AHA Journals, Author Interviews, Gender Differences, Heart Disease, Lifestyle & Health, McGill / 18.09.2015

MedicalResearch.com Interview with: Sylvie S.L. Leung Yinko, MSc, RD Division of Clinical Epidemiology Research Institute of McGill University Health Centre (RI MUHC) Montreal (QC) and Louise Pilote, MD, MPH, PhD Professor of Medicine McGill University and Director of the Division of General Internal Medicine McGill University Health Centre Medical Research: What is the background for this study? What are the main findings? Response: Patients with premature acute coronary syndrome (ACS) are a vulnerable population of young or middle-aged adults at risk for future cardiovascular events. However, while health behaviors such as diet, physical activity, smoking, alcohol consumption and recreational drug use are important lifestyle factors that can influence cardiovascular risk, there is limited information about health behaviors in this population group. Additionally, there is indication in the literature regarding sex and age differences in health behaviors, but whether such differences exist in patients with premature acute coronary syndrome remained to be explored. Using data from GENESIS-PRAXY (GENdEr and Sex determInantS of Cardiovascular Disease from bench to beyond in PRemature Acute Coronary Syndrome), a large-scale prospective cohort study across Canada, US and Switzerland, we explored the health behavior profile of patients with premature ACS. As well, we examined whether there is a change in health behaviors 1 year post-ACS and assessed sex differences. Our results showed that the health behavior profile of men and women with premature Acute Coronary Syndrome are worse than that of the general population. We found a high prevalence of poor health behaviors in a young population with only modest changes after Acute Coronary Syndrome. Health behaviors remained suboptimal and worse than the general population, especially with regards to diet, smoking and recreational drug use. Sex differences existed in the prevalence of these behaviors at baseline and 1 year post-ACS but not in the magnitude of change after the ACS event.
Author Interviews, BMJ, Outcomes & Safety / 18.09.2015

MedicalResearch.com Interview with: Dr Daniel Boden Emergency Medicine Consultant Derby Hospitals NHS Foundation Trust Medical Research: What is the background for this study? What are the main findings? Dr. Boden: The overall objective was to evaluate whether there is an association between an intervention to reduce medical bed occupancy and both performance on the 4-hour target and hospital mortality. We undertook a before-and-after study in Derby teaching Hospitals NHS Foundation Trust (a large UK District General Hospital) over a 32 month period. A range of interventions were undertaken to reduce medical bed occupancy within the Trust. Performance on the four-hour target and hospital mortality (HSMR, SHMI and Crude Mortality) were compared before, and after, intervention. Daily data on medical bed occupancy and percentage of patients meeting the four-hour target was collected from hospital records. Segmented regression analysis of interrupted time-series method was used to estimate the changes in levels and trends in average medical bed occupancy, monthly performance on the target and monthly mortality measures (HSMR, SHMI and crude mortality) that followed the intervention. Medical Research: What are the main findings? Dr. Boden:
  • Mean medical bed occupancy decreased significantly from 93.7% to 90.2% (p=0.02).
  • The trend change in 95% target performance, when comparing pre- and post-intervention, revealed a significant improvement (p=0.019). The intervention was associated with a mean reduction in all markers of mortality (range 4.5% - 4.8%). SHMI (p=0.02) and Crude Mortality (p=0.018) showed significant trend changes after intervention.
  • Our conclusion is that lowering medical bed occupancy is associated with reduced patient mortality and improved ability of the acute Trust to achieve the 95% four hour target. Whole system transformation is required to create lower average medical bed occupancy.
Author Interviews, Lifestyle & Health, Sugar / 18.09.2015

Louise Brunkwall Nutritionist, MPH and Phd-student Diabetes and Cardiovascular Disease, Genetic Epidemiology Lund University, Clinical Sciences Malmö, Sweden MedicalResearch.com Interview with: Louise Brunkwall Nutritionist, MPH and Phd-student Diabetes and Cardiovascular Disease, Genetic Epidemiology Lund University, Clinical Sciences Malmö, Sweden  Medical Research: What is the background for this study? What are the main findings? Response: There has been a huge interest for sugar sweetened beverages (SSB) the last years and SSB has been associated with various diseases like type 2 diabetes and obesity, while juice for example which have approximately the same amount of energy have not. We find this very interesting and wanted to know more about who the people were that consumed a lot of these different beverages. We started of by looking at diet and found that the different beverages were associated with different dietary patterns. Sugar sweetened beverages were associated with a more unhealthy diet while juice was associated with a more healthy diet. We see the same for tea which is a beverage previously associated with a lower risk of several diseases, that it is associated with an overall very healthy diet. Therefore we draw the conclusions that beverages are a part of the overall diet which might contribute to the previous findings of associations with different diseases. This also tells us that it is of great importance to know more about the overall diet than just consumption of a single product when investigating beverages-dieases association studies.
AHA Journals, Author Interviews, Blood Clots, Brigham & Women's - Harvard, Medical Imaging / 17.09.2015

