired thrombotic thrombocytopenic purpura (TTP) is a rare and life-threatening coagulation disorder, in which accumulation of ultra-large von Willebrand factor (ULvWF) multimers is implicated, leading to an increased risk of thrombus formation in small blood vessels due to excessive platelet aggregation. There are no approved pharmacological therapies for acquired TTP. Despite treatment with the current standard of care (plasma exchange and immunosuppressive therapy), mortality remains at 10-20% and there is significant neurological, cardiac, and renal morbidity. Caplacizumab is a bivalent Nanobody that binds to the A1 domain of vWF thereby preventing vWF-mediated platelet aggregation. The clinical effects of caplacizumab were demonstrated in the phase II randomised, placebo-controlled TITAN study in 75 patients with acquired TTP. Compared to placebo, there was a nearly 40% reduction in median time to platelet count normalisation in the caplacizumab group (p = 0.005). Treatment with caplacizumab reduced the use of daily plasma exchange and prevented further consumption of platelets in microthrombi and small blood vessel occlusion. In addition, there were fewer recurrences of TTP requiring re-initiation of daily plasma exchange during treatment with caplacizumab (N=3) vs. placebo (N=11). The safety profile of caplacizumab was favorable, with a slightly higher tendency of mostly mild bleeding events.11 Feb Euthanasia and/or Physician Assisted Suicide in Psychiatric Disorders Legal in Belgium and The Netherlands
MedicalResearch.com Interview with: [caption id="attachment_21492" align="alignleft" width="160"]
Dr. Scott Kim[/caption]
Scott Y. H. Kim, MD, PhD
Department of Bioethics, National Institutes of Health
Bethesda, MD 20892
Medical Research: What is the background for this study?
Dr. Kim: Euthanasia and/or physician assisted suicide (EAS) of persons suffering from psychiatric disorders is increasingly practiced in some jurisdictions such as Belgium and the Netherlands but very little is known about the practice. There is an active debate over whether to legalize such a practice in Canada, after a Supreme Court ruling last year that struck down laws banning physician assisted death.
Medical Research: What are the main findings?
Dr. Kim: The main findings are that:
- Most patients who receive psychiatric euthanasia and/or physician assisted suicide are women, of diverse ages, with a variety of chronic psychiatric conditions accompanied by personality disorders, significant physical problems, and social isolation/loneliness, often in the context of refusals of treatment. A minority who are initially refused EAS ultimately receive euthanasia and/or physician assisted suicide through a mobile euthanasia clinic.
- Given that the patients have chronic, complicated histories requiring considerable physician judgment, extensive consultations are common. But independent psychiatric input does not always occur; disagreement among physicians occurred in one in four cases; and the euthanasia review committees generally defer to the judgments of the physicians performing euthanasia and/or physician assisted suicide.
11 Feb Accidents, Guns and Overdoses Account For Increase in Death Rate in US Adults
MedicalResearch.com Interview with: [caption id="attachment_21326" align="alignleft" width="166"]
Dr. Andrew Fenelon[/caption]
Dr. Andrew Fenelon PhD
NIH Postdoctoral Fellow
Brown University
Medical Research: What is the background for this study? What are the main findings?
Dr. Fenelon: The life expectancy of the US population is about 2 years less than that of other high-income nations, which is an important problem in public health. Although much previous work looks at differences in death rates among older adults, some recent work has shown that deaths at younger ages (below age 50) account for a significant fraction of the life expectancy gap. Our study examines the contribution of major injuries, Motor Vehicle Crashes, Firearm-related deaths, and drug poisonings, which often occur at younger ages and account for many years of lost life.
Our findings indicate that US men and women experience significantly higher death rates from these three causes of injury death than each of the 12 comparison high-income countries. Overall, these three causes of death explained 48% of the 2.2 year life expectancy gap between the United States and other high-income countries among men, with firearm injuries alone explaining 21%. Among women, these causes explained 19%.
11 Feb Radiation Converts Some Resistant Head and Neck Cancer Cells Into Aggressive Stem Cells
MedicalResearch.com Interview with: [caption id="attachment_21484" align="alignleft" width="120"]
Dr. Erina Vlashi[/caption]
Erina Vlashi, PhD
Assistant Professor
Department of Radiation Oncology
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095-1714
Medical Research: What is the background for this study? What are the main findings?
