Anesthesiology, Author Interviews, Breast Cancer, Journal Clinical Oncology, Surgical Research / 19.08.2015

Jaclyn Bradley Palmer, MM, MT-BC University Hospitals Of Cleveland Cleveland, OHMedicalResearch.com Interview with: Jaclyn Bradley Palmer, MM, MT-BC University Hospitals Of Cleveland Cleveland, OH  Medical Research: What is the background for this study? What are the main findings? Response: Patients awaiting breast cancer surgery may be understandably anxious. While pharmacologic intervention may reduce anxiety, higher doses of preoperative drugs can depress circulation and respiration, making alternative measures a particular interest. Music therapy is the clinical use of music interventions to accomplish individualized goals within a therapeutic relationship by a board-certified music therapist. While music in surgery has been researched under the label of "music therapy", many of the studied investigations illicit recorded music provided by non-music therapy staff, making it truly "music medicine" practices instead. In this investigation, the effect of both live and recorded music therapy on anxiety, anesthesia requirements, recovery time and patient satisfaction were studied perioperatively. Breast cancer surgery patients were engaged in a brief music therapy session which consisted of one live or recorded preferred song choice, followed by discussion and processing of emotions. Compared to usual care, both live and recorded music therapy groups experienced significantly greater reductions in anxiety (p<.001) with point reductions of 27.5 (42.5%) and 26.7 (41.2%), respectively. During surgery, both music groups listened to music-therapist selected recorded, instrumental harp music, chosen for it's evidence-based therapeutic value of smooth lines, consistent volumes and stable melodies. In measuring the amount of interoperative drug (propofol) needed to reach moderate sedation, the intraoperative music was not found to have an effect in this trial. Patient satisfaction was universally high in all three study groups. Those who received live music preoperatively were discharged an average of 12.5 minutes sooner than those who received recorded music preoperatively, although neither music group was dischanged significantly sooner than the control group. Subjective reactions to the music interventions relayed that music therapy in surgery was an enjoyable addition. (more…)
Author Interviews, Ovarian Cancer / 18.08.2015

Oleh Taratula,PhD Assistant Professor Oregon State University/Oregon Health & Science University College of PharmacyMedicalResearch.com Interview with: Oleh Taratula, PhD Assistant Professor Oregon State University/Oregon Health & Science University College of Pharmacy MedicalResearch: What is the background for this study? Dr. Taratula: The background for the study consists of previous work we had published in the lab using photodynamic therapy (PDT) as the stand alone treatment modality. We were successful in synthesizing and incorporating the photodynamic nanoplatform in the treatment for ovarian cancer, but our current graduate student, Canan Schumann said he could make the therapy more efficient using his current research on gene therapy. The gene therapy he is currently working on is the delivery of siRNA targeted to the multifaceted oncogenic protein DJ-1 which has been implicated in antioxidative stress defense as well as the overall survival of ovarian cancer. Cancer is highly intelligent able to adapt quickly to new insults that it comes across, even ROS formed inside the cell. Cancer cells can even upregulate a whole host of antioxidant stress response proteins to combat the formation of or scavenge already created ROS. The idea was can we combine our currently used PDT, which uses the generation of reactive oxygen species (ROS) as its cytotoxic mechanism of action, coupled with gene therapy targeted to DJ-1, in hope to drastically increase ROS inside the cell leading to a more pronounced cell death. (more…)
Author Interviews / 18.08.2015

MedicalResearch.com Interview with: Jessica Leung, MPH and Rafael Harpaz, MD, MPH Division of Viral Diseases, National Center for Immunization and Respiratory Diseases (NCIRD) Centers for Disease Control and Prevention (CDC) MedicalResearch: What is the background for this study? Authors’ Response: Prior to the introduction of varicella (chickenpox) vaccination in the U.S., there were millions of cases, tens of thousands of hospitalizations, and hundreds of deaths due to varicella. One-dose of varicella vaccination was recommended in 1995, and two-doses in 2006. Since 1995, there have been substantial declines in varicella disease. In a previously published paper by authors Zhou et al (JAMA. 2005 Aug 17;294(7):797-802), they found an 88% decrease in varicella-related hospitalizations and a 59% decrease in outpatient visits during 1994-2002, a period after the one-dose program began in the U.S. but before the two-dose program started. We wanted to update the prior analyses with an additional 10 years of data to describe the impact of the varicella vaccination program during a period of high 1-dose coverage and increasing levels of 2-dose coverage. We looked at claims data during the 1994-2012 period using the Truven Health MarketScan® databases. (more…)
Author Interviews, Brigham & Women's - Harvard, Genetic Research, Heart Disease, Nature / 18.08.2015

Susan A. Slaugenhaupt PhD Professor of Neurology, Harvard Medical School Associate Geneticist, Department of Neurology, Molecular Neurogenetics Unit Center for Human Genetic Research Massachusetts General HospitalMedicalResearch.com Interview with: Susan A. Slaugenhaupt PhD Professor of Neurology, Harvard Medical School Associate Geneticist, Department of Neurology, Molecular Neurogenetics Unit Center for Human Genetic Research Massachusetts General Hospital   Medical Research: What is the background for this study? What are the main findings? Dr. Slaugenhaupt: Mitral valve prolapse (MVP) is one of the most common human diseases affecting 1 out of every 40 people worldwide.  The mitral valve is found between two chambers of the heart, and mitral valve prolapse results when the valve does not close properly.  By studying families in which multiple members have mitral valve prolapse, we have identified a biological explanation for the disease.  Mutations in the DCHS1 gene cause mitral valve prolapse in three families, and suggest that early defects in heart valve formation during development contribute to the progressive deterioration of the valve. (more…)
Addiction, Author Interviews, Mental Health Research, Psychological Science / 18.08.2015

