Author: Marie Benz MD FAAD
13 Nov No evidence dietary acid load has detrimental effect on childhood bone health
[caption id="attachment_19359" align="alignleft" width="183"]
Dr. Garcia[/caption]
MedicalResearch.com Interview with:
Audry H. Garcia PhD
Scientist Department of Epidemiology
Erasmus MC, University Medical Center Rotterdam
Rotterdam, The Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Garcia: Mild and chronic metabolic acidosis as a result of a diet rich in acid-forming nutrients, such as cheese, fish, meat and grain products, may interfere with optimal bone mineralization and indirectly increase the risk of osteoporosis later in life. Previous observational studies in adults have reported inverse associations between dietary acid load and bone mass. However, the evidence in younger populations is scarce; only a few studies have been performed in healthy children and adolescents with inconsistent results, and not much is known on the effects of dietary acid load on bone mass in younger children or in children with a non-European background.
In a prospective multiethnic population-based cohort study of 2,850 children from the city of Rotterdam, the Netherlands, we found that dietary acid load estimated as dietary potential renal acid load (dPRAL), and as protein intake to potassium intake ratio (Pro:K) at 1 year of age, was not consistently associated with childhood bone health. Furthermore, associations did not differ by sex, ethnicity, weight status, or vitamin D supplementation.
13 Nov Medication Adherence Rates Vary Widely Across US Hospitals
[caption id="attachment_18995" align="alignleft" width="110"]
Dr. Tracy Wang[/caption]
MedicalResearch.com Interview with:
Dr. Tracy Wang MD MHS MSc
Assistant Dean, Continuing Medical Education
Director, Center for Educational Excellence
Fellowship Associate Program Director
Associate Professor of Medicine, Cardiology
Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Response: Medication non-adherence is a known challenge in the management of patients with coronary artery disease. Barriers to adherence are multifactorial, attributed to patient, healthcare provider, and social determinants. However, whether patient medication adherence varies across different hospitals is unknown. In this study, we sought to determine whether inter-hospital differences exist in the degree of patient adherence to secondary prevention medications after discharge. Moreover, we assessed whether these hospital-specific variations in medication adherence, if any, correspond to downstream patient outcomes.
We observed that the majority of post-MI patients were prescribed guideline-recommended secondary prevention medications at discharge. However, among those prescribed, we see a significant decline in the use of these medications within just 90 days after discharge. Medication adherence rates varied markedly across U.S. hospitals, with the widest variation seen for post-discharge use of beta-blockers. Hospitals with high post-discharge medication adherence were associated with significantly lower risk of major adverse cardiovascular events and death or all-cause readmissions when compared with hospitals with low adherence rates, even after adjustment for differences in patient case-mix.
12 Nov Should All Patients with Resistant Hypertension Be Screened for Primary Aldosteronism?
Posted at 23:07h
in AHA Journals, Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Heart Disease
[caption id="attachment_19340" align="alignleft" width="135"]
Dr. Lubitz[/caption]
MedicalResearch.com Interview with:
Carrie C. Lubitz, MD, MPH
Assistant Professor of Surgery, Harvard Medical School
Senior Scientist, Institute for Technology Assessment
Attending Surgeon, Mass General/North Shore Center for Outpatient Care
Danvers, Massachusetts
Medical Research: What is the background for this study? What are the main findings?
Dr. Lubitz: Given reported estimates of resistant hypertension and the proportion of resistant hypertensive patients with primary hyperaldosteronism (PA) - the most common form of secondary hypertension caused by a nodule or hyperplasia of the adrenal glands – we estimate over a million Americans have undiagnosed PA. Furthermore, it has been shown that patients with PA with the same blood pressure as comparable patients with primary hypertension have worse outcomes.
In our study, we found that identifying and appropriately treating patients with PA can improve long-term outcomes in patients in a large number of patients who have resistant hypertension.
12 Nov New Enzyme Inhibitor Shows Modest Effect Against Relapsed Lymphoma
[caption id="attachment_19307" align="alignleft" width="114"]
Dr. Shah[/caption]
MedicalResearch.com Interview with:
Dr. Jatin J. Shah, MD
Associate Professor, Department of Lymphoma/Myeloma
Assistant Professor, Lymphoma/Myeloma
Division of Cancer Medicine
The University of Texas, MD Anderson Cancer Center
Houston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Shah: The ubiquitin-proteasome system (UPS) is one of the key regulatory systems in our body’s cells. It controls the destruction of the majority of cellular proteins, which can be involved in making cells grow, expand, or die, among other functions. Defects in the UPS can result in a number of diseases, including cancer, for example by destroying too quickly the proteins that cause cells to die. The UPS has already been shown to be a rational target for cancer therapy: the approved drugs bortezomib and carfilzomib inhibit the proteasome itself, thus causing cancer cells to die. However, by completely blocking the proteasome, which is at the ‘end’ of the UPS, these drugs block the destruction of 100% of proteins, and can cause side effects. By contrast, blocking the NEDD8-activating enzyme (NAE) stops the cellular processes that are responsible for only approximately 20% of proteins being degraded by the UPS – including proteins of relevance to cancer development. Previous studies of pevonedistat in animals have shown that inhibiting NAE alters the ability of a cancer cell to repair its DNA after it is damaged; this leads to the death of cancer cells.