Dr. Vlashi: It has been known for quite some time that head and neck squamous cell carcinomas (HNSCC) that test positive for human papilloma virus (HPV) respond to radiation therapy more favorably than HPV-negative HNSCCs. Our team reviewed a cohort of 162 patients with a head and neck squamous carcinoma diagnosis over a two-year period, and confirmed that the outcomes were correlated with the patient's HPV status. The work that followed was prompted by a discovery we had made earlier in breast cancer suggesting that breast cancer cells that manage to survive radiation therapy have the capacity to convert into more de-differentiated, therapy-resistant cells with characteristics of cancer stem cells, and that the degree of this conversion depended on the type of breast cancer: the more aggressive types of breast cancer being more prone to the therapy-induced phenotype conversion. So, we hypothesized that this therapy-induced conversion phenomenon may especially be at play in head and neck squamous cell carcinomas given the clinical observation that HPV-positive HNSCCs respond to radiation therapy much more favorably than HPV-negative HNSCCs, despite optimum treatment modalities. And indeed, that is what we found: tumor cells derived from a panel of head and neck squamous cell carcinomas cell lines that do not respond well to radiation therapy have an enhanced ability to convert the cells that survive radiation into more aggressive cells, cancer stem-like cells that will resist the next round of radiation therapy.
11 Feb Gastric Bypass Surgery Reduces Mortality Even In Older Patients
MedicalResearch.com Interview with: [caption id="attachment_21478" align="alignleft" width="143"]
Dr. Lance Davidson[/caption]
Lance Davidson, PhD
Assistant Professor
Department of Exercise Sciences
Brigham Young University
Provo, UT 84602
Medical Research: What is the background for this study? What are the main findings?
Dr. Davidson: A growing body of literature indicates that bariatric surgery imparts a mortality benefit in severely obese individuals. Whether age at surgery affects this relationship is not well established. One might suppose that a person who has been severely obese for several decades may already have sustained enough metabolic damage that weight loss surgery would have less influence on subsequent mortality. We conducted an age-specific analysis of a previously-published mortality cohort in gastric bypass patients and severely obese controls, following them for up to 18 years (mean 7.2 years), and examined mortality rates in four age categories: under 35, 35-44, 45-54, and 55-74.
The primary finding of this retrospective cohort study was that gastric bypass surgery attenuated the age-related increase in mortality, demonstrating a widening gap in mortality risk when compared to age-matched severely obese controls as age-at-surgery increased, with a 66% reduction in mortality in the oldest group. Another interesting result, highlighted in our previous publication on this cohort (Adams et al. NEJM 2007), was a higher mortality rate from external causes (accidents, poisonings, suicides, homicides) in surgery patients. We explored this phenomenon further by age at surgery and found that externally-caused deaths were only increased in women (not men) who had surgery before age 35.
10 Feb Alcohol Impaired Driving Crimes Rise Right After Legal Drinking Age Reached
MedicalResearch.com Interview with: [caption id="attachment_21473" align="alignleft" width="170"]
Dr. Russ Callaghan[/caption]
[wysija_form id="5"]Dr. Russ Callaghan, PhD
Associate Professor
Northern Medical Program
University of Northern British Columbia
Prince George, British Columbia
Medical Research: What is the background for this study?
Dr. Callaghan: In Canada, the minimum legal drinking age (MLDA) is 18 years in Alberta, Manitoba and Québec, and 19 in the rest of the country. Given that public-health organizations not only have recommended increasing the MLDA to 19 years, but also have identified 21 years as ideal, the current study tested whether drivers slightly older than the MLDA had significant and abrupt increases in alcohol-impaired driving (AID) crimes, compared with their counterparts just younger than the MLDA. Data on the effectiveness of Canadian drinking-age laws is lacking, and the current study provides important information for the current national and international MLDA debates.
