Author Interviews, OBGYNE, Surgical Research / 03.01.2016
Surgical Abortions Raise Risk of Future Pre-Term Births and Obstetrical Complications
MedicalResearch.com Interview with:
Gabriele Saccone, MD
Department of Neuroscience
Reproductive Sciences and Dentistry
School of Medicine
University of Naples Federico II Naples, Italy
Vincenzo Berghella, MD
Department of Obstetrics and Gynecology
Division of Maternal-Fetal Medicine
Thomas Jefferson University
Philadelphia, PA 19107, USA
Medical Research: What is the background for this study? What are the main findings?
Dr Saccone: Preterm birth (PTB) is the number one cause of perinatal mortality in many countries, including the US. The annual societal economic burden associated with Preterm birth in the US was at least $26.2 billion in 2006, or about $51,600 per infant born preterm. Defining risk factors for prediction of PTB is an important goal for several reasons.
- First, identifying women at risk allows initiation of risk-specific treatment.
- Second, it may define a population useful for studying particular interventions.
- Finally, it may provide important insights into mechanisms leading to Preterm birth.Prior surgery on the cervix, such as cone biopsy and LEEP procedures, is associated with an increased risk of spontaneous PTB. History of uterine evacuation for abortion, by either induced termination of pregnancy (I-TOP) or treatment of spontaneous abortion (SAB) by suction dilation and curettage (D&C) or by dilation and evacuation (D&E), which may involve mechanical and/or osmotic dilatation of the cervix, has been associated with an increased risk of PTB in some studies, but not in others. Our systematic review and meta-analysis pooled data from 36 studies including 1,047,683 women with prior abortion. We found that history of surgical abortion is an independent risk factor for Preterm birth and also other obstetric complications including low birth weight and small for gestational age, while prior medical abortion with first-trimester mifepristone or mid-trimester misoprostol was not associated with an increased risk of PTB. The biological plausibility to explain our findings is not completely clear. However, three main hypotheses can be made.
- The increased risk of Preterm birth could result from the overt or covert infection following surgically uterine evacuation,
- as well as from mechanical trauma to the cervix leading to increased risk of cervical insufficiency.
- Moreover, surgical procedures including curettage during D&E may result in scar tissue that may increase the probability of faulty placental implantation.
Dr. David Gallego Ortega PhD[/caption]
MedicalResearch.com Interview with:
David Gallego Ortega, PhD
Group Leader, Tumour Development Group Cancer Division
Garvan Institute of Medical Research
Conjoint Lecturer, St Vincent’s Clinical School, Faculty of Medicine, UNSW, Australia
National Breast Cancer Foundation and Cure Cancer Foundation Australia Fellow
Medical Research: What is the background for this study? What are the main findings?
Dr. Ortega: We have identified a protein that 'goes rogue’ in breast cancer. The protein, called Elf5, ‘tricks' the immune system producing inflammation so that the immune cells now help the breast cancer cells to spread throughout the body.
Cancer spread, or metastasis, is the ultimate cause of death of 
Dr. Gágyor[/caption]
MedicalResearch.com Interview with:
Ildikó Gágyor MD
Senior researcher in primary care
Department of General Practice
University Medical Center Göttingen
Göttingen, Germany
Medical Research: What is the background for this study? What are the main findings?
Dr. Gágyor: Uncomplicated urinary tract infection is a common problem for women. Affected patients are usually treated with antibiotics to combat both unpleasant symptoms and to combat infection. However, prescription of antibiotics for a self-limiting condition, contributes to increased resistance rates posing a serious long-term threat to public health. In a double blind randomised controlled trial we examined whether symptomatic treatment of uncomplicated urinary tract infection with ibuprofen reduces the rate of antibiotic prescriptions without a significant increase in symptoms, recurrences, or complications. In all, 494 women were randomly assigned to receive: either ibuprofen for three days and antibiotics only if symptoms are persistent; or antibiotic treatment with fosfomycin. Results showed that antibiotic use could be reduced significantly: of the 248 women in the ibuprofen group two thirds recovered without antibiotics and one third received antibiotics subsequently. Women in the ibuprofen group had a higher symptom burden but in both groups, symptoms decreased within the first week (Figure 1). Six cases of pyelonephritis occurred, one in the fosfomycin group, five in the ibuprofen group.