Peter Caravan, PhD Co-Director, Institute for Innovation in Imaging (I3) Martinos Center for Biomedical Imaging Massachusetts General Hospital Associate Professor of Radiology Harvard Medical SchoolMedicalResearch.com Interview with: Peter Caravan, PhD Co-Director, Institute for Innovation in Imaging (I3) Martinos Center for Biomedical Imaging Massachusetts General Hospital Associate Professor of Radiology Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Caravan: The motivation for this work was to develop a technique that would allow the detection of thrombus (clot) anywhere in the body after injection of a molecular probe called 64Cu-FBP8.  Current techniques for thrombus detection are limited to specific vascular territories.  In instances where the location of the thrombus is unknown or if there is suspicion of multiple thrombi, then multiple imaging tests must be performed.  We sought to develop a test that could be used to find clots anywhere:  brain, thorax, abdomen, legs and in arteries, veins, or the cardiac chambers.  In addition to whole body thrombus detection, we sought a technique that could address some of the limitations with current thrombus imaging techniques.  For example computed tomography (CT), which is used to detect pulmonary emboli, requires a contrast agent that cannot be used in patients with poor kidney function.  Transesophageal echocardiography used to identify thrombus in the chambers of the heart requires that the patient be sedated. Our approach is to use a small peptide that recognizes the protein fibrin, which is a key component of blood clots.  We tagged the peptide with an isotope of copper, Cu-64, that allows the peptide to be detected by positron emission tomography (PET). 64Cu-FBP8 binds specifically to fibrin but not to other proteins in the blood and this means that the uptake in the clot is high while background signal is very low.  We combined PET imaging which finds the clot with CT imaging or magnetic resonance imaging (MRI).  By overlaying the PET image with the CT or MRI image, we could precisely localize the clot within the We were interested to see if the age of the clot impacted our ability to detect it.  We imaged animals with a total of 42 arterial or venous clots and then the images were analyzed by two reviewers who had no prior knowledge of the location of the clot.  Overall the accuracy was 98% for detection. Another key finding was that the uptake of 64Cu-FBP8 strongly correlated with the amount of fibrin in the clot and that younger, fresher clots had more fibrin than older clots.  This could be very useful in distinguishing newer clots which may be the source of cardiovascular events from older, clots that may pose less risk. We also showed using combined PET-MRI that we could detect multiple blood clots in the animal in a single whole body scan.  The procedure involves a single intravenous administration of 64Cu-FBP8 and clots in the deep veins of the legs or in the carotid arteries were readily detected.
Author Interviews, Cost of Health Care, Primary Care / 17.09.2015

Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT 84108MedicalResearch.com Interview with: Michael K. Magill, MD Professor and Chairman, Family and Preventive Medicine University of Utah School of Medicine Salt Lake City, UT  84108   Medical Research: What is the background for this study? What are the main findings? Dr. Magill: The Patient Centered Medical Home (PCMH) model of primary care is becoming more common. The model focuses on team delivery of care with other medical staff joining the primary care provider/clinician to provide for all patients’ healthcare needs.  However, the cost of sustaining PCMH functions is not well understood. This  study assessed direct personnel cost of delivering PCMH services in 20 diverse primary care practices in Utah and Colorado. The main finding is that PCMH services cost on average around $105,000 per clinician FTE per year, or around $4.00 per member per month for an imputed panel size of 2000 patients per FTE clinician. 
Author Interviews, Hand Washing / 17.09.2015

hand washingMedicalResearch.com Interview with: Min Suk Rhee, Ph.D. Professor Department of Biotechnology Department of Food Bioscience & Technology College of Life Sciences & Biotechnology Korea University Seoul Korea  Medical Research: What is the background for this study? What are the main findings? Dr. Min Suk Rhee: In December 2013, the US FDA (United States Food and Drug Administration) proposed an amendment that manufacturers of antibacterial hand soaps intended for use with water must demonstrate that they are safer and more effective than plain soap. As triclosan is the most common active antiseptic ingredient used in soap and its potential risk remains controversial, we investigated the effectiveness of antibacterial soap containing triclosan 0.3% from in vitro and in vivo experiment. The main finding of this study is that presence of antiseptic ingredients (in this case, triclosan) in soap does not always guarantee higher antimicrobial efficacy during hand washing.
Author Interviews, Biomarkers, Mayo Clinic, Melanoma / 17.09.2015