Professor Jackie Andrade PhD School of Psychology Cognition Institute Plymouth University Plymouth Australia MedicalResearch.com Interview with: Professor Jackie Andrade PhD School of Psychology Cognition Institute Plymouth University Plymouth Australia   Medical Research: What is the background for this study? What are the main findings? Dr. Andrade: We want to understand the mental processes that are going on during episodes of craving for drugs or food. We know that cravings are largely mental events because people rarely experience them when in the middle of a mentally-engaging task - giving a presentation or finishing an exciting novel, for example. By understanding the mental processes underpinning cravings, we can improve treatments for addiction and eating problems, and also find ways of strengthening desires for healthy activities. Visual mental imagery is a key component of craving, with people picturing themselves indulging their desires. Laboratory research has shown that blocking this craving imagery can reduce the strength of cravings for food and cigarettes. Tetris is a good task for doing this because it involves a lot of visual processing to keep track of the different coloured shapes and mentally rotate them to fit the spaces. For our latest study, we wanted to find out if Tetris helped block cravings in ‘real life’ rather than in the laboratory, and whether it worked for a range of common cravings. We asked 31 participants to carry iPods with them for a week. They received text messages 7 times a day prompting them to use the iPod to report whether they were craving something and, if so, what it was and how strong the craving was. A random 15 participants assigned to the Tetris condition were also asked to play Tetris for 3 minutes and answer the craving questions again. For this group, we compared the before-Tetris and after-Tetris craving scores on each occasion and found that cravings were 20% weaker after playing Tetris. People played Tetris 40 times on average, but the craving-reducing effect did not wear off as they got used to the game. The control group who reported cravings without playing Tetris allowed us to see how cravings varied naturally across the week. Tetris reduced craving strength across the range of cravings reported, which included cravings for drugs (alcohol, nicotine, caffeine), food, and ‘other activities’ including sleep, videogaming, sex and social interaction. (more…)
Author Interviews, Depression, JAMA, Pediatrics / 18.08.2015

Edward D. Barker, PhD Developmental Psychopathology Group Department of Psychology, King’s College London Institute of Psychiatry LondonMedicalResearch.com Interview with: Edward D. Barker, PhD Developmental Psychopathology Group Department of Psychology, King’s College London Institute of Psychiatry London Medical Research: What is the background for this study? Dr. Barker: The study looks at how the brain may be affected by experiences that happen early in life and adolescence. It has been known for a long time now that people who experience intense adversity are at increased risk of developing depression and other psychiatric problems. Previous research has also shown that both adversity and depression can affect the development of the brain and lead to altered brain structure. In this study, we wanted to examine how early adversity and depression relate to altered brain structure when you examined each within a specific temporal order (i.e., adversity, then depression/anxiety, then brain structure). This study design allowed us to examine not only the effects of adversity and depression, but also if some of the variation in brain structure associated with depression may also be explained by early adversity. Other researchers have previously suggested that some of the variation in brain structure observed in depressed patients may relate to early adversity, but no previous study has examined this prospectively like we did, using the Avon Longitudinal Study of Parents and Children. (more…)
Author Interviews, Osteoporosis / 17.08.2015

MedicalResearch.com Interview with: Prof. Jonathan M. Hodgson School of Medicine and Pharmacology Royal Perth Hospital University of Western Australia Perth, Australia MedicalResearch What is the background for this study? What are the main findings? Prof. Hodgson: Flavonoids are a class of phytochemicals present at high levels in tea. Observational studies have found that higher tea and flavonoid intakes are associated with higher bone mineral density. However, the relationships of tea and flavonoid intakes with fracture risk are not clear. We therefore examined the relationship of black tea drinking and flavonoid intake with fracture risk in a population of women aged over 75 years followed for 10 years. We found that a higher intake of black tea and particular classes of flavonoids, some of which are derived primarily from tea, were associated with lower risk of fracture-related hospitalizations in these elderly women. (more…)
Author Interviews, Chemotherapy, Lancet / 17.08.2015

Bernardo L. Rapoport M. D. The Medical Oncology Centre of Rosebank Johannesburg, South AfricaMedicalResearch.com Interview with: Bernardo L. Rapoport M. D. The Medical Oncology Centre of Rosebank Johannesburg, South Africa Medical Research: What is the background for this study? What are the main findings? Dr. Rapoport: Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared side effects of chemotherapy, and can lead to dose reductions or discontinuations of life-extending anti-cancer therapy. In the past, the serotonin (5-HT3) receptor antagonists, such as granisetron, palonosetron , and ondansetron, have shown effectiveness in preventing acute CINV (0-24 hours after chemotherapy administration), but many chemotherapies, such as cisplatin, carboplatin, and anthracycline/cyclophosphamide combinations, can cause delayed chemotherapy-induced nausea and vomiting that occurs from >24 hours to 5 days or more after chemotherapy. Neurokinin-1 receptor antagonists (NK-1 RAs) work though the substance P signaling pathway and are effective at preventing the delayed phase of chemotherapy-induced nausea and vomiting. Aprepitant was the first NK-1 RA to come to market in 2003, followed by a fixed dose of netupitant plus palonosetron late last year. (more…)
Addiction, Author Interviews / 17.08.2015