The man finding is this was the first reported study of pevonedistat in patients with multiple myeloma or lymphoma. It demonstrated that pevonedistat hits its target in cancer cells, exerted anticipated pharmacodynamic effects, and has modest activity as a single-agent in heavily pretreated patients with relapsed/refractory lymphoma.
12 Nov Low Calorie Sweeteners Not Linked To Weight Gain
[caption id="attachment_19336" align="alignleft" width="166"]
Prof. Rogers[/caption]
MedicalResearch.com Interview with:
Prof. Peter J. Rogers PhD
School of Experimental Psychology
University of Bristol, Bristol, UK
Medical Research: What is the background for this study?
Prof. Rogers: In recent years low-calorie sweeteners have been in the headlines because of concern that they may undermine rather than help with healthy weight management. That concern is based on selective reporting of studies and outright speculation. Our aim was to review the totality of evidence on this subject, which included results from human and animal (mouse and rat) studies.
Medical Research: What are the main findings?
Prof. Rogers: We found that randomised, controlled intervention trials in humans showed consistently that low-calorie sweeteners versus sugar consumption reduced energy intake and body weight, with no effect or even reduced body weight compared with consumption of water. These types of studies provide the strongest form of evidence – superior to animal and observational studies. In the animal studies, exposure to low-calorie sweeteners was mostly not representative of how people consume low-calorie sweeteners.
12 Nov Study Supports Shared Biology Between Schizophrenia and Epilepsy
Posted at 21:06h
in Author Interviews, Brigham & Women's - Harvard, Genetic Research, JAMA, Neurological Disorders, Schizophrenia
[caption id="attachment_19334" align="alignleft" width="150"]
Dr. Vonberg[/caption]
MedicalResearch.com Interview with:
Frederick W. Vonberg, MA, MBBS
Research Fellow in Neurocritical Care
Boston Children's Hospital and Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Response: An association between schizophrenia and epilepsy has long been suspected, ever since people noticed similarities in some aspects of the presentation of the two conditions, and in their epidemiology. For example, people with epilepsy are thought to be more at risk of developing schizophrenia. Furthermore, a psychosis resembling schizophrenia can characterize some forms of epilepsy. Whether this link reflected an overlap in the genetics of the two conditions has remained a mystery, however. In this study, we used a recently developed computational technique to show that there is a significant positive correlation between the genetic variants that are associated with epilepsy and with those that are associated with schizophrenia.
12 Nov New Tool Predicts Risk of Blindness and Amputation in Diabetes
MedicalResearch.com Interview with: Prof. Julia Hippisley-Cox PhD Professor of Clinical Epidemiology & General Practice Faculty of Medicine & Health Sciences The University of Nottingham Medical Research: What is the background for this study? What are the main findings? Prof. Hippisley-Cox: Patients with type 1 or type 2 diabetes are at increased risk of blindness and amputation but generally do not have an accurate assessment of the magnitude of their individual risk. There are currently no tools available to calculate risk of other complications such as amputation or blindness. This is important since these are the complications which patients with diabetes fear most and which most impair quality of life. They are also the complications for which patients are most likely to over-estimate their risk and over-estimate the benefits of intensive treatment. We have developed and externally validated new risk prediction algorithms which calculates absolute risk of developing these complications over a 10 year period in patients with diabetes, taking account of their individual risk factors.12 Nov Study Examines Link Between L-Carnitine and Atherosclerosis
Posted at 11:50h
in Author Interviews
[caption id="attachment_19328" align="alignleft" width="225"]
Dr. Bellamine[/caption]
MedicalResearch.com Interview with:
Aouatef Bellamine,
Medical Research: What is the background for this study? What are the main findings?
Dr. Bellamine: About two years ago, Robert Koeth and his colleagues (Nat Med. 2013 May;19(5):576-85) published a paper linking atherosclerosis and increased cardiac disease risks to Trimethylamine N-oxide (TMAO), a degradation product of dietary quaternary ammonium compounds such as L-Carnitine, Betaine and Choline. When these compounds are not completely absorbed into the intestine, bacterial gut metabolizes them to TMA (Trimethylamine) which is absorbed to the blood and further metabolized by the liver flavin-containing mono-oxygenases (FMOs) to TMAO. This is why some people use injectable l carnitine products.