Dr. Chugani[/caption]
MedicalResearch.com Interview with:
Diane C. Chugani, PhD
Director, Nemours Neuroscience Research
Nemours—AI DuPont Hospital for Children
Wilmington, DE 19803
Medical Research: What is the background for this study? What are the main findings?
Dr. Chugani: This clinical trial was performed at 5 sites throughout the country and was lead by our team at Wayne State University and Children’s Hospital of Michigan in Detroit. The study was sponsored by the National Institutes of Health through an Autism Centers of Excellence Network grant. Based upon our previous PET scanning studies showing low serotonin synthesis in the brains of young children with autism, we tested whether the serotonin-like drug buspirone would be beneficial in treating young children with Autism Spectrum Disorder. We found that low doses of buspirone were effective in reducing repetitive behaviors with no significant side effects in this group of children.
Dr. Eberth[/caption]
MedicalResearch.com Interview with:
Jan Marie Eberth, PhD
Assistant Professor, Department of Epidemiology and Biostatistics
Deputy Director, SC Rural Health Research Center
Core Faculty, Statewide Cancer Prevention and Control Program
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
Medical Research: What is the background for this study?
Dr. Eberth: With the breakthrough findings of the National Lung Screening Trial released in 2011, professional organizations have largely embraced population-based screening guidelines for patients at high risk for 
Dr. Mubdiul Ali Imtiaz[/caption]
MedicalResearch.com Interview with:
Mubdiul Ali Imtiaz, MD
Department of Internal Medicine
Rutgers University, New Jersey Medical School
Newark, NJ 07103
Medical Research: What is the background for this study?
Response: Resident physicians (RPs) were defined to be all individuals enrolled in a graduate medical education training program in a healthcare setting. There were 611 resident physicians enrolled in 47 post-graduate residency and fellowship programs at RU-NJMS during the 2013-2014 academic year. Influenza immunization was strongly recommended, but not mandatory for Resident physicians during 2013-2014. A link to the online survey using a standardized, anonymous, self-administered questionnaire was emailed by the program-chiefs to their respective RPs to collect demographic characteristics, influenza immunization status during the 2013-2014 and the previous season, and reasons for non-vaccination.
Medical Research: What are the main findings?
Response: The overall self-reported immunization rate of Resident physicians in 2013-2014 was 76.7%. The immunization rate did not differ by the location of medical school attended (P= 0.55) or sex (P= 0.69). Among the respondents, 95.8% had influenza vaccination in the past and 83.1% received influenza vaccine during 2012-2013 flu season. History of influenza vaccination ever and in 2012-2013 were both significantly associated with receiving the vaccine during the 2013-2014 season (P<0.01 for both). The most common reason for not being vaccinated (38.6%) was “lack of time to get immunized” (see Figure 1). The most common cited motivating factors to be vaccinated during the next influenza season among the NVRPs were “making vaccinations in the workplace at convenient locations and times” (43.2%), “availability of mobile flu vaccination carts in hospital floors” (40.9%), and “establishing mandatory flu vaccination for employment” (36.4%).
Dr. Halwani[/caption]
MedicalResearch.com Interview with:
Muhammad A. Halwani, MSc, PhD
Faculty of Medicine, Al Baha University
Al Baha, Saudi Arabia.
Medical Research: What is the background for this study? What are the main findings?
Response: The study idea was based on examining the current rate of post cesarean section infections that were detected in the hospital at the time. It was hypothesized that the detected infections were actually less than the real number identified. Therefore, we challenged the traditional surveillance method that was applied in the hospital with a new enhanced methodology which is telephone follow-ups for patients who under go C-section operations.