MedicalResearch.com Interview with: Kathrine Sullivan Ph.D. Candidate University of Southern California School of Social Work Medical Research: What is the background for this study? What are the main findings? Response: Military families and military-connected youth exhibit significant strengths; however, a sizeable proportion of these families appear to be struggling in the face of war-related stressors. Understanding the consequences of war is critical as a public health concern and because additional resources may be needed to support military families. This study used a large, normative, and geographically comprehensive dataset to determine whether military-connected youth are at risk of adverse outcomes, including substance use, victimization, and weapon-carrying, during wartime.  Results indicated that military-connected 7th, 9th and 11th grade students had greater odds of substance use, victimization, and weapon-carrying compared to non-military connected peers. Specifically, more military-connected students reported using alcohol (45 percent vs. 39 percent), being hit, kicked, slapped or pushed (36 percent vs. 27 percent) or bringing a gun to school (10 percent vs. 5 percent) than other students.  Children with parents or a caregiver in the armed forces were also much more likely to have used prescription medications (36 percent vs. 27 percent), brought a knife to school (15 percent vs. 9 percent), been in a fight (27 percent vs. 17 percent) or feared being beaten up (24 percent vs. 18 percent). (more…)
Author Interviews, Baylor University Medical Center Dallas, OBGYNE, Pediatrics / 17.08.2015

Arpitha Chiruvolu MD FAAP Neonatologist Baylor University Medical Center Department of Neonatology Dallas, TX 75246 MedicalResearch.com Interview with: Arpitha Chiruvolu MD FAAP Neonatologist Baylor University Medical Center Department of Neonatology Dallas, TX 75246  MedicalResearch: What is the background and main findings of the study? Dr. Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes. We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort. Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort.  A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities. (more…)
Author Interviews, Nutrition / 17.08.2015

Karen Hardy ICREA, Catalan Institution for Research and Advanced Studies Departament de Prehistòria Facultat de Filosofia i Lletres Universitat Autònoma de Barcelona Barcelona, SpainMedicalResearch.com Interview with: Dr. Karen Hardy  ICREA, Catalan Institution for Research and Advanced Studies Departament de Prehistòria Facultat de Filosofia i Lletres Universitat Autònoma de Barcelona Barcelona, Spain   MedicalResearch: What is the background for this study? What are the main findings? Dr. Hardy: There continues to be little clear agreement on what quantitatively constitutes a healthy diet. The global increase in the incidence of obesity and diet-related metabolic diseases have intensified interest in ancestral or “Palaeolithic” diets as it is clear that to a first order of approximation our physiology should be optimized to the diet that we have experienced during our evolutionary past. However, reconstructing ancestral diets is very challenging, and exactly what was eaten during the Palaeolithic remains largely unknown. Until now, there has been a heavy focus on the role of animal fats and protein in the development of the human brain and there is little doubt that increases in meat consumption from around 3.4 million years ago, was a major driver. However, the role of carbohydrates, particularly in the form of starch-rich plant foods, has largely been overlooked. But the human brain today uses up to 25 % of the body’s energy budget and up to 60 % of blood glucose as a general rule, while pregnancy and lactation in particular, place additional demands on the body’s glucose budget. In this study we integrated multiple lines of evidence from human genetics, archaeology, anthropology, physiology, and nutrition, to hypothesise that cooked carbohydrates played an important part in the evolution of the body, and particularly the brain, over the last 800,000 years. Our results suggest that while meat was important, brain growth is less likely to have happened without the energy obtained from carbohydrates. While cooking has also been proposed as contributing to early brain development, it has a particularly profound effect on the digestibility of starch. Furthermore, humans are unusual among primates in that they have many copies of the salivary amylase gene (average of around six salivary amylase genes, other primates have only two) leading to more efficient starch digestion. This suggests that cooking starch-rich plants and having more amylase coevolved. We don’t know exactly when the number of amylase gene copies multiplied, but genetic data suggest it was in the last million years; a timeframe that brackets archaeological evidence for cooking and when our brain size increase accelerated (around 800,000 years ago). Salivary amylases are largely ineffective on raw crystalline starch, but cooking substantially increases both their energy-yielding potential and glycemia. (more…)
Author Interviews, Biomarkers, Pancreatic / 17.08.2015

Tatjana Crnogorac-Jurcevic MD PhD Reader Centre for Molecular Oncology Barts Cancer Institute, Queen Mary, University of London London UKMedicalResearch.com Interview with: Tatjana Crnogorac-Jurcevic MD PhD Reader Centre for Molecular Oncology Barts Cancer Institute, Queen Mary University of London London UK  Medical Research: What is the background for this study? What are the main findings? Dr. Crnogorac-Jurcevic: Pancreatic adenocarcinoma (PDAC) is one of the most difficult cancers to detect. More than 80% of patients usually present at a late stage, with either locally advanced or with already metastatic disease. This is one of the major reasons for a bleak prognosis of this malignancy, which is typically 3-6 months and with <5% five-year survival. However, if patients are diagnosed with stage II disease, the survival rate is 20%, and at stage I, in patients with very small tumours, the five-year survival can increase up to 60%. In order to find biomarkers for early detection of this disease, we have performed in depth GeLC/MS/MS (SDS-PAGE-liquid chromatography-tandem mass spectrometry) analysis of 18 proteomes of urine samples collected from healthy controls, chronic pancreatitis, and patients with Pancreatic adenocarcinoma and obtained around 1500 non-redundant proteins. From these, three proteins, LYVE-1, REG1A, and TFF1, were selected for further analysis based on their known biological functions and statistical difference in comparisons of the experimental groups. These biomarkers were subsequently validated using ELISA assays in a multicenter cohort of urine samples: 87 from healthy people, 92 from patients with chronic pancreatitis, and 192 from PDAC patients. Multiple logistic regression was then applied: when comparing Pancreatic adenocarcinoma with healthy urine specimens, the resulting areas under the receiver-operating characteristic curves (AUC) of the three biomarkers combined into a panel were 0.89 (95% confidence interval: 0.84–0.94) in the training dataset (70% of the data) and 0.92 (95% confidence interval: 0.86–0.98) in the validation dataset (30% of the data). When the results from the analysis of PDAC stage I–II (n=71) urine samples were compared with the healthy urine specimens, the panel achieved AUCs of 0.90 (95% confidence interval: 0.84–0.96) and 0.93 (95% confidence interval: 0.84–1.00) in the training and validation datasets, respectively. In comparison to matching plasma CA19.9 values, the only Pancreatic adenocarcinoma biomarker in widespread clinical use (albeit mostly for monitoring of the disease), the panel achieved a higher AUC of 0.97 (95% confidence interval: 0.94–0.99) than CA19.9 (AUC 1/4 0.88; 95% confidence interval: 0.81–0.95, P=0.005). When combined with CA19.9, increased AUC of 0.99 (95% confidence interval: 0.97–1.00, P=0.04) was achieved, but this was not seen in a panel combined with plasma CA19.9 in stage I–IIA PDAC (n =17) vs. healthy sample comparison. (more…)
Author Interviews, Brigham & Women's - Harvard, Gastrointestinal Disease, Technology / 16.08.2015