Koeth’s observation was based on
- 1- clinical association between L-Carnitine levels increased incidence of major cardiac events,
- 2- on increased lesion formation in ApoE-/- mouse, a disease model used to study atherosclerosis.The conclusion was that TMAO promotes atherosclerosis. Although the association is established, the cause to effect cannot be clarified given the lack of dose response in this mouse model (a single dose has been used) and the small number of animals in the treatment group making the difference between treatments (3 out of 11 animals). In addition, TMAO has been described to play the role of a molecular chaperone, preventing the protein unfolding. TMAO is also found in fish where it plays an important role in maintaining a normal osmolality. Fish is reported otherwise to be a healthy food source and its consumption is not linked to atherosclerosis occurrence.
12 Nov Anti-VEGF Treatment Plus Radiation For Schwannoma Control
[caption id="attachment_19325" align="alignleft" width="150"]
Dr. Lei Xu[/caption]
MedicalResearch.com Interview with:
Lei Xu, MD, PhD
Steele Laboratory of Tumor Biology
Radiation Oncology Department
Massachusetts General Hospital
Medical Research: What is the background for this study?
Dr. Lei Xu: Neurofibromatosis 2 is characterized by benign tumors that develop throughout the nervous system. The most common site of these tumors is the eighth cranial nerve, which carries hearing and balance information from the ears to the brain. Although these vestibular schwannomas grow slowly, they usually lead to a significant or total hearing loss by young adulthood or middle age. The tumors can also press on the brain stem, leading to headaches, difficulty swallowing and other serious neurologic symptoms. While the tumors can be surgically removed or destroyed with radiation treatment, both approaches can also damage hearing.
Several previous investigations had suggested that – unlike other benign tumors – vestibular schwannomas induce the formation of new blood vessels, as malignant tumors do. A 2009 New England Journal of Medicine study led by Scott Plotkin, MD, PhD, at Massachusetts General Hospital reported that treatment with the antiangiogenesis drug bevacizumab caused shrinkage of NF2-schwannomas in most of the treated patients and improved hearing in more than half. But the limitations of that approach – the fact that not all patients responded, that the hearing improvement was often transient and that some patients could not tolerate long-term bevacizumab treatment – indicated the need to better understand the mechanisms of anti-angiogenesis on the function of tumor-bearing nerves.
12 Nov An Episode of Acute Kidney Injury Increases Risk and Rate of End Stage Renal Failure
[caption id="attachment_19312" align="alignleft" width="160"]
Dr. Thakar[/caption]
MedicalResearch.com Interview with:
Charuhas Thakar, MD
Director, Division of Nephrology and Hypertension Professor of Medicine
University of Cincinnati
Medical Research: What is the background for this study? What are the main findings?
"Diabetes is the major contributor to the growing burden of end-stage renal disease,” says Charuhas Thakar, MD, professor and director of the Division of Nephrology and Hypertension at the UC College of Medicine.
"Acute kidney injury is a common problem among diabetic patients who require admissions to hospitals. Approximately one-third of patients who develop AKI also have diabetes mellitus.”
Dr. Thakar along with a team of researchers have looked at a cohort of about 3,700 patients with Type 2 diabetes longitudinally followed for a five-year period to determine AKI’s impact.
AKI is a rapid loss of kidney function, which is common in hospitalized patients.
It has many causes that include low blood volume, exposure to substances or interventions harmful to the kidney and
obstruction of the urinary tract.
11 Nov Radial Access For Coronary Angiography Can Reduce Bleeding and Mortality
MedicalResearch.com Interview with:
Dr. Giuseppe Andò
University of Messina, Messina, Italy
Medical Research: What is the background for this study?
Dr. Andò: Patients’ preference for radial access for coronary angiography and percutaneous intervention is paralleled by an almost complete abolition of access-site bleeding. Given the deleterious impact of any clinically relevant bleeding event on short- and long-term outcomes, the use of radial access should translate into a reduction in net adverse events, especially in patients with high risk of bleeding such as those with an acute coronary syndrome. Nonetheless, studies conducted over the past decade by pioneers of radial access were relatively small and not sufficiently compelling to affect guidelines and endorse a change in current practice.
Medical Research: What are the main findings?
Dr. Andò: We have pooled in the present study 4 well-conducted, large, multicenter studies with data from centers with different expertise in radial procedures across America, Europe, Asia and Oceania. We demonstrate that the use of radial access can reduce mortality in patients with acute coronary syndromes undergoing invasive management by a consistent reduction in major bleeding.