10 Feb Link Between Zika Virus, Microcephaly, Stillbirths and Miscarriages
MedicalResearch.com Interview with: Nancy Dirubbo, DNP, FNP, FAANP, Certificate in Travel Health, American Association of Nurse Practitioners (AANP) Fellow Cindy Cooke, DNP, FNP-C, FAANP, American Association of Nurse Practitioners (AANP) President of the Board Medical Research: Can you provide some background on what is the Zika virus? Response: Zika virus was first found in monkeys in the Zika Forest of Uganda in 1947 during a research project on mosquito borne viral diseases. From Africa, it spread to India, Indonesia and South East Asia over the next 20-30 years. Not much attention was paid to this illness, as it is often asymptomatic (perhaps as much as 80% of all cases). It causes few symptoms in adults (mild rash, conjunctivitis and headache) and so is often underdiagnosed or misdiagnosed as other self-limiting, viral diseases. Then fast forward to 2015, when a sudden increase in infants born in Brazil with microcephaly occurred and a connection was made with a sharp increase in Zika viral infections, even though the direct mechanism for causing this birth defect is not known. In 2014, there were less than 150 cases of microcephaly in Brazil, and by October 2015, there were 4,700 cases reported. Medical Research: What is the concern regarding pregnant women and their babies? Response: The concern for pregnant women is that there appears to be a link between Zika virus and microcephaly, still birth and miscarriages. Children who do survive have severe intellectual disabilities. The virus is most often transmitted by mosquitos, but may also be sexually transmitted. According to the CDC, “Sexual transmission of Zika virus is possible, and is of particular concern during pregnancy. Current information about possible sexual transmission of Zika is based on reports of three cases.” The CDC also recommends, “Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse or fellatio) for the duration of the pregnancy.” It has yet to be determined if Zika virus can be transmitted in other ways, including blood transfusions.10 Feb Flu Infection Raises Risk of New Onset Atrial fibrillation
MedicalResearch.com Interview with: Tze-Fan Chao MD PhD Division of Cardiology, Department of Medicine Taipei Veterans General Hospital Institute of Clinical Medicine, and Cardiovascular Research Center National Yang-Ming University, Taipei, Taiwan Su-Jung Chen MD Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Institute of Public Health and School of Medicine, National Yang-Ming University Taipei, Taiwan MedicalResearch: What is the background for this study? What are the main findings? Response: Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, accounting for frequent hospitalizations, hemodynamic abnormalities, and thromboembolic events. Although the detailed mechanism of the occurrence of Atrial fibrillation remains unclear, systemic inflammation and sympathetic nervous system have been demonstrated to play an important role in the pathogenesis of AF. Flu (influenza infection) is a common disease which could happen to everyone in the daily life. It could cause significant morbidity and mortality, and is a serious human health concern worldwide. Previous studies have shown that influenza infection not only results in the productions of pro-inflammatory cytokines, but also activates the sympathetic nervous system, which are all related to the occurrence of Atrial fibrillation. Therefore, we hypothesized that influenza infection could be a risk factor of new-onset AF. We also tested the hypothesis that influenza vaccination, a useful way to reduce the risk of influenza infection, could decrease the risk of AF. In this large scale nationwide case-control study, a total of 11,374 patients with newly diagnosed Atrial fibrillation were identified from the Taiwan National Health Insurance Research Database. On the same date of enrollment, 4 control patients (without AF) with matched age and sex were selected to be the control group for each study patient. The relationship between AF and influenza infection/vaccination 1 year before the enrollment was analyzed. The results showed that influenza infection was associated with an 18% increased risk of AF, and the risk could be easily reduced through influenza vaccination.10 Feb Only Small Increase in CT Screening for Lung Cancer Despite New Guidelines
Posted at 16:28h
in Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Lung Cancer, Radiology
MedicalResearch.com Interview with:
[caption id="attachment_21454" align="alignleft" width="172"]
Dr. Phillip Boiselle[/caption]
Phillip M. Boiselle, MD
Professor of Radiology and Associate Dean for Academic and Clinical Affairs
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Medical Research: What is the background for this study?
Dr. Boiselle: We surveyed leading academic medical centers in 2013 and found considerable variability in their practice patterns as well as a relatively small number of patients being screened for lung cancer at these sites. Considering landmark developments since that time, including favorable policy and payment decisions by USPSTF and CMS and development of radiology-specific nodule guidelines by the American College of Radiology, we were curious to see whether there would be greater conformity of practice patterns and increased patient volumes in response to these developments.
Medical Research: What are the main findings?
Dr. Boiselle: First, our finding of greater conformity of lung cancer screening practices at present compared to 2013 confirmed our hypothesis that the development of radiology-specific guidelines by ACR would contribute to greater uniformity.
Second, we were surprised by the very modest level of increase in patient volumes for CT screening over time despite the favorable USPSTF and CMS decisions. We emphasize, however, that the timing of our survey occurred too early to determine the full impact of CMS coverage on patient volumes
10 Feb Some Bacteria In Stored Food Raise Markers of Inflammation
MedicalResearch.com Interview with: [caption id="attachment_21450" align="alignleft" width="160"]
Dr. Clett Erridge[/caption]
Dr. Clett Erridge PhD
Department of Cardiovascular Sciences
University of Leicester
Clinical Science Wing
Glenfield General Hospital
Leicester
Medical Research: What is the background for this study? What are the main findings?