Dr. Roxana S. Dronca, M.D Assistant Professor of Oncology Assistant Program Director of Hematology-Oncology Fellowship Mayo Clinic College of Medicine Rochester, Minnesota MedicalResearch.com Interview with: Dr. Roxana S. Dronca, M.D Assistant Professor of Oncology Assistant Program Director of Hematology-Oncology Fellowship Mayo Clinic College of Medicine Rochester, Minnesota  Medical Research: What is the background for this study? What are the main findings? Dr. Dronca: We previously showed that Bim (BCL-2-interacting mediator of cell death ) is a downstream signaling molecule of PD-1 pathway reflecting the degree of PD-1 interaction with its ligand PD-L1 (unpublished data). In the current study we found that patients who experienced clinical benefit (CR/PR/SD) after 4 cycles of anti-PD1 therapy had higher frequency of Bim+ PD-1+ T-killer cells in the peripheral blood at baseline compared to patients with radiographic progression, likely reflecting an abundant PD-1 interaction with its tumor-associated ligand PD-L1 (B7-H1). In addition, the frequencies of Bim+ PD-1+ CD8 T cells decreased significantly after the first 3 months of treatment in responders compared to nonresponders, indicating tumor regression and therefore less PD-1 engagement with tumor-associated PD-L1.
Author Interviews, Brigham & Women's - Harvard, Hospital Readmissions, JAMA / 17.09.2015

J. Michael McWilliams MD, PhD Associate Professor andMedicalResearch.com Interview with: J. Michael McWilliams MD, PhD Associate Professor and Dr. Michael Barnett MD Researcher and General Medicine Fellow Dept. of Health Care Policy Harvard Medical School Boston MADr. Michael Barnett MD Researcher and General Medicine Fellow Dept. of Health Care Policy Harvard Medical School Boston MA Medical Research: What is the background for this study? Response: The financial impact of Medicare’s Hospital Readmissions Reduction Program on hospitals is growing.  In this year’s round of penalties, nearly 2,600 hospitals were collectively fined $420 million for excess readmissions. There has been concern that the risk-adjustment methods used by Medicare to calculate a hospital’s expected readmission rate is inadequate, meaning that hospitals disproportionately serving sicker and more disadvantaged patients are being penalized because of the populations they serve rather than their quality of care.  Specifically, Medicare accounts only for some diagnoses, age and sex but no other clinical or social characteristics of patients admitted to the hospital. No study to date has examined the impact adjusting for a comprehensive set of clinical and social factors on differences in readmission rates between hospitals. We did this by using detailed survey data from the Health and Retirement Study linked to information on admissions and readmissions in survey participants’ Medicare claims data.  We then compared differences in readmission rates between patients admitted to hospitals in the highest vs. lowest quintile of publicly reported readmission rates, before vs. after adjusting for a rich set of patient characteristics.  These included self-reported health, functional status, cognition, depressive symptoms, household income and assets, race and ethnicity, educational attainment, and social supports. Medical Research: What are the main findings? Response: Our two most important findings were: 1) Patients admitted to hospitals with higher readmission rates are sicker and more socially disadvantaged in a variety of ways than patients admitted to hospitals with lower readmission rates. 2) After adjusting for all measurable patient factors that are not accounted for in standard Medicare adjustments, the difference in readmission rates between hospitals with high vs. low readmission rates fell by nearly 50%.
Author Interviews, Diabetes, Lancet, Surgical Research / 17.09.2015

Martin Neovius PhD Department of Medicine, SolnaMedicalResearch.com Interview with: Martin Neovius PhD Department of Medicine, Solna Medical Research: What is the background for this study? What are the main findings? Dr. Neovius: Long-term real world data on economic effects of bariatric surgery versus nonsurgical treatment are scarce. We have previously looked at long-term drug costs, inpatient and outpatient care in the overall bariatric surgery population (Neovius, Narbro et al, JAMA 2012). However, overall findings may mask important subgroup variations. Based on data from the Swedish Obese Subjects (SOS) study, we documented large drug cost savings over 15 years after bariatric surgery versus non-surgically treated controls in patients who had diabetes and prediabetes before intervention. No savings were seen in patients who were euglycemic at baseline. In terms of overall healthcare costs, we saw cost-neutrality versus non-surgically treated patients for the diabetes group, while costs were higher for both patients with normal blood glucose and those with prediabetes (due to the initial high cost of surgery and inpatient care). For the subgroup of patients with diabetes, we also found that patients with recent diabetes onset had more favorable economic outcomes than patients with established diabetes. 
Alcohol, Author Interviews, Cancer Research, Heart Disease / 17.09.2015