MedicalResearch.com Interview with: Dr. Jeff Karp Ph.D Associate Professor of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge, MA 02139 Dr. Jeff Karp Ph.D Associate Professor of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge, MA  02139 and Giovanni Traverso M.B., B.Ch., Ph.DDr-Giovanni-Traverso The David H. Koch Institute for Integrative Cancer Research Massachusetts Institute of Technology, Cambridge, MA   Medical Research: What is the background for this study? What are the main findings Dr. Karp: Almost all patients with ulcerative colitis will require enema-based therapy at some point in their treatment.  Enema therapy has 3 major issues.
  • It is difficult to retain
  • There is high systemic absorption of the drug (that can lead to toxic side effects), and
  • Compliance is low as patients must take enemas every day.
Our approach can potentially address all three.  The engineered gel that we designed has dual targeting capability. It rapidly attaches to ulcers within seconds to minutes (we have 5-10x less systemic absorption as the gel only attaches to ulcers) and selectively releases drug in the presence of ulcers, and we showed that we could reduce the dosing frequency. (more…)
Annals Internal Medicine, Author Interviews, Infections, Respiratory / 16.08.2015

Reed A.C. Siemieniuk, MD Department of Clinical Epidemiology & Biostatistics Ontario CanadaMedicalResearch.com Interview with: Reed A.C. Siemieniuk, MD Department of Clinical Epidemiology & Biostatistics Ontario Canada Medical Research: What is the background for this study? What are the main findings? Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of  benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration. Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence). For an interactive summary of findings table that shows the study's findings, please see: http://isof2.epistemonikos.org/#/finding/550bc6acf30d0c43083e63a0. (more…)
AHRQ, Author Interviews, Outcomes & Safety / 16.08.2015

MedicalResearch.com Interview with: Kevin Heslin, Ph.D., Staff Service Fellow, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality Medical Research: What is the background for this study? Dr. Heslin: Previous trends in inpatient mortality suggest that rates have been decreasing for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, and pneumonia (Hines et al., 2010; Stepanova et al., 2013).  Continued study of these trends can help researchers and policymakers assess the impact of health care quality efforts.  Further, examining trends across patient and hospital subgroups may inform strategies for addressing disparities in health care quality by identifying groups that are leading and lagging in improvement. Medical Research: What is the background for this study Dr. Heslin: From 2002 to 2012, inpatient mortality decreased among patients admitted to U.S. hospitals for pneumonia (45 percent decrease, from 65.0 to 35.8 deaths per 1,000 admissions), AMI (41 percent decrease, from 94.0 to 55.9 deaths per 1,000 admissions), CHF (29 percent decrease, from 44.4 to 31.4 deaths per 1,000 admissions), and stroke (27 percent decrease, from 112.6 to 82.6 deaths per 1,000 admissions).  The inpatient mortality rate for all four conditions decreased among both younger and older patients, and among men and women. (more…)
Author Interviews, HIV, NIH, Pediatrics, Vaccine Studies / 15.08.2015

George K Siberry, MD, MPH, Medical Officer Maternal and Pediatric Infectious Disease (MPID) Branch Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, MDMedicalResearch.com Interview with: George K Siberry, MD, MPH, Medical Officer Maternal and Pediatric Infectious Disease (MPID) Branch Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, MD Medical Research: What is the background for this study? Dr. Siberry:  Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger. Medical Research:  What are the main findings? Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control.  When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection.  For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment. (more…)
Author Interviews, Dermatology / 15.08.2015

Susana C. M. Fernandes, PhD Researcher (Individual Marie Curie Fellowship - IEF) and Professor Vincent Bulone Division of Glycoscience, School of Biotechnology Royal Institute of Technology (KTH), Stockholm, Sweden and ARC Centre of Excellence in Plant Cell Walls, School of Agriculture, Food and Wine, University of Adelaide, Waite campus, Urrbrae, South Australia Australia MedicalResearch: What is the background for this study? What are the main findings? Response: We have exploited unique properties of natural compounds to develop novel materials that are capable of absorbing both UV-A and UV-B radiations. The active UV-absorbing molecules are known as mycosporines and mycosporines like-amino acids and they occur in different organisms such as algae, photosynthetic bacteria (cyanobacteria) and some fish species that thrive in, e.g., the tropical waters of the Great Barrier Reef. These compounds were combined with a carbohydrate polymer found in the shells of crustaceans, the exoskeleton of insects and the cell walls of fungi. Chitosan provided a matrix on which mycosporines were attached using a simple chemical method already used for other purposes in, e.g., the pharmaceutical industry. Chitosan can typically be extracted from food waste such as the shells of shrimps. The immobilization of mycosporines on chitosan allowed the development of unique materials that have many potential applications relevant to a wide range of sectors, including cosmetics, sunscreen creams, wound dressings, plasticizers in paints and varnishes, coatings of outdoor furniture and other materials such as fabrics for shades, textiles, car dashboards, etc. In addition to being highly efficient for protection against UV-A and UV-B, the materials were shown to be photostable, thermoresistant and biocompatible. Compared to existing sunblock formulations, the materials have no detrimental effects on health and the environment. They are also fully recyclable. (more…)
Author Interviews, Lung Cancer, Outcomes & Safety, Surgical Research, University of Michigan / 15.08.2015