11 Nov Study Examines Higher Systolic Blood Pressure and Kidney Disease Progression
MedicalResearch.com Interview with: Dr Will Herrington MD, MRCP and Dr Natalie Staplin PhD Nuffield Department of Population Health, University of Oxford Oxford, UK Medical Research: What is the background for this study? What are the main findings? Response: These analyses use data from SHARP, a trial of 9000 patients with chronic kidney disease which established that lowering LDL-cholesterol with a statin-based regime (simvastatin 20mg/ezetimibe 10mg) safely reduced risk of a heart attack or stroke in kidney patients. We have now used the SHARP dataset to investigate the association between blood pressure and rate of renal progression among those with different levels of albumin in the urine. These observations show that higher systolic blood pressure is associated with faster rate of renal progression irrespective of the presence or absence of albumin in the urine.11 Nov White Coat Hypertension Is Not Benign and Should Not Be Ignored
MedicalResearch.com Interview with:
Dr. Wanpen Vongpatanasin MD
Program Director, Hypertension Fellowship Program
Professor of Internal Medicine
Director of the University of Texas Southwestern Hypertension Program
Medical Research: What is the background for this study? What are the main findings?
Dr. Vongpatanasin: Home blood pressure measurement may reveal very different number when compared to clinic blood pressure in hypertensive patients. This difference can manifest as white coat hypertension (White Coat Hypertension; elevated office blood pressure with normal ambulatory or home blood pressure), or masked hypertension (MH; elevated ambulatory or home BP with normal office blood pressure). Although numerous epidemiological studies from Europe and Asia have shown increased cardiovascular risks associated with White Coat Hypertension and masked hypertension, previous studies have not addressed cardiovascular outcomes associated with White Coat Hypertension and masked hypertension in the general population in the United States.
We found that participants in the Dallas Heart Study, a multiethnic populational-based study in the Dallas County, both White Coat Hypertension and MH are associated with increased aortic stiffness and markers of kidney damage when compared to the group with normal blood pressure both at home and in the clinic. Furthermore, both white coat hypertension and masked hypertension are associated with increased risk of cardiovascular events, including coronary heart disease, stroke, atrial fibrillation, heart failure, and cardiovascular death over a median follow-up period of 9 years.
11 Nov NYU Dermatologist Addresses Common Skin Concerns
[caption id="attachment_18899" align="alignleft" width="185"]
Dr. Nagler[/caption]
MedicalResearch.com Interview with:
Arielle Nagler MD
Instructor, Department of Ronald O. Perelman Department of Dermatology
NYU Langone Medical Center
Medical Research: What are some of the best ways to keep our skin healthy?
Dr. Nagler: Sun protection is the single, most important step you can take to keep your skin healthy. Sun protection can help to prevent many of the signs of aging including wrinkles, changes in skin texture, and uneven pigmentation. Also sun protection has been shown to prevent certain types of skin cancer, which may save you from the distress and scarring of treatment. While we should all be careful in the sun, sun protection doesn’t mean that you have to avoid all outdoor activities and deprive yourself of outdoor fun. If you have any issues with your skin, or want more information, you might want to look into someone like this Ava MD cosmetic dermatologist or dermatologist local to you. However, you can take steps to protect your skin. Here are a couple of tips:
- Limit activities that require noon time sun exposure.
- Wear sunscreen with broad UV coverage (including UVA and UVB). Physical blockers such as zinc oxide and titanium dioxide are ideal.
- Buy a stylish wide brimmed hat.
- There is an enlarging retail space for UV protective clothing. Check them out!
11 Nov Intestinal Pathogens Change the Microbiome, Cause E. Coli To “Bloom”
[caption id="attachment_19265" align="alignleft" width="200"]
Dr. Manning[/caption]
MedicalResearch.com Interview with:
Shannon D. Manning, Ph.D., M.P.H.
Dept. of Microbiology and Molecular Genetics
Michigan State University
E. Lansing, MI 48824
Medical Research: What is the background for this study? What are the main findings?
Dr. Manning: Diarrheal disease is a leading cause of morbidity and mortality in children under the age of five and is commonly caused by many different bacterial pathogens.
We have observed that infection with four different bacterial pathogens (Salmonella, Shigella, Shiga toxin-producing E. coli, and Campylobacter) all induce the proliferation of a population of microbes, namely Escherichia, which are already present in the gut of healthy individuals.
10 Nov Parkinson’s Drug L-DOPA May Protect Against Macular Degeneration
[caption id="attachment_19258" align="alignleft" width="150"]
Dr. McKay[/caption]
MedicalResearch.com Interview with:
Brian S. McKay, Ph.D
Associate Professor
Department of Ophthalmology and Vision Science
University of Arizona
Medical Research Building, Room 212
Tucson, AZ 85724
Medical Research: What is the background for this study?