Our main finding proved that this new applied method was able to detect more cases than the traditional one. Using phone calls as a gold standard, the sensitivity of the standard methodology to capture SSI after cesarean increased to 73.3% with the new methodology identifying an extra five cases. These patients represented 26.3% (5 of 19) of all the patients who developed SSI. In other words, for every 100 C-section procedures there were 2.6% missed cases which the new method was able to detect. The duration of the calls ranged from 1 to 5 minutes and were well received by the patients.
Dr. LaRochelle[/caption]
MedicalResearch.com Interview with:
Marc R. Larochelle, MD, MPH
Assistant Professor of Medicine
Boston Medical Center
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Dr. Larochelle: More than 16 thousand people in the United States die from prescription opioid overdose each year. However, morbidity extends well beyond fatal overdose - nearly half a million emergency department visits each year are related to prescription opioid-related harms. Emergency department visits for misuse of opioids represent an opportunity to identify and intervene on opioid use disorders, particularly for patients who receive prescriptions for opioids to treat pain. We examined a cohort of nearly 3000 commercially insured individuals prescribed opioids for chronic pain who were treated for a nonfatal opioid overdose in an emergency department or inpatient setting. We were interested in examining rates of continued prescribing after the overdose and the association of that prescribing with risk of repeated overdose. We found that 91% of individuals received another prescription for opioids after the overdose. Those continuing to receive 
Dr. Leigh Peterson[/caption]
MedicalResearch.com Interview with:
Leigh A. Peterson, PhD, MHS
Post-doctoral fellow
Department of Surgery - Bayview
Johns Hopkins School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Peterson: From our previous study published in Obesity Surgery earlier this year, we knew that vitamin D deficiency and insufficiency was very common in our bariatric surgery candidates (71.4% < 20 ng/ml and 92.9% < 30 ng/ml). We wanted to explore the effect of this deficiency on adverse outcomes after bariatric surgery such as wound healing, infection, and extended hospital stay.
We turned to the Nationwide Inpatient Sample to answer this question, as it would contain enough surgeries to detect changes in even less frequent outcomes such as wound infection. But blood concentration of vitamin D is not available, so we used a traditional method to estimate group vitamin D status with season and geography. 
Dr. Jenny C. Chang[/caption]
MedicalResearch.com Interview with:
Jenny C. Chang, M.D.
Director, Houston Methodist Cancer Center
Professor of Medicine, Weill Cornell Medical College
Full Member, Houston Methodist Research Institute
Houston, Texas
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Chang: The current treatment of triple negative breast cancer, which accounts for about 15% of all cases of breast cancer, is still based on surgery, radiotherapy, and classic chemotherapy because, unlike other types of breast cancer, it is not amenable to hormonal or targeted therapy. However, research findings suggest that cancer stem cells, which represent about 2% of all neoplastic cells, may play a role in disease relapses and the formation of distant metastases. As these cells may represent a therapeutic target, the aim of this study is to modify the micro-environment in which they reproduce by acting directly on the chemokines involved in inflammation because there is evidence indicating a possible mechanism of action of reparixin, a molecule developed by Dompé, an Italian biopharmaceutical company, in the targeted treatment of these cancers.
Dr. Rebold[/caption]
MedicalResearch.com Interview with:
Michael Rebold, PhD, CSCS
Assistant Professor
Department of Exercise Science
Bloomsburg University
Bloomsburg, PA 17815
Medical Research: What is the background for this study?
Dr. Rebold: The obesity epidemic seen in children. If we can make children at a young age physically active then maybe they will be more likely to be physically active into their adult years. Since parents are the primary role models for younger children we must find ways to get the parents involved in physical activity as well, because children will model their parent's behaviors.
Medical Research: What are the main findings?