Dr. Erridge: We have spent many years seeking potential stimuli that might be responsible for triggering the chronic inflammatory processes that underpin atherosclerosis. Our earlier work focused mainly on the questions of whether and how various molecules related to lipoprotein particles, oxidised lipids and fatty acids interacted with receptors of the innate immune system, which we believe are central players in the initiation of atherosclerosis. However, we were surprised to discover (as a result of some control experiments that we expected to yield a null result), that extracts of some, but not all, foods trigger inflammatory cytokine production in human monocytes via stimulation of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4. The molecules responsible for triggering these responses (collectively termed PAMPs, 'pathogen-associated molecular patterns'), were found to arise in foods that have been finely chopped and stored at refrigeration temperature or above for some time, as a result of the growth and activity of common food spoilage bacteria. The foods most commonly affected are minced meats, ready chopped vegetables, some cheeses and chocolates.
The present study found that in 11 healthy volunteers who habitually consumed food products rich in PAMPs, switching to a low PAMP diet for 7 days resulted in an 18% reduction in LDL-cholesterol, 11% reduction in white blood cell count, a 1.5 cm reduction in waist circumference and a 0.6 kg reduction in body weight. Switching back to a high PAMP diet, in which the same volunteers were then fed meals tested and proven to be high in PAMPs, for just 4 days reversed these beneficial effects.
A second study in 13 healthy volunteers then showed that PAMPs can exert effects on white cell markers of inflammation within 24 h of consumption, when volunteers were fed either fresh or processed onion-based meals, which were nutritionally identical other than for content of bacteria and PAMPs.
10 Feb Tumor Suppressor Protein p53 Affects Progression of Rare Kidney Disease
MedicalResearch.com Interview with: [caption id="attachment_21496" align="alignleft" width="149"]
Prof. Hirofumi Kai[/caption]
Prof. Hirofumi Kai
Kumamoto University
Japan
MedicalResearch: What is the background for this study?
Dr. Kai: Alport Syndrome (AS) is a hereditary progressive kidney disease that affects 1 in 5000-10000 individuals in the US. Depending on the specific subtype and genetic mutation, the onset, symptoms and progression vary among patients. Some have earlier onset and severe phenotypes while others have slow progression towards end-stage renal disease (ESRD). The gene affected in Alport Syndrome is type 4 collagen, which codes for a protein component of the glomerular basement membrane (GBM). This mutation leads to the dysregulated proliferation (or dysplasia) of the GBM, which has an important role in urine filtration. The pathophysiological process of dysplasia indicates a dysfunction of protein/s that control cellular homeostasis. Because the tumor suppressor p53 is critically involved in modulating cell proliferation, we focused our attention on this protein.
10 Feb States That Spend More On Social Services Have Lower AIDS Deaths
MedicalResearch.com Interview with: [caption id="attachment_21438" align="alignleft" width="191"]
Dr. Talbert-Slagle[/caption]
Kristina Marie Talbert-Slagle, PhD
Lecturer in Epidemiology (Microbial Diseases) and in Public Health (Health Policy); Senior Scientific Officer, Yale Global Health Leadership Institute
Yale School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Talbert-Slagle: The interest for this study originally came as a result of work done by Elizabeth Bradley, PhD, co-author of The American Health Care Paradox. In the book, Dr. Bradley compared spending rates of social services to health care services between the U.S. and other countries and found that while the U.S. invested more money in health care services than any other country we had worse health outcomes. By contrast, countries that spent more on social services per dollar spent on health care had better outcomes.
We applied that same idea to AIDS. There are still more than 50,000 cases of HIV/AIDS diagnosed in the U.S. each year. Although many medical advances have been made in treatment and prevention of this infection, we were curious as to why rates of HIV/AIDS have remained stagnate. We wanted to explore how spending relates to differences in case rates among the states and found a significant difference among states regarding social service and public health spending related to HIV/AIDS. We looked at all 50 states’ spending habits over the past 10 years and discovered that states that invested more money in social services such as education, housing, and nutrition per person in poverty had significantly lower rates of HIV/AIDS deaths.
10 Feb HIV Continues To Disproportionately Affect African Americans
MedicalResearch.com Interview with: [caption id="attachment_21447" align="alignleft" width="133"]
Dr. Sharoda Dasgupta[/caption]
Sharoda Dasgupta, PhD, MPH
US Public Health Service and Epidemic Intelligence Service Officer
CDC
Medical Research: What is the background for this study?