MedicalResearch.com Interview with: Dr Andrew Smyth PhD Population Health Research Institute, McMaster University and Hamilton Health Sciences Hamilton, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr Smyth: Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms and previous studies were mostly done in high income countries. In this study we explored the associations between alcohol consumption and clinical outcomes in a prospective cohort study of 12 countries from different economic levels. Over an average of four years of follow-up of almost 115,000 participants, we found that although current drinking was associated with a 24% reduction in risk of heart attack, there was no reduction in the risk of death or stroke, and there was a 51% increase in risk of alcohol-related cancers (mouth, oesophagus, stomach, colorectum, liver, breast, ovary and head and neck) and a 29% increase in risk of injury. For a combination of all outcomes, we found no overall benefit from current alcohol use. We also found differences between countries of different income levels: for higher income countries current drinking was associated with a 16% reduction in risk of the combined outcome, but in lower income countries there was a 38% increase in risk.
Author Interviews, Cancer Research, Leukemia, Lymphoma / 17.09.2015

Angelica Loskog, PhD Professor of Immunotherapy (adjunct) Dept of Immunology, Genetics and Pathology Uppsala University Uppsala SwedenMedicalResearch.com Interview with: Angelica Loskog, PhD Professor of Immunotherapy (adjunct) Dept of Immunology, Genetics and Pathology Uppsala University Uppsala Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Loskog: CAR T cells have shown remarkable effect in patients with B cell malignancy in the US using 2nd generation CAR T cells. Acute leukemia (ALL) seems easier to treat than lymphomas and one of the reasons may be difficulties for CAR T cells to penetrate a solid lesion or due to a higher local presence of immunosuppressive cells within a lesion. As one of the first centers outside US we are evaluating 3rd generation CAR T cells in both lymphoma and ALL aiming to compare the responses and investigating biological reasons for the different responses. So far we have treated 11 patients and 6 of them had initial complete responses. Unfortunately, some progressed later.
Author Interviews, Cannabis, Gender Differences, Pediatrics / 16.09.2015

MedicalResearch.com Interview with:Renee M. Johnson, PhD, MPH Assistant Professor Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health Deputy Director, Drug Dependence Epidemiology Training Program (DDET) Baltimore MD Renee M. Johnson, PhD, MPH Assistant Professor Johns Hopkins Bloomberg School of Public Health, Dept. of Mental Health Deputy Director, Drug Dependence Epidemiology Training Program (DDET) Baltimore MD Medical Research: What is the background for this study? What are the main findings? Dr. Johnson: There has been a lot of policy change with regard to marijuana. Several states have enacted laws regarding medical marijuana and decriminalization, and now four states and the District of Columbia have legalized use for adults. Along with these policy changes, there’s been concern that adolescent marijuana use would skyrocket. This prompted me to think about what’s happened over the past 15 years, and so I decided to examine past 15-year trends in adolescent marijuana use among US high school students. Our research team analyzed data from the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance Study, or YRBS. It is a nationally-representative survey of high school students. A lot of the information we have about adolescents’ risk behavior comes from the YRBS. What we found is that marijuana use among US high school students has gone down over the time period. In 1999, 47% of high school students reported lifetime use of marijuana. By 2013, 41% reported lifetime use. Use was lowest in 2009, with 37% of high school students reporting lifetime use. The increase in use from 2009 to 2013 was not statistically significant, so we aren’t sure whether it represents random fluctuation or whether it indicates a reversal in trend. We also found that gender differences have gotten smaller over the time period, reflecting a real change. Boys have historically had higher rates of use, but that’s changing. In 1999, 51% of boys and 43% of girls reported lifetime marijuana use. By 2013, 42% of boys and 39% of girls reported lifetime use.
Author Interviews, Exercise - Fitness, Gender Differences, Pediatrics / 16.09.2015