Dr. Rebold: The main findings from this study are that when parents are actively participating in activities with their children, their children spend more time in physical activities and less time in sedentary activities. When parents are not present and children are alone, then they spend more time engaging in sedentary activities and less time in physical activities. When parents are actively watching their children, children still engaged in a significant more amount of time in physical activities than sedentary activities when compared to the alone condition but still not as great as with parents participating.
Children also liked and were motivated to engage in additional physical activity time when parents were participating with them.
Dr. Odejide[/caption]
MedicalResearch.com Interview with:
Oreofe O. Odejide, MD
Instructor in Medicine, Harvard Medical School
Dana-Farber Cancer Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Odejide: The care that patients with hematologic cancers receive near the end of life is distinct from patients with solid tumors. For instance, previous research has shown that patients with blood cancers are more likely to receive intensive care at the end of life such as chemotherapy within 14 days of death, intensive care unit admission within 30 days of death, and they are less likely to enroll in hospice. My colleagues and I hypothesized that timing of discussions regarding end-of-life preferences with patients may contribute to these findings, and we wanted to examine hematologic oncologists’ perspectives regarding end-of-life discussions with this patient population.
We conducted a survey of a national sample of hematologic oncologists obtained from the publicly available clinical directory of the American Society of Hematology. We received responses from 349 hematologic oncologists, giving us a response rate of 57.3%. In our survey, we asked hematologic oncologists about the typical timing of EOL discussions in general, and also about the timing of the first discussion regarding resuscitation status, hospice care, and preferred site of death for patients. Three main findings emerged:
Dr. Deirdre Murray[/caption]
MedicalResearch.com Interview with:
Dr. Deirdre Murray
Senior Lecturer/Consultant Paediatrician
Dept of Paediatrics and Child Health
University College Cork
Clinical Investigations Unit Cork University Hospital
Principal Investigator
Irish Centre for Fetal and Neonatal Translational Research
Medical Research: What is the background for this study? What are the main findings?
Dr. Murray: Everyday in clinic, and in waiting rooms and in restaurants we see parents are handing over their smart phones and iPads to occupy young children. The nature of childhood play is changing rapidly. The exact frequency and the effect of this change in unknown. We wanted to first measure how young children 12-36 months are using touchscreen devices. We asked parents who attended our paediatric unit, both outpatients and short stay inpatients to answer a study specific questionnaire.
We found that of the 82 parents surveyed, 82% of parents owned a touchscreen device, and of these 87% gave their device to their toddler to play with. Thus 71% of toddlers had access to a touchscreen device. This rate was similar across the age range studied (12-36 months). By parental report, 24 months was the median age of ability to swipe (IQR: 19.5–30.5), unlock (IQR: 20.5–31.5) and active looking for touch-screen features (IQR: 22–30.5), while 25 months (IQR: 21–31.25) was the median age of ability to identify and use specific touch-screen features. Overall, 32.8% of toddlers could perform all four skills.
Touchscreen usage was common at a very young age and from 2 years of age toddlers have the ability to interact purposefully with touch-screen technology. 
Dr. Shinkai[/caption]
MedicalResearch.com Interview with:
Kanade Shinkai, MD PhD
Associate Professor of Clinical Dermatology
Director, Residency Program
Endowed Chair in Dermatology Medical Student Education
UCSF Department of Dermatology
San Francisco, CA 94115
Medical Research: What is the background for this study? What are the main findings?
Dr. Shinkai: Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder in the United States that has important skin manifestations including acne, hair loss, hirsutism, and acanthosis nigricans. We performed a retrospective cross-sectional study of women referred to a multidisciplinary PCOS clinic at UCSF to determine whether skin findings and systemic associations differ between women who meet diagnostic criteria for PCOS versus those suspected of having PCOS but do not meet diagnostic criteria. We found that women with PCOS commonly have skin findings, however, present across a broad spectrum of cutaneous manifestations.