Tyler Grenda, MD House Officer VI Section of General Surgery Department of Surgery University of Michigan MedicalResearch.com Interview with: Tyler Grenda, MD House Officer VI Section of General Surgery Department of Surgery University of Michigan   Medical Research: What is the background for this study? What are the main findings? Dr. Grenda: The main purpose for this study was to better understand the factors underlying differences in mortality rates for hospitals performing lung cancer resection.  The methodology we used included only the highest and lowest mortality hospitals (Commission on Cancer accredited cancer programs) so the sampling frame was specific. There are wide variations in mortality rates across hospitals performing lung cancer resection (overall unadjusted mortality rates were 10.8% vs. 1.6%, respectively. (more…)
Author Interviews, Diabetes, Diabetes Care, Lifestyle & Health / 14.08.2015

Dr. Kaberi Dasgupta MD, MSc, FRCPC Associate Professor, Department of Medicine Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism Royal Victoria Hospital Quebec, Canada MedicalResearch.com Interview with: Dr. Kaberi Dasgupta MD, MSc, FRCPC Associate Professor, Department of Medicine Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism Royal Victoria Hospital Quebec, Canada   Medical Research: What is the background for this study? What are the main findings? Dr. Dasgupta: We know that health behaviours can contribute to developing gestational diabetes and type 2 diabetes (e.g., eating out frequently, lack of fruits and vegetables, not walking enough, spending most of the day sitting). We also know that genetic factors are important. Sometimes we focus more on the genetic factors than on health behaviours. By showing that spouses share diabetes risk, we highlight the importance that behaviour and environment play as spouses are not generally related biologically. In a previous meta-analysis, we showed that spouses were concordant for diabetes (if one had it, there was a 24% relative risk increase that the other did too.) In the study Gestational Diabetes Mellitus in Mothers as a Diabetes Predictor in Fathers: A Retrospective Cohort Analysis, we took it further and compared men whose partners had gestational diabetes and men whose partners did not. Over a 13 year period of follow-up, the men whose partners had gestational diabetes were 33% more likely to develop diabetes.  (more…)
Accidents & Violence, Author Interviews / 14.08.2015

April M. Zeoli, PhD, MPH Associate Professor School of Criminal Justice Michigan State UniversityMedicalResearch.com Interview with: April M. Zeoli, PhD, MPH Associate Professor School of Criminal Justice Michigan State University Lansing, MI 48824 Medical Research: What is the background for this study? What are the main findings? Dr. Zeoli: My team and I are interested in whether an infectious disease model can be applied to homicide. In other words, can homicide be described as being “contagious” and does it spread through a city in a systematic pattern? In our previous research, we showed that homicide did spread through Newark, New Jersey, in a manner similar to an infectious disease (http://msutoday.msu.edu/news/2012/homicide-spreads-like-infectious-disease/). However, not all types of homicide may be “contagious.” In this research, we looked at seven motive types of homicide to determine which, if any, of them clustered and spread from one place to another over time. Of the seven types of homicide we examined, only gang-motivated homicides displayed a pattern of clustering and spreading through Newark, NJ. However, while drug-motivated and revenge homicides did not spread, they did cluster in the same general geographic areas during much of the same time that gang-motivated homicides clustered together. (more…)
Author Interviews, Lancet, Pain Research, Surgical Research / 14.08.2015

Dr Martin Hirsch Clinical Research Fellow Women’s Health Research Unit Queen Mary University of LondoMedicalResearch.com Interview with: Dr Martin Hirsch Clinical Research Fellow Women’s Health Research Unit Queen Mary University of London and Dr Jenny Hole Foundation Year 1 Doctor Kettering University Hospital Dr Jenny Hole Foundation Year 1 Doctor Kettering University Hospital   MedicalResearch: What is the background for this study? What are the main findings? Response: As doctors we see medicines being prescribed on a daily basis and the benefit but also harm that they can cause. We wanted to assess the role of non pharmaceutical interventions which can benefit patients with a low or minimal potential for harm. We all have an interest in music of different genres and we agreed that we didn’t know anybody who did not like music of one sort or another. On the basis that we all have gained pleasure from music, we wanted to see if this pleasurable experience at the time of a difficult and painful stimulus could reduce the problems encountered as people recover from surgery. We searched all published medical literature and found 73 of the highest quality studies (randomised controlled trials) to compare and combine their findings in a meta-analysis. This technique aims to strengthen the validity by producing a combined result. We found that using music before during or after surgery reduced pain, reduced the requirement for pain killers, reduced anxiety, and improved satisfaction. (more…)
Author Interviews, Baylor College of Medicine Houston, Heart Disease / 14.08.2015