Dr. McKay: AMD (age-related macular degeneration) is a disease that is race-related. White people get the disease and lose vision to AMD at much higher rate than Blacks or Hispanics.
Thus, while race is complex, pigmentation may protect from the disease. With this starting point, my laboratory went after the pigmentation pathway to determine how pigment may affect photoreceptor (the retinal cells that actually catch the light) survival. The pigmented cells in the back of the eye are the retinal pigment epithelial cells (RPE), the rest of the retina does not pigment, it is clear not brown. We discovered that when the RPE make pigment they turn on molecular pathways to foster photoreceptor survival. Next we discovered the ligand for a receptor on the RPE that was tied to governing photoreceptor survival and pigmentation. That ligand was L-DOPA.
Knowing that L-DOPA is given to many aging individuals (those at risk of AMD), we developed a team to ask whether those taking L-DOPA for movement disorders are protected from AMD.
10 Nov Acute Gout Episodes Peaks in November
MedicalResearch.com Interview with: Paras Karmacharya, MD Internal Medicine Reading Health System West Reading, PA 19611 Co-Authors: Ranjan Pathak MD, Madan Raj Aryal MD, Smith Giri MD, Anthony A Donato MD MHPE Medical Research: What is the background for this study? Response: Studies describing seasonal variations in acute gouty arthritis note a seasonal trend, but disagree on timing, with most showing a peak in spring months while others showing peaks later in the year. However, serum uric acid (SUA) levels seem to peak in the summer months. This disparity has led to the hypothesis that the flares might be related to factors other than elevated serum uric acid levels. Various theories on the effects of weather and immune system changes on the chronobiology of the equilibrium and precipitation of monosodium urate crystals have been proposed. We aimed to shed light on this question by examining the seasonal variation in the incidence of acute gouty arthritis in the US using a large inpatient database. Medical Research: What are the main findings? Response: We used the Nationwide Inpatient Sample (NIS) database, a large national database that represents 20% of all hospital admissions, to identify adult patients with a primary diagnosis of acute gouty arthritis from 2009-2011 during their hospitalization. A total of 28,172 hospitalizations with primary diagnosis of acute gouty arthritis were reported from 2009-11. The peak incidence of acute gout was seen in the month of November (peak/low ratio 1.34, 95% CI 1.29-1.38, p<0.05) (Figure 1). The highest number of hospitalizations was observed in autumn months, while the lowest incidence was observed in spring (28.12% vs. 23.13%, p<0.001). Medical Research: What should clinicians and patients take away from your report? Response: Unlike previous studies, our analysis found the peak incidence of acute gout in the fall with its peak in the month of November. Various environmental (temperature, humidity, diet, physical activity) and biochemical factors (low cortisol levels, high absolute neutrophil counts and plasminogen activator inhibitor-1) have been implicated for the seasonal variation, but the data on this is conflicting. Whether our findings are reflective of purine and alcohol intake over the US holidays in November and December is a hypothesis that requires further testing.10 Nov Large Racial and Ethnic Gaps Exist In US For Premature Births
[caption id="attachment_19247" align="alignleft" width="147"]
Dr. McCabe[/caption]
MedicalResearch.com Interview with:
Edward R. B. McCabe, MD, PhD
Senior Vice President and Chief Medical Officer
Professor Adjunct of Pediatrics
Yale University School of Medicine
Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine
Inaugural Physician-in-Chief, Mattel Children's Hospital
Chief Medical Officer March of Dimes
Medical Research: What is the background for this study? What are the main findings?
Dr. McCabe: The March of Dimes Prematurity Campaign was launched in 2003. The goal of the campaign is to lower the rate of premature birth to 8.1 percent of live births by 2020 and to 5.5 percent by 2030.
Premature birth is the leading cause of death for newborns, and a major cause of childhood disabilities. Worldwide, 15 million babies are born preterm, and nearly one million die due to complications of an early birth. The U.S. preterm birth rate ranks among the worst of high-resource nations. Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays.
The US earned a “C” on the 8th annual March of Dimes Premature Birth Report Card which revealed persistent racial, ethnic and geographic disparities within states. The report card provided preterm rates and grades for each state and the largest cities. The report card showed that although some progress is being made in reducing preterm births, not all families are sharing in the success.
State specific information is available at marchofdimes.org/reportcard
Portland, Oregon has the best preterm birth rate of the top 100 cities with the most births nationwide, while Shreveport, Louisiana has the worst, according to the 2015 Report Card. The U.S. preterm birth rate was 9.6 percent in 2014. The report card shows more than 380,000 babies were born too soon last year.