Dr. Dasgupta: Roughly 1.2 million people in the United States are living with HIV, and about 40,000 diagnoses occur each year, according to the most recent CDC data.
According to national estimates published by CDC, African Americans remain disproportionately affected by the virus. African Americans represent 12 percent of the U.S. population but accounted for almost 50 percent of HIV diagnoses in 2014. Some signs have emerged that HIV is loosening its grip on the African American community, but persistent disparities are prolonging HIV transmission.
Antiretroviral therapy (ART) improves clinical outcomes for people living with HIV and reduces their risk of transmitting the virus to others. Racial and ethnic disparities in HIV care, however, limit access to ART, which perpetuates disparities in survival and HIV transmission.
Although previous studies have mostly analyzed HIV care by race and ethnicity during a single year, the purpose of this study was to better understand how people living with HIV remain in care over a longer period in time – and whether their retention in care differed by race and ethnicity.
Medical Research: What are the main findings?
Dr. Dasgupta: This analysis focused on 12 U.S. jurisdictions that reported comprehensive HIV lab results to CDC from January 2010 – December 2013. They represent approximately 25 percent of HIV diagnoses in 2010.
The findings demonstrate yet another persistent disparity that prolongs the epidemic among African Americans. Only 38 percent of African Americans received consistent HIV care from 2011 – 2013, compared with 49% of whites and 50% of Latinos. Additionally, African American males were less likely to receive consistent medical care than African American females (35 percent and 44 percent, respectively).
Among African Americans, receiving consistent HIV care was highest among those whose HIV infections were attributable to heterosexual contact. Those who received consistent HIV medical care for three years were considered consistently retained in care.
09 Feb Compilation of Mosaics Explain Differences in Male and Female Brains
MedicalResearch.com Interview with: [caption id="attachment_21428" align="alignleft" width="160"]
Prof. Daphna Joel[/caption]
Prof. Daphna Joel PhD
School of Psychological Sciences and Sagol School of Neuroscience
Tel-Aviv University
Medical Research: What is the background for this study?
Prof. Joel: The aim of the PNAS study was to test the mosaic hypothesis, published in 2011 (“Male or female? Brains are intersex”), according to which there are no “male brains” and ‘female brains” but rather brains are composed of unique mosaics of features, some more common in males and other more common in females. This hypothesis was build on animal data showing that the effects of sex on the brain may be different and even opposite under different environmental conditions (i.e., what is typical in one sex under some conditions may be typical in the other sex under other conditions).
In the Phil.Trans. paper, we use a very simple mathematical illustration to explain why the existence of sex differences is not sufficient to conclude that there are two types of brain, and how the answer to this question depends on the prevalence of ‘mosaic’ brains.
Medical Research: What are the main findings?
Prof. Joel: In the PANS study we, found differences between brains from males and brains from females, as has previously been reported. What we have done in addition, and no previous study has, is look whether brains are internally consistent, that is, have either only “male-end” features (i.e., features in the form more common in males compared to females) of only “female-end” features (i.e., features in the form more common in females compared to males). We found that internally consistent brains are much less common compared to ‘substantially variable’ brains (i.e., brains with both “female-end” and “male-end” features), and that the large majority of brains are composed of unique mosaic of “female-end”, “male-end”, and “intermediate” (i.e., common in both females and males) features. On the basis of these findings we concluded that there are no “male brains” and “female brains”.
In the Phil.Trans. paper we further suggest that human brains belong to a single highly heterogeneous population (see also Joel, 2011, Male or female? Brains are intersex), in which there may be differences between females and males in the frequencies of rare brain mosaics (e.g., brains with only “female-end” characteristics although rare in the population, are more common in females compared to males).
09 Feb Skin and Lip Cancer Risk Varies By Immunosuppression in Transplant Patients
MedicalResearch.com Interview with: [caption id="attachment_21418" align="alignleft" width="180"]
Dr. Claire Vajdic[/caption]
Claire M. Vajdic, PhD
Center for Big Data Research in Health
University of New South Wales
Australian Graduate School of Management Bldg,
Sydney Australia on behalf of the authors.
Medical Research: What is the background for this study?
Dr. Vajdic: Lip cancer is one of the most common cancers in solid organ transplant recipients. Iatrogenic immunosuppression is a strong risk factor for lip cancer but the dose-related association between individual immunosuppressive agents and risk of lip cancer has not been examined. Therefore, we investigated the association between the type, dose and duration of immunosuppressive therapy and lip cancer risk in Australian liver, heart and lung transplant recipients.