Dr. Kristin Kostick PhD on behalf of the authors Research Associate - Decision Making and Ethics Research Program Center for Medical Ethics and Health Policy Baylor College of Medicine Houston, TXMedicalResearch.com Interview with: Dr. Kristin Kostick PhD on behalf of the authors Research Associate - Decision Making and Ethics Research Program Center for Medical Ethics and Health Policy Baylor College of Medicine Houston, TX Medical Research: What is the background for this study? What are the main findings? Response: The idea of this study came from a larger research study we’re doing to develop and test a decision aid for patients and caregivers considering LVAD treatment. As part of that study, we interviewed LVAD patients, candidates, caregivers and decliners of LVAD treatment to explore their decisional needs. One of the things that kept coming up in these interviews was the need for “support,” which everyone, including clinicians, identified as a crucial aspect of post-implant recovery. There is an excellent clinical support team at our partnering hospital in Houston, as well as a community of LVAD recipients and caregivers where people can get together to share their stories and resources face-to-face. But for other people who find it difficult to get to the hospital, either because they have transportation barriers or they simply live too far away, we began to wonder whether support services might be available to them in virtual settings. So we decided to do this analysis to see what social media sites exist for the LVAD community. What is the content of these sites? Are there different kinds for different support needs? What are patients getting from them? How might they be used in the future for improving patient care and support? (more…)
Author Interviews, Breast Cancer, NEJM, Radiation Therapy / 14.08.2015

MedicalResearch.com Interview with: Philip M.P. Poortmans PhD MD Head of Department, Radiation Oncology ESTRO President Radboud university medical center The Netherlands Medical Research: What is the background for this study? Dr. Poortmans: Based on the former hypothesis that breast cancer sequentially spreads from breast to lymph nodes and from there to distant organs, up to the eighties it was very custom to perform extended radical surgery and to irradiate extensively locoregional for most patients. With the growing interest in systemic treatments to prevent development (= from already present undetectable cancer cells to really visible and threatening metastases) of distant metastases, new information about possible late side effects and our increasing knowledge about the biological behaviour of breast cancer in the eighties and the nineties, the extend of especially locoregional treatment was gradually reduced. For radiation therapy, often the irradiation of the internal mammary lymph nodes was left aside, as this was linked to the delivery of radiation dose to the heart, possibly or probably leading to late side effects. At the start of the study, about half of the radiation oncology departments did include irradiation of the internal mammary lymph nodes in patients with risk factors, while the other half did not. Hereby we had an ideal base for the investigation of the value of treating the non-operated part of the regional lymph nodes. Medical Research: What are the main findings? Dr. Poortmans: We found a decreased risk for development of distant metastases of 3% at 10 years, translated in a 3% overall improved overall disease free survival. Up to now, It leads to an improvement of 1.6% in overall survival at 10 years, which is, in contrast to the earlier 2 findings, just not statistically significant (borderline at p = 0.06). On the other hand, breast cancer related mortality is significantly improved and we did not see an increase in non breast cancer related causes of death. Overall toxicity was limited with only a significant increase in pulmonary toxicity, however to a low grade in the big majority of those patients. The benefit in overall survival is in a similar order of magnitude than adding for example taxanes to anthracycline-based adjuvant chemotherapy for a similar patient population as ours. Medical Research: What should clinicians and patients take away from your report? Dr. Poortmans:  First, we should appreciated that the regional (lymph node) recurrence rate is a poor endpoint for evaluation of also locoregional treatment. This can be explained by the fact that once distant metastases are found, no further search for local (breast) or regional (lymph nodes) recurrences is performed any more, as this is not relevant anymore for treatment or prognosis. However, the spread of distant metastases might occur from cancer involvement of the lymph nodes, explaining why we saw the effect of the lymph node irradiation basically only on the rate of development of distant metastases.  As a second message, we can appreciate that the 3% decreased distant metastases rate did not yet fully translate into a survival benefit, which can be explained by the need for even longer follow-up than 10 years. The explanation lies simply in the fact that even after development of distant metastases, patients can live for quite some more years with, however, only very little chance for definitive cure.  Thirdly, we demonstrated with the quality assurance programme linked to this trial that radiation treatment as used those days (the accrual phase was from 1996 until January 2004) radiation therapy techniques should be nowadays considered as suboptimal with a lack of full coverage of the target volumes and delivery of a too high dose to the organs at risk. With modern techniques, we expect that the results will even be quite better.  And finally, that the overall outcome of breast cancer improved a lot: at the start of the trial, we estimated overall survival at 10 years being 50%, which we revised in 2000 to 75% and we ended up with more than 80%. Thereby, it becomes more of a challenge to demonstrate benefits of further improving treatment as the same relative improvement will be translated into a lower absolute improvement. Nevertheless, by more effectively preventing the development of distant metastases by improved systemic therapy (or even better by earlier detection with a lower basal rate of distant metastases) the importance of optimizing locoregional control becomes even higher. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Poortmans: o First of all we have to improve our ability to define which patients will gain most from this treatment. o Secondly, we have to further investigate how to optimize the technical aspects of this loco regional treatment and … o Thirdly how to optimally integrate all treatment aspects including locoregional ones and systemic ones. o Based on all this, we can develop and then provide the patients with shared decision making tools. Citation: Internal Mammary and Medial Supraclavicular Irradiation in Breast Cancer Philip M. Poortmans, Ph.D., Sandra Collette, M.Sc., Carine Kirkove, Ph.D., Erik Van Limbergen, Ph.D., Volker Budach, Ph.D., Henk Struikmans, Ph.D., Laurence Collette, Ph.D., Alain Fourquet, Ph.D., Philippe Maingon, M.D., Mariacarla Valli, M.D., Karin De Winter, M.D., Simone Marnitz, M.D., Isabelle Barillot, Ph.D., Luciano Scandolaro, M.D., Ernest Vonk, M.D., Carla Rodenhuis, Ph.D., Hugo Marsiglia, Ph.D., Nicola Weidner, Ph.D., Geertjan van Tienhoven, Ph.D., Christoph Glanzmann, Ph.D., Abraham Kuten, M.D., Rodrigo Arriagada, M.D., Harry Bartelink, Ph.D., and Walter Van den Bogaert, Ph.D. for the EORTC Radiation Oncology and Breast Cancer Groups N Engl J Med 2015; 373:317-327 July 23, 2015 DOI: 10.1056/NEJMoa1415369 MedicalResearch.com is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional. The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Philip.Poortmans@radboudumc.nl MedicalResearch.com Interview with: Philip M.P. Poortmans PhD MD Head of Department, Radiation Oncology ESTRO President Radboud university medical center The Netherlands   Medical Research: What is the background for this study? Dr. Poortmans: Based on the former hypothesis that breast cancer sequentially spreads from breast to lymph nodes and from there to distant organs, up to the eighties it was very custom to perform extended radical surgery and to irradiate extensively locoregional for most patients. With the growing interest in systemic treatments to prevent development (= from already present undetectable cancer cells to really visible and threatening metastases) of distant metastases, new information about possible late side effects and our increasing knowledge about the biological behaviour of breast cancer in the eighties and the nineties, the extend of especially locoregional treatment was gradually reduced. For radiation therapy, often the irradiation of the internal mammary lymph nodes was left aside, as this was linked to the delivery of radiation dose to the heart, possibly or probably leading to late side effects. At the start of the study, about half of the radiation oncology departments did include irradiation of the internal mammary lymph nodes in patients with risk factors, while the other half did not. Hereby we had an ideal base for the investigation of the value of treating the non-operated part of the regional lymph nodes. (more…)
Author Interviews, NIH, Pain Research / 14.08.2015