10 Nov For Medicare Patients, Dabigatran Offers Significant Cost Savings Over Warfarin
Posted at 17:35h
in Author Interviews, Clots - Coagulation, Heart Disease, Stroke, University of Michigan
[caption id="attachment_19214" align="alignleft" width="144"]
Dr. Barnes[/caption]
MedicalResearch.com Interview with:
Geoffrey Barnes, MD, MSc
Clinical Lecturer
Cardiovascular Medicine and Vascular Medicine
University of Michigan Health System
Medical Research: What is the background for this study?
Dr. Barnes: Although warfarin has been the primary anticoagulant used for stroke prevention in atrial fibrillation for over 60 years, four new direct oral anticoagulants (DOACs) have been introduced into the market since 2010. Dabigatran, which directly inhibits thrombin, was found to have better prevention of ischemic stroke and a significant reduction in hemorrhagic stroke (bleeding strokes) for patients with atrial fibrillation at intermediate and high risk of stroke. Prior cost-effectiveness studies have shown that dabigatran is cost-effective from both the societal and payer (usually Medicare) perspectives. However, none of those studies looked at the patient’s out-of-pocket costs and the impact of prescription drug coverage
Medical Research: What are the main findings?
Dr. Barnes: We found that patients with prescription drug coverage (Medicare Part D) had significant cost savings when choosing dabigatran over warfarin. This is primarily because of the reduction in both types of stroke as well not needing to have frequent blood draws, as are required by warfarin. However, when patients do not have prescription drug coverage, the costs for dabigatran are quite high.
10 Nov Plasma cfDNA Can Monitor Response To Metastatic Colon Cancer Treatment
[caption id="attachment_19099" align="alignleft" width="114"]
Dr. Morris[/caption]
MedicalResearch.com Interview with:
Van K. Morris, M.D.
Assistant Professor, GI Medical Oncology
University of Texas – M.D. Anderson Cancer Center
Houston, TX 77030
Medical Research: What is the background for this study? What are the main findings?
Dr. Van K Morris: BRAF V600E mutations are associated with poor clinical outcomes for patients with metastatic colorectal cancer. Patients were enrolled in a phase I clinical trial with the BRAF inhibitor vemurafenib, the anti-EGFR antibody cetuximab, and irinotecan. Blood samples were collected every two weeks with each dose, and plasma was analyzed for changes in the fraction of mutant BRAF V600E allele relative to wild-type BRAF allele with time. Trends in circulating free DNA (cfDNA) changes were compared with radiographic changes by RECIST 1.1 criteria to examine this technique as a marker for response to therapy.
For patients who had a response radiographically, drastic reductions in the BRAF V600E allele fraction were observed even after two weeks of starting therapy, well before the first restaging scan. Patients who did not have responses radiographically had less dramatic changes relative to baseline in the BRAF V600E allele fraction. This technique analyzing cfDNA from plasma was validated using two different approaches – digital droplet PCR and next-generation sequencing by Guardant Health. Sequencing of cfDNA was also compared in pretreatment and post-progression samples, and novel mutations in MEK1 and GNAS were observed uniquely in post-progression samples.
10 Nov Relatively Few Women Physicians Choose Cardiology as Career
Posted at 16:35h
in AHA Journals, Author Interviews, Duke, Education, Gender Differences, Heart Disease
[caption id="attachment_19201" align="alignleft" width="160"]
Dr. Douglas[/caption]
MedicalResearch.com Interview with:
Pamela S. Douglas, MD, MACC, FASE, FAHA
Ursula Geller Professor of Research in Cardiovascular Disease
Duke University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Douglas: The impetus for our study was the concern that cardiology as a profession might be enhanced by greater diversity. By not attracting women in larger numbers (9% of FACCs are female), our fellowships have incomplete access to the talent pool of outstanding residents, and we do not have a diverse group of clinicians to care for our increasingly diverse patient population, or of researchers to explore potentially important health care disparities.
Our findings were twofold: first, job descriptions for men and women cardiologists are dramatically different. Men are much more likely to do invasive procedures while women are more likely to see patients and perform imaging/noninvasive tests. While there were slightly more women working part time than men this was still rare, and the difference in number of days worked was just 6, across an entire year.
The second finding was that there was a significant difference in compensation. Unadjusted, this was over $110, 000 per year; after very robust adjustment using over 100 personal, practice, job description and productivity measures, the difference was $37, 000 per year, or over a million dollars across a career. A separate independent economic analysis of wage differentials yield a similar difference of $32,000 per year.