Yang Bai Graduate research assistant Department of Kinesiology College of Human Science Iowa State University, Ames, IAMedicalResearch.com Interview with: Yang Bai Graduate research assistant Department of Kinesiology College of Human Science Iowa State University, Ames, IA Medical Research: What is the background for this study? What are the main findings? Yang Bai: The last national youth physical fitness survey that covered the full developmental age range was conducted more than 25 years ago. A new study conducted by The Cooper Institute known as the NFL PLAY 60 FITNESSGRAM Partnership Project offers potential to study youth fitness on a national level. The NFL PLAY 60 FITNESSGRAM Partnership Project is a participatory research network that tracks health and fitness data from over 1000 schools across the country. The present study describes the distribution of health-related fitness in 1st-12th grade youth from this large nationwide sample of schools. The main finding included that the fitness levels varied greatly based on gender and age and the percentage of youth had adequate aerobic fitness and healthy BMI were low. For example, there were 62.1％ to 37.6％ (different from grade 4th to 12th) boys meeting the requirements for healthy aerobic capacity, and the range for girls were 50.8％to 26.1％. Aerobic capacity among boys started to decline in the sixth grade, while girls experienced a continual decline with age. There was less variation among boys and girls with a healthy BMI, which ranged 52.7% to 65.0%.
Author Interviews, Infections, PLoS / 16.09.2015

Dr Mark Webber PhD, MSc, BSc Senior Research Fellow School of Immunity and Infection University of Birmingham and the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC)MedicalResearch.com Interview with: Dr Mark Webber PhD, MSc, BSc Senior Research Fellow School of Immunity and Infection University of Birmingham and the National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre (SRMRC) Medical Research: What is the background for this study? What are the main findings? Dr. Webber: Infection is a major problem for patients who suffer burn injuries and these are vary hard to treat with traditional antibiotics which struggle to effectively reach the wound and kill the bugs. One alternative which has been used in the Queen Elizabeth Hospital in Birmingham for some time is the use of acetic acid, basically vinegar. Acetic acid has long been known to be a useful antimicrobial but clinicians in Birmingham have found it to be effective in treating wounds infected, particularly with Pseudomonas. There is though very little science about what concentration of acetic acid would work best and how it kills bugs. We have shown the acetic acid works well against lots of different bugs and at much lower concentrations than are used in practice. Importantly we showed that the acetic acid works well against bugs stuck to a surface - in what's known as a 'Biofilm'. Biofilms are typically highly drug resistant.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Cognitive Issues, Mental Health Research / 16.09.2015

Daniela Carnevale, PhD, Researcher Laboratory of Giuseppe Lembo, MD, PhD Dept. of Molecular Medicine "Sapienza" University of Rome & Dept. of Angiocardioneurology and Translational Medicine IRCCS Neuromed - Technology Park Località CamerelleMedicalResearch.com Interview with: Daniela Carnevale, PhD, Researcher Laboratory of Giuseppe Lembo, MD, PhD Dept. of Molecular Medicine "Sapienza" University of Rome & Dept. of Angiocardioneurology and Translational Medicine IRCCS Neuromed - Technology Park Località Camerelle Medical Research: What is the background for this study? Dr. Carnevale: Nowadays, one of the most demanding challenge in medicine is preserving cognitive functions during aging. It is well known that cardiovascular risk factors have a profound impact on the possibility of developing dementia with aging. However, we have no means to investigate this aspect in patients with cardiovascular diseases. Indeed, although we have clear clinical paradigms to explore target organ damage of vascular diseases like hypertension, we are less prepared to afford the brain damage that may result from chronic vascular diseases and impact on cognitive functions. Thus, we aimed at finding a diagnostic paradigm to assess brain damage that could predict for future development of dementia. Since it is becoming increasingly clear that hypertension may determine cognitive decline, even before manifest neurodegeneration, we elaborated a paradigm of analysis that are essentially focused on brain imaging and cognitive assessment. In particular, we used diffusion tensor imaging (DTI) on magnetic resonance that allows to reconstruct white matter connections that correlate with selective cognitive functions, and specifics tests for the evaluation of subtle alterations of cognitive functions.
Author Interviews, Cancer Research, Case Western, Colon Cancer, Genetic Research / 16.09.2015

Ahmad M. Khalil, PhD Department of Genetics School of Medicine Case Western Reserve University Cleveland, Ohio 44106-4955 MedicalResearch.com Interview with: Ahmad M. Khalil, PhD Department of Genetics School of Medicine Case Western Reserve University Cleveland, Ohio 44106-4955 Medical Research: What is the background for this study? What are the main findings? Dr. Khalil: DNA in human cells is modified chemically by methylation. The process of DNA methylation plays important roles in protecting human DNA and ensures proper gene expression.  In cancer cells, the process of DNA methylation becomes deregulated, however, the mechanisms of how this occurs are not known.  In our study, we have uncovered a novel mechanism on how colon cancer cells change their DNA methylation, and consequently, become more tumorigenic. We specifically identified a long non-coding RNA that interacts with and regulates the enzyme that modifies DNA with methylation - the enzyme is called DNMT1. This lncRNA become suppressed in colon tumors, which we believe is a key step in loss of DNA methylation in colon cancer cells.
Author Interviews, Pediatrics, Weight Research / 16.09.2015