Richard L. Nahin, Ph.D., M.P.H National Center for Complementary and Integrative Health National Institutes of Health, Bethesda, MarylandMedicalResearch.com Interview with: Richard L. Nahin, Ph.D., M.P.H National Center for Complementary and Integrative Health National Institutes of Health, Bethesda, Maryland Medical Research: What is the background for this study? Dr. Nahin: In 2011 the Institute of Medicine published a blueprint for transforming pain care in the United States.  In this report the IOM noted the lack of a comprehensive picture of pain’s prevalence and severity in the U.S., and especially noted that lack of data examining racial and ethnic groups. The current analysis of data from the 2012 National Health Interview survey is a step toward addressing these deficiencies.  Medical Research: What are the main findings? Dr. Nahin: The analyses found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain.  Those with severe pain are also likely to have worse health status.  There were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, while Asians were less likely.  Minorities who did not choose to be interviewed in English are markedly less likely to report pain. (more…)
Author Interviews, Case Western, Diabetes, Infections, PLoS / 14.08.2015

Wesley M. Williams, PhD Cell molecular biologist Department of Biological Sciences Case Western Reserve University School of Dental MedicineMedicalResearch.com Interview with: Wesley M. Williams, PhD Cell molecular biologist Department of Biological Sciences Case Western Reserve University School of Dental Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Williams: Individuals with uncontrolled blood sugar levels frequently present with higher than normal rates of infection and protracted wound healing. The beta-defensin family of antimicrobial peptides responds to bacterial, fungal and viral invasion. As part of the innate immune system, these cationic peptides normally expressed by epithelial cells are important early responders that, together with other components of the innate immune response, act to inhibit microbial infection. Our initial observations led us to question whether glucose or a metabolite of glucose could contribute to antimicrobial peptide dysfunction, and thus compromise control of infection. Elevated levels of glucose result in increased production of dicarbonyls, a class of molecule that can selectively react with proteins having an unusually high content of cationic amino acids, such as arginine and lysine. We first investigated the effects of two well-characterized dicarbonyls, methylglyoxal (MGO) and glyoxal (GO) on recombinant beta-defensin 2 (rHBD-2) structure using MALDI TOF and LC/MS/MS mass spectral analysis of the recombinant peptide. We found MGO to be particularly reactive with the rHBD-2 peptide as it readily and irreversibly adducted to two arginine residues and the N-terminal glycine. Next we tested in vitro for the effects of adducted rHBD-2 on antimicrobial and chemotactic functions, both essential to an effective innate and adaptive immune response in vivo. Through radial diffusion testing on gram-negative E. coli and P. aeruginosa, and gram-positive S. aureus, and a chemotaxis assay for CEM-SS cells, we found that both antimicrobial and chemotactic functions of rHBD-2 were significantly compromised by MGO. (more…)
Allergies, Asthma, Author Interviews, Microbiome / 14.08.2015