10 Nov Benefits of tPS Outweigh Risks in Ischemia Stroke, Even in Patients on Antiplatelet Medications
[caption id="attachment_19166" align="alignleft" width="137"]
Dr. Ying Xian[/caption]
MedicalResearch.com Interview with:
Ying Xian, PhD
Assistant Professor of Medicine.
Member in the Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Xian: Intravenous tissue plasminogen activator (tPA) is the only FDA approved medical therapy to reduce disability and improve outcomes for patients with acute ischemic stroke. But treatment with tPA also carries the risk of symptomatic intracranial hemorrhage (sICH), which is often fatal. Nearly half of ischemic stroke patients are taking antiplatelet drugs such as aspirin and/or clopidogrel prior to stroke. We found these patients had higher risk for sICH when treated with tPA. But the risk is relatively small. For every 147 patients on aspirin treated with tPA, only 1 more symptomatic intracranial hemorrhage as compared with those treated with tPA without prior antiplatelet therapy. The risk is slightly higher among those on dual antiplatelet therapy of aspirin and clopidogrel (number needed to harm 60). Despite the higher bleeding risk, patients treated with tPA on prior antiplatelet therapy appeared to have better functional outcomes in terms of ambulatory status and modified Rankin scale than those not on prior antiplatelet therapy. Therefore, overall the benefits of thrombolytic therapy may outweigh the risks.
10 Nov Majority of Gout Patients Do Not Achieve Target Uric Acid Level
[caption id="attachment_19091" align="alignleft" width="150"] Dr. Raebel[/caption] MedicalResearch.com Interview with: Marsha A. Raebel, PharmD Senior Investigator Kaiser Permanente Colorado's Institute for Health Research Medical Research: What is the background for this study? What are the main findings? Dr. Raebel: Gout is an inflammatory arthritis that affects at least 7.5 million American adults. A hallmark of gout is...
10 Nov Probiotics May Reduce Risk of Type 1 Diabetes
MedicalResearch.com Interview with:
Dr. Ulla Uusitalo PhD
University of South Florida, Tampa
Medical Research: What is the background for this study? What are the main findings?
Dr. Uusitalo: The TEDDY Study is an international prospective cohort study with the primary goal to identify environmental causes of Type 1 Diabetes (T1D). It is carried out in six clinical research centers, in four countries: University of Colorado Health Science Center (US), Georgia Regents University (US), Pacific Northwest Diabetes Research Institute (US), Turku University Hospital (Finland), Institute of Diabetes Research (Germany), and Lund University (Sweden), since 2004.
One possible environmental factor related to Type 1 Diabetes etiology is diet. Dietary supplements including probiotics as well as various types of infant formulas including probiotic fortified infant formula are studied. The microbial composition of gut has been shown to be associated with the development of Type 1 Diabetes. Colonization of the infant gut starts already in utero and early microbial exposures have been found to be important in defining the trajectory of colonization. Probiotics have been demonstrated to induce favorable immunomodulation and it has been suggested that probiotic treatment could prevent T1D. Therefore we wanted to study the early exposures of probiotic and risk of islet autoimmunity, a condition often preceding Type 1 Diabetes.
This study produced very interesting results. The main finding was that we found 60% decrease in the risk of islet autoimmunity among children with HLA genotype of DR3/4 (high risk), who were exposed to probiotics during the first 27 days of life.
10 Nov Depression Raises Risks of Kidney and Heart Disease in Diabetic Patients
[caption id="attachment_17645" align="alignleft" width="150"]
Dr. Molnar[/caption]
MedicalResearch.com Interview with:
Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN
Associate Professor of Medicine
Division of Nephrology, Department of Medicine
University of Tennessee Health Science Center
Memphis, TN, 38163
Medical Research: What is the background for this study? What are the main findings?
Dr. Molnar: We examine the association between presence of depression and all-cause mortality; incident Coronary Heart Disease (CHD) (new onset AMI, CABG or PCI), incident ischemic stroke, slopes of eGFR (OLS, <-5 vs ≥-5 ml/min/1.73m2/yr) in 933,211 diabetic (based on ICD9, medication and HbA1c ≥ 6.5%) US Veterans with eGFR ≥ 60 ml/min/1.73m2 at baseline. We adjusted for independent covariates, collected from VA databases, such as age, gender, race, BMI, marital status, income, service connection, comorbid conditions (ICD9), baseline eGFR, serum albumin.