MedicalResearch.com Interview with: Annemarie Schalkwijk, MSc/MD PhD candidate, GP in training Diabetes Research Group EMGO Institute for Health and Care Research VU University Medical Center Amsterdam The Netherlands Medical Research: What is the background for this study? Dr. Schalkwijk: Overweight and obese children are at increased risk of becoming overweight and obese adults and therefore are an important risk factor for developing type 2 diabetes. It is known from the literature that being overweight or obese is associated with environmental, parental and socioeconomic status (SES) characteristics. However, the interdependence of these variables has not been studied before.Therefore, the aim of our study is to assess the influence of the amount of green space, accessibility to a garden and the safety of the surroundings during ages 3-5 on being overweight or obese at age 7. Furthermore, we want to assess if parental choices and SES moderate or mediate this influence. Medical Research: What are the main findings? Dr. Schalkwijk: Statistically significant associations (p≤0.05) were found between low levels green space, not having access to a garden, shabbiness of the neighborhood and childhood obesity (OR (95% CI) respectively: 1,14 (1,02-1,27), 1,35 (1,16-1,58), 1,22 (1,05-1,42)). Parental determinants were related to the environmental determinants and childhood overweight/obese but did not moderate or mediate the association between the latter two. Therefore no parental variables were left in the model. As for SES, the highest level of education in the household did diminish the magnitude of the associations found between the environmental determinants and being overweight/obese. In the final model the remaining significant associations with childhood overweight/obese were no garden access for lower educated households and shabbiness of the neighborhood for higher educated households (OR (95% CI) respectively: 1,38 (1,16-1,58), 1,38 (1,12-1,70). We can conclude from our study, that environmental factors do have an association with children being overweight or obese. However, these associations are complex and might not be as distinct as previously assumed.
Author Interviews, Cleveland Clinic, Cost of Health Care, Heart Disease, JAMA, Radiology / 16.09.2015

Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic Cleveland, OH MedicalResearch.com Interview with: Wael A. Jaber, MD FACC, FAHA Professor of Medicine Cleveland Clinic Lerner College of Medicine Fuad Jubran Endowed Chair in Cardiovascular Medicine Heart and Vascular Institute Cleveland Clinic  Cleveland, OH Medical Research: What is the background for this study? What are the main findings? Prof. Jaber: Risk stratification of patients presenting with atrial fibrillation often includes a non-invasive evaluation for coronary artery disease. However, the yield of such testing in patients without angina or anginal-equivalent symptoms is uncertain. That is, how often do we find silent myocardial ischemia? In our cohort of 1700 consecutive patients with atrial fibrillation, less than 5% had ischemia on nuclear stress testing, even though comorbidities were prevalent. Moreover, in patients with ischemia that had invasive coronary angiography, less than half had obstructive coronary artery disease.
Author Interviews, Cancer Research, Pain Research, Pediatrics / 16.09.2015