Comparing the skin findings in women who meet diagnostic criteria for PCOS with women who are suspected of having PCOS suggests that it can be very difficult to distinguish a patient with PCOS based on skin findings alone. Hirsutism and acanthosis nigricans are the most helpful findings to suggest 
Dr. Carr[/caption]
MedicalResearch.com Interview with:
Tara F Carr, MD
Assistant Professor, Medicine and Otolaryngology
Allergy and Immunology Fellowship Training Program Director
Director, Adult Allergy
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine
University of Arizona
Tucson, AZ 85724
Medical Research: What is the background for this study? What are the main findings?
Dr. Carr: Some patients with chronic rhinosinusitis continue to suffer from symptoms despite aggressive medical and surgical treatments. For these individuals, therapy is generally chosen based on bacterial culture results, and often includes the use of topical antibacterial rinses with a medication called mupirocin. We found that if patients are still having problems after this treatment, the bacteria identified from repeated 
Dr. Kunisaki[/caption]
MedicalResearch.com Interview with:
Ken M. Kunisaki , MD
Associate Professor of Medicine
Pulmonary, Allergy, Critical Care and Sleep Medicine
University of Minnesota
Medical Research: What is the background for this study? What are the main findings?
Dr. Kunisaki : Obstructive sleep apnea (OSA) is a very common condition that is the result of recurrent complete or partial closure of the upper airway during sleep. OSA leads to poor sleep quality and excessive daytime sleepiness.
A previous study suggested that OSA is more common in the winter, but there were no vitamin D measurements in that study, which seemed potentially relevant since many people have lower vitamin D levels in the winter, due to less sunlight exposure in the winter. Several studies have also shown that people with low vitamin D levels have worse muscle function. Since muscles are partially responsible for keeping the upper airway open during sleep, we wondered whether people with low vitamin D levels might have weaker upper airway muscles and therefore be more prone to having OSA.
In our study, we found that indeed, persons with OSA had lower vitamin D levels than those without OSA, but this was explained by obesity. In other words, the low vitamin D levels seen in OSA patients is likely just a marker of obesity and not likely related to the presence or absence of OSA.
Prof. Kazem Rahimi[/caption]
MedicalResearch.com Interview with:
Kazem Rahimi | FRCP DM MSc FESC
Associate Professor of Cardiovascular Medicine, University of Oxford
Deputy Director, The George Institute for Global Health
James Martin Fellow in Healthcare Innovation, Oxford Martin School
Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust
Medical Research: What is the background for this study? What are the main findings?
Prof. Rahimi: Although the benefits of blood pressure lowering treatment for prevention of cardiovascular disease are well established, the extent to which these effects differ by baseline blood pressure, presence of co-morbidities (such as stroke or diabetes), or drug class is less clear.
Medical Research: What should clinicians and patients take away from your report?
Prof. Rahimi: Our study has several implications for clinical practice. Our findings suggest that blood pressure lowering to levels below those recommended in current guidelines (ie, systolic
blood pressure of less than 140 mm Hg) will reduce the risk of cardiovascular disease. By showing no evidence for a threshold below which blood pressure lowering ceases to work, the findings call for blood pressure lowering based on an individual’s potential net benefit from treatment rather than treatment of the risk factor to a specific target. Furthermore, the differences we identified between classes of drugs support more targeted drug use for individuals at high risk of specific outcomes (eg, calcium channel blocker therapy for individuals at high risk of stroke or and diuretics are more eff ective for prevention of heart failure).
Overall, our findings clearly show that treating 
Dr. Cassie Kennedy[/caption]
MedicalResearch.com Interview with:
Cassie Kennedy, M.D.
Pulmonology and Critical Care Medicine
Mayo Clinic
Medical Research: What is the background for this study?
Dr. Kennedy: Lung transplant is a surgical procedure that can offer extended life expectancy and improved quality of life to selected patients with end-stage lung disease. However there are about 1700 patients awaiting lung transplant at any given time in the United States because transplant recipients far exceed potential donors. In addition, even with carefully chosen candidates, lung transplant recipients live on average about 5.5 years. It is therefore very important for transplant physicians to choose patients who will receive the most benefit from their lung transplant.