Yvonne J. Huang, MD Assistant Professor, Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI 48109-5642 MedicalResearch.com Interview with: Yvonne J. Huang, MD Assistant Professor, Division of Pulmonary & Critical Care Medicine University of Michigan Health System Ann Arbor, MI  48109-5642   Medical Research: What is the background for this study? Dr. Huang: Asthma is a disease with many different clinical manifestations, and it is likely that multiple mechanisms play a role in asthma. Understanding the biological processes that contribute to this heterogeneity is an important goal of current translational research in asthma. One hypothesis that dates back several decades is whether asthma, at least in some forms, is linked to chronic airway infection or colonization by particular species of bacteria.  Results of early investigations in this regard were mixed, in part due to reliance on less sensitive methods to detect bacterial infection, but a new spin on this hypothesis has emerged in recent years.   This stems from the technological advances that now enable one to molecularly profile all bacteria present in a sample, such as via sequence analysis of conserved bacterial genes (such as that for 16S ribosomal RNA). 16S rRNA-based methods are now commonly used to profile bacterial microbiota in a variety of human niches, including in studies of respiratory disease. Prior to our current study, a few investigations had shown that the lower respiratory microbiome in adult asthmatics differs in bacterial composition (i.e. the types and relative abundance of bacteria present), compared to healthy controls.   In a previous study of patients with mild-moderate asthma, we also had found that clinical features of asthma, such as bronchial hyper-responsiveness, were associated with increased abundance of specific bacterial groups.  However, whether similar relationships between clinical features and the  microbiome exist in severe asthma was unknown, which we addressed in the current study. (more…)
Alzheimer's - Dementia, Author Interviews, Diabetes, Diabetologia / 14.08.2015

Laura Ekblad, MD, researcher Turku PET CentreMedicalResearch.com Interview with: Laura Ekblad, MD, researcher Turku PET Centre Medical Research: What is the background for this study? What are the main findings? Dr. Ekblad: The background for our study is that the metabolic syndrome and diabetes have been shown to increase the risk for cognitive decline and dementia. Also, insulin resistance is thought to play a pivotal role in the pathophysiology of Alzheimer´s disease. In addition, intranasal insulin administration is being studied as a promising treatment for Alzheimer´s disease. Previous studies indicate that both gender and APOE epsilon 4 genotype modulate the effects of insulin on cognition. Our main findings are that insulin resistance is associated with poorer verbal fluency, but only in women. Our population-based study consisted of adults from 30-97 years of age and we had nearly 6000 participants. Age did not modulate the association of insulin resistance and cognition, which means that our results apply even to young adults. We also found that insulin resistance associated with poorer verbal fluency only in non-carriers of the APOE epsilon 4 genotype. (more…)
Author Interviews, Columbia, Emergency Care, Race/Ethnic Diversity, Stroke / 14.08.2015

Heidi Mochari-Greenberger Ph.D., M.P.H Associate research scientist Columbia University Medical Center New York, N.YMedicalResearch.com Interview with: Heidi Mochari-Greenberger Ph.D., M.P.H Associate research scientist Columbia University Medical Center New York, N.Y MedicalResearch: What is the background for this study? Dr. Mochari-Greenberger: Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity or sex among a contemporary, diverse national sample of hospitalized acute stroke patients. MedicalResearch: What are the main findings? Dr. Mochari-Greenberger: Use of EMS transport among hospitalized stroke patients was less than 60% and varied by race/ethnicity and sex; EMS use was highest among white females and lowest among Hispanic males. Our analyses showed that Hispanic and Asian men and women were significantly less likely than their white counterparts to use EMS; black females were less likely than white females to use EMS, but black men had a similar rate to white men. These observed associations between race/ethnicity and sex with EMS use persisted after adjustment for stroke symptoms and other factors known to be associated with EMS use, indicating they were not driven solely by stroke symptom differences. (more…)
Annals Internal Medicine, Author Interviews, Cancer Research / 14.08.2015

Thomas F. Imperiale, MD Indiana University Medical Center Regenstrief Institute Indianapolis, IN 46202 MedicalResearch.com Interview with: Thomas F. Imperiale, MD Indiana University Medical Center Regenstrief Institute Indianapolis, IN 46202   Medical Research: What is the background for this study? Dr. Imperiale: The background is that colorectal cancer (CRC) screening is effective and cost-effective, but it is underutilized (35% of eligible persons in the U.S. are not current with screening; 28% have never been screened) and inefficient (persons at low risk have colonoscopy; persons at high risk have stool blood testing or nothing). We know about several risk factors for colorectal cancer and advanced, precancerous polyps. We wanted to see how those factors perform together in stratifying (or separating) risk among the 85% of the U.S. population that is considered to be “average-risk”. Medical Research: What are the main findings? Dr. Imperiale: We found that age, sex, whether a first-degree relative has or had colorectal cancer, cigarette smoking, and waist circumference do a good job in separating risk into the 4 categories described in the paper.  When tested in the validation subgroup, the risk estimates reproduced themselves fairly well.  (more…)
Cost of Health Care / 13.08.2015

Noam Y. Kirson, Ph.D. Vice President Analysis Group, Inc. Economic, Financial, and Strategy Consulting Boston, MA 02199MedicalResearch.com Interview with: Noam Y. Kirson, Ph.D.  Vice President Analysis Group, Inc. Economic, Financial, and Strategy Consulting Boston, MA 02199 Medical Research: What is the background for this study? What are the main findings? Dr. Kirson: Developments in diagnostic technology now support ruling out Alzheimer’s disease (AD) among patients presenting with symptoms of cognitive decline, possibly facilitating earlier and more accurate diagnosis of non-Alzheimer’s dementias. Our study assessed potential economic benefits of timely rule out of Alzheimer’s disease among U.S. Medicare beneficiaries eventually diagnosed with vascular dementia (VD) or Parkinson’s disease (PD) by estimating excess medical costs among those previously misdiagnosed withAlzheimer’s. We found that approximately one in six beneficiaries with VD and one in twelve beneficiaries with PD had a prior Alzheimer’s disease diagnosis. Further, we found that VD and PD patients previously diagnosed with Alzheimer’s disease incurred substantially higher medical costs in periods leading up to and including their VD/PD diagnoses, compared with matched counterparts with no prior AD diagnosis during the same timeframe. Perhaps most interestingly, excess costs declined – and eventually dissipated – following the confirmed VD/PD diagnoses. (more…)