Prof. Dr. Holger Lode Clinical Immunology, Pediatrics University of Greifswald, GreifswaldMedicalResearch.com Interview with: Prof. Dr. Holger Lode Clinical Immunology, Pediatrics University of Greifswald, Greifswald Medical Research: What is the background for this study? Response: Neuroblastoma is a cancer in childhood with one of the highest death rates.  Standard treatment is already very intensive. It includes chemotherapy, surgery, radiation, high dose chemotherapy followed by autologous stem cell transplantation. However, the progress made in improving survival rates is still poor. The use of an immune-modulatory treatment with a neuroblastoma specific monoclonal antibody ch14.18 (100 mg/m2 /cycle) in combination with cytokines and 13cis retinoic acid (13 cis RA) has shown benefit for patients with this disease [1].  This antibody targets ganglioside GD2 abundantly expressed on neuroblastoma with limited to no expression on healthy tissue. Low expression of GD2 on pain fibers is associated with an on-target side effect of the treatment, which is the induction of neuropathic pain. Approval of ch14.18 (dinutuximab) for the treatment of children with neuroblastoma has been provided by FDA. In Europe, ch14.18 was not available for a long time. There were several reasons why the antibody in the US could not be given to children in Europe. Therefore a new development of this side of the Atlantic was initiated following the remanufacturing of the antibody in CHO cells [2] (dinutuximab beta) and was made available within clinical trials of the SIOPEN group. The SIOPEN group is a network of leading European pediatric oncology centers to improve outcome for children with neuroblastoma (http://www.siopen.org), similar to the COG (children`s oncology group in the USA; https://www.childrensoncologygroup.org). Following the recloning procedure, ch14.18/CHO was first evaluated for safety in a Phase I study [3], which confirmed the tolerability and showed activity at a dosing regimen of 20 mg/m2 given by 8 hour infusions on 5 consecutive days. Dinutuximab beta is further developed by Apeiron Biologics. The current way to apply 100 mg /m2 / cycle is by 4 short term infusions of 25 mg/m2/day each over 8 hrs on 4 consecutive days. The entire treatment consists of 5 cycles. The drawback is that STI is associated with a high amount of intravenous morphine required to make this treatment tolerable for patients. Also the rate of inflammatory side effects observed is substantial. Clinical observation indicates that if patients treated by STI suffer from pain despite analgesic treatments, a decrease in speed of antibody infusion improves this on target toxicity. Therefore, we hypothesized that significant prolongation of the time of antibody infusion will improve tolerability of that treatment, but at the same time maintains clinical activity and efficacy in high risk neuroblastoma patients.
Author Interviews, BMJ, Nursing / 16.09.2015

Chiara Dall'Ora MSc Nursing and Midwifery Sciences University of SouthamptonMedicalResearch.com Interview with: Chiara Dall'Ora MSc Nursing and Midwifery Sciences University of Southampton  Medical Research: What is the background for this study? What are the main findings? Response: There is a trend for healthcare employers to adopt longer shifts, typically 2 shifts per day each lasting 12 hours. This allows nurses to work fewer shifts each week. Changes are driven by perceived efficiencies for the employer, and anecdotal reports of improved work life balance for employees because they work fewer days per week. However, it is unclear whether these longer shits adversely affect nurses' wellbeing, in terms of burnout, job dissatisfaction, dissatisfaction with work schedule flexibility and intention to leave the job. We found that when nurses work 12 h shifts or longer they are more likely to experience high burnout, dissatisfaction with work schedule flexibility and intention to leave their job, compared to nurses working 8 h or less. All shifts longer than 8 hours are associated with nurses' job dissatisfaction.
Author Interviews, Blood Pressure - Hypertension, Heart Disease, Race/Ethnic Diversity, Women's Heart Health / 16.09.2015

MedicalResearch.com Interview with: Carmen De Miguel, PhD | Postdoctoral Scholar Section of Cardio-Renal Physiology and Medicine Department of Medicine | Division of Nephrology UAB | The University of Alabama at Birmingham Medical Research: What is the background for this study? Dr. De Miguel: It is known that obesity is a major risk for cardiovascular disease and that cardiovascular disease is more prevalent in the African American population. Specifically, female African Americans have an exceptionally high risk of developing cardiovascular disease. Obesity is known to contribute to the development of diabetes, hypertension, heart disease, etc. All these diseases have in common persistent low-grade inflammation, and we also know that signs of inflammation can be observed in patients with cardiovascular disease years before the disease is diagnosed. A better understanding of the differences within ethnicities regarding the development of cardiovascular disease is needed and will lead to the development of better therapies targeted to each population. Based on all of this knowledge, we hypothesized that obesity would lead to different changes in the immune system of male and female, Caucasian and African American teenagers (14-20 year old). Medical Research: What are the main findings? Dr. De Miguel: We found differences in the immune cell profile in white and black teenagers, and within gender in the African American subjects. We believe that monitoring these differences could be used to recognize at an earlier stage those individuals that are at-risk of developing cardiovascular disease in the future, and this could allow for preventive therapies that would reduce such risk. Specifically, we found that obese white teenagers decrease the numbers of T cells (a kind of immune cell) in the circulation (blood) compared to African American teenagers, which indicates that they have less systemic inflammation than the African Americans subjects in response to obesity. Within the African American subjects, we found that obese males had smaller numbers of T cytotoxic cells (CD8+ cells, a specific kind of T cell) and smaller numbers of activated T cytotoxic cells than lean males, what tells us that obese males are trying to decrease their inflammation levels. However, obese African American females do not decrease those levels, so their inflammation remains elevated. We think that the fact that they do not decrease the activation of T cytotoxic cells (CD8+ cells) could be important in explaining the high risk that black females have of developing cardiovascular disease later in life.
AHA Journals, Author Interviews, Gastrointestinal Disease, Heart Disease, Microbiome / 16.09.2015