Frailty (defined as an increased vulnerability to adverse health outcomes) has typically been a subjective consideration by transplant physicians when choosing lung transplant candidates. The emergence of more objective and reproducible frailty measures from the geriatric literature present an opportunity to study the prevalence of frailty in lung transplant (despite that subjective screening) and to determine whether the presence of frailty has any impact on patient outcomes.
Medical Research: What are the main findings?
Dr. Kennedy: Frailty is quite common --46 percent of our patient cohort was frail by the Frailty Deficit Index. We also saw a significant association between frailty and worsened survival following lung transplantation: one-year survival rate for frail patients was 71.7 percent, compared to 92.9 percent for patients who were not frail. At three years this difference in survival persisted--the survival rate for frail patients was 41.3 percent, compared to 66.1 percent for patients who were not frail.
Dr. Vitiello[/caption]
MedicalResearch.com Interview with:
Gerardo Vitiello, MD
Emory University School of Medicine
Emory Transplant Center
NYU Langone Medical Center
Department of Surgery
Medical Research: What is the background for this study? What are the main findings?
Dr. Vitiello: Screening for prostate cancer with prostate specific antigen (PSA) levels is highly controversial, as it is a non-specific marker for prostate cancer. A PSA level may be elevated in a variety of disease processes (not only prostate cancer), and even in the general population, the benefit of early intervention for prostate cancer is unclear. In contrast, end stage renal disease (ESRD), where patients no longer have renal function and require dialysis, is a major health problem with a huge impact on a patient’s quality of life. The only cure for ESRD is kidney transplantation, which has been shown to have an enormous health and quality of life benefit for transplant recipients. Transplant centers have rigorously screened candidates for potential malignancy prior to transplantation to ensure that there are no contraindications to receiving a transplant. For the first time, we demonstrate that screening for prostate cancer in kidney transplant candidates is not beneficial, and may actually be harmful, since it delays time to transplant and reduces a patient’s chance of receiving a transplant without an apparent benefit on patient survival.
Dr. Schuetz[/caption]
MedicalResearch.com Interview with:
Philipp Schuetz, MD, MPH
University Department of Medicine
Clinic for Endocrinology/Metabolism/Clinical Nutrition,
Kantonsspital Aarau, Aarau, Switzerland
Medical Faculty of the University of Basel
Basel, Switzerland
Medical Research: What is the background for this study? What are the main findings?
Dr. Schuetz: Malnutrition is common in hospitalised patients and associated with detrimental metabolic consequences. The current clinical approach is to provide at risk patients nutritional support as a strategy to tackle malnutrition and its associated adverse outcomes. Yet, whether this strategy is effective and improves clinical outcomes in the medical inpatient population is unclear. In addition, recent trials from critical care have shown adverse outcomes when nutritional therapy was used too aggressively.
Herein, our metaanalysis is the first to systematically investigate effects of nutritional support in medical inpatients. Our analysis shows that nutritional support is highly effective in increasing energy and protein intake and helps to stabilize weight loss. Also, risk for unplanned readmission after discharge from the hospital was reduced and length of stay was shorter in the patient population with established malnutrition.
Yet, for other important clinical outcomes such as mortality and functional outcomes effects of nutritional support remained uncertain. Also, the quality of evidence was found to be moderate to low.
Dr. Schmidt[/caption]
MedicalResearch.com Interview with:
Dr. Marjanka Schmidt PhD
Group Leader, Molecular Pathology
Netherlands Cancer Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Schmidt: BRCA1/2 mutation carriers who developed a primary breast cancer are thought to be at high risk to develop a contralateral breast cancer (breast cancer in the opposite breast). Our study is one of the first to provide unbiased risk estimates for young breast cancer patients with a pathogenic BRCA1/2 mutation. We also showed that age of onset of the first breast cancer is a predictor for the development of contralateral breast cancer in BRCA1/2 mutation carriers, but not in non-carriers.