Mean age was 64±11 years, 97% were male and 18% African-American. Depression was present in 340,806 (37%) patients at enrollment. During a median follow-up of 7.3 years, 180,343 patients (19%) developed Chronic Kidney Disease (CKD).AS (adjusted hazard ratio [aHR] and 95% confidence interval [CI]: 1.20 (1.19-1.21)). Similarly, depression was associated with 35% higher risk of incident stroke (aHR and 95% CI: 1.35 (1.32-1.39), 24% higher risk of incident CHD (aHR and 95% CI: 1.24 (1.22-1.27) and 25% higher risk of all cause mortality (aHR and 95% CI: 1.25 (1.24-1.26) during the follow-up.
10 Nov microRNAs in Joint Fluid As Biomarker For Antibiotic Refractory Lyme Arthritis
MedicalResearch.com Interview with: Robert B. Lochhead PhD Clinical Fellow in Medicine Division of Rheumatology, Allergy & Immunology Massachusetts General Hospital Harvard Medical School, Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Lochhead: Lyme arthritis (LA), caused by the tick-borne spirochete Borrelia burgdorferi, usually resolves appropriately with antibiotic treatment, called antibiotic-responsive Lyme arthritis. However, in some patients, arthritis persists for months or years after spirochetal killing with oral and IV antibiotic therapy, called antibiotic-refractory Lyme arthritis. Synovial lesions in these patients show marked synovial proliferation, inflammation, and vascularization, accompanied by autoimmune T and B cell responses. MicroRNAs (miRNAs) regulate many biological processes including inflammation, immune responses, and cell proliferation, and are effective biomarkers that may reveal molecular mechanisms of disease. Our objective here was to identify extracellular miRNAs (ex-miRNAs) in synovial fluid (SF) that distinguish regulated (responsive) from dysregulated (refractory) immune responses in Lyme arthritis, thereby providing insights into underlying biological processes and potential diagnostic biomarkers to distinguish between these disease courses.10 Nov Some Triple Negative Breast Cancers Show Response To New Drug Conjugate
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Dr. Bardia[/caption]
MedicalResearch.com Interview with:
Aditya Bardia MD, MPH
Attending Physician, Massachusetts General Hospital Cancer Center,
Assistant Professor, Harvard Medical School,
Boston, MA 02114
Medical Research: What is the background for this study? What are the main findings?
Dr. Bardia: Triple negative breast cancer (TNBC) represents breast cancers that are negative for estrogen and progesterone receptors, as well as human epidermal growth factor receptor 2, or HER2. This type of breast cancer comprises about 15-20% of all invasive breast cancers and is more prevalent in young and African-American women.Triple negative breast cancer characteristically has a high recurrence rate and is perhaps the most difficult type of breast cancer to treat successfully with current cytotoxic agents. Trop-2 is a protein present in limited amounts in normal human tissues but widely found in many human cancers. It is expressed in more than 80 percent of Triple negative breast cancer, making it an attractive therapeutic target.
Sacituzumab govitecan (IMMU-132) is a first-in-class ADC developed by Immunomedics, Inc. by linking moderately-toxic drug, SN-38, to an antibody that binds to the Trop-2 target found in many solid cancers. We conducted a clinical trial with this drug for patients with advanced tumors, including patients with TNBC who either had failed their previous treatments for Triple negative breast cancer or their cancer had returned.
We have found that even though patients who participated in this trial had very advanced stages of the disease, approximately 30% of these patients responded with 30% or more tumor shrinkage. The response rate to standard agents is usually 10 to 20 percent, while the response rate with IMMU-132 was approximately 30 percent. If you include patients with stable disease, the clinical disease control rate, which is complete response [CR] + partial response [PR] + stable disease, was about 75 percent.
10 Nov Patients With Eczema Receive More Preventative Health Care Services
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Dr. Silverberg[/caption]
MedicalResearch.com Interview with:
Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois
Medical Research: What is the background for this study? What are the main findings?
Dr. Silverberg: We previously showed that adults with eczema are more likely to smoke cigarettes, drink alcohol and have sedentary lifestyle. We wondered whether chronic eczema might negatively impact upon other health behaviors, such as seeking preventive care and vaccinations. On the other hand, previous studies from our group and others found that both children and adults with eczema have a number of comorbid medical and mental health conditions. One potential reason for this is detection bias from since eczema patients are “plugged into” the healthcare system because of their skin disease, which allows them to be diagnosed more frequently with other health problems.
We sought to understand the routine and preventive healthcare behaviors of children and adults with eczema. We found that adults with eczema were more likely to be vaccinated for tetanus, influenza, hepatitis A and B viruses, human papilloma virus and pneumonia. Moreover, they were more likely to undergo age-appropriate health screenings, such as blood pressure and cholesterol checks, but not cancer screening. Adults with eczema were more likely to interact with a variety of general doctors and specialists.
Similarly, childhood eczema was associated with higher rates of vaccination for influenza, well child checkups and interaction with most types of healthcare providers.