Jingyuan Fu, Ph.D. Associate professor of genetics University Medical Center Groningen NetherlandsMedicalResearch.com Interview with: Jingyuan Fu, Ph.D. Associate professor of genetics University Medical Center Groningen Netherlands  Medical Research: What is the background for this study? What are the main findings? Dr. Jingyuan Fu: Abnormal blood lipid levels are important risk factors for cardiovascular diseases. Because of that, a common advice is to have a healthy lifestyle or take lipid-lowering drugs like statin to control the blood lipid level. However, the problem is only partially solved. Cardiovascular disease remains the No 1 cause of death globally, representing 31% of all global deaths.  The primary purpose of the study is to look for a new solution in humans’ gut. Over millions of years, microbes and humans have formed a truly symbiotic relationship. Human body contains 10 trillion bacteria, 10x more than human cells. They help digest food and train our immune systems. As less than 30% of bacteria in human gut can be cultured, we know very little how they are and what they do in our gut. With the state-of-art deep sequencing technology, we are now able to see who are there. The research questions would be how much effect these bacteria could affect the blood lipids levels and which bacteria play important role. No such an analysis was done in large-scale human population. Our study was the first to provide solid evidence for the associations between gut bacteria and blood lipids. Although we cannot conclude cause-effect relationship yet, it serves an important step in narrowing possible therapeutic targets.
Author Interviews, CDC, Pediatrics, Weight Research / 15.09.2015

MedicalResearch.com Interview with: Jessica M. Robbins, PhD Adjunct Assistant Professor Public Health Epidemiologist Philadelphia Department of Public Health  Medical Research: What is the background for this study? Response: The rapid increase in child obesity rates across the US in recent decades has affected Philadelphia as it has other cities.  The Philadelphia Department of Public Health has worked with the School District of Philadelphia to analyze data on students' heights and weights to determine trends in obesity since the 2006-2007 school year.  Data we had examined through the 2009-2010 school year indicated that the prevalence of obesity and severe obesity were declining in this population, and notably were declining in African-American and Hispanic students as well.  We updated the analyses with data through the 2012-2013 school year to see if that trend had continued. Medical Research: What are the main findings? Response: Overall, the prevalence of obesity and particularly of severe obesity continued to decline, although more slowly than in the earlier period.  However, there were some disturbing disparities, with improvement largely limited to boys.  Girls in grades kindergarten through 5 and Hispanic girls actually saw increased obesity since 2009-2010.
Author Interviews, CDC, MRSA / 15.09.2015

MedicalResearch.com Interview with: Dr. Lauren Epstein M.D., M.S. Division of Healthcare Quality Promotion Epidemic Intelligence Service Centers for Disease Control and Prevention Atlanta, GA, USA  Medical Research: What is the background for this study? What are the main findings? Dr. Epstein: Nearly 80% of methicillin resistant Staphylococcus aureus (MRSA) infections occurs outside of the hospitals and mostly among individuals with a recent hospitalization.  However, risk factors for MRSA infections among patients recently discharged from an acute care hospital have not been well explored.   The goal of this study was to identify modifiable risk factors associated with MRSA infections among recently discharged patients to target future prevention efforts.  We found that patients with a history of MRSA colonization, chronic wounds, invasive devices at discharge such as central lines and surgical drains, and those discharged from a hospital to a nursing home are at increased risk of invasive MRSA infections within 12 weeks after hospital discharge. Medical Research: What should clinicians and patients take away from your report? Dr. Epstein: MRSA infections are a significant public health concern and patients remain at risk for MRSA infections following acute care hospitalizations, especially in the 3 months following discharge from an acute care facility. Patients with a prior history of MRSA colonization are at increased risk for MRSA infections following an acute care hospitalization.  In addition, patients who have an invasive device (such as a central line or surgical drain) or a chronic wound at the time of discharge from a hospitalization are at increased risk of MRSA infection following discharge.  Finally, patients who are discharged to a long term care facility, regardless of other risk factors, are at increased risk of MRSA infection.
Author Interviews, Menopause, Weight Research / 15.09.2015

Jennifer W. Bea, PhD Assistant Professor, Medicine Assistant Research Scientist, Nutritional Sciences University of Arizona Cancer Center Tucson, AZ 85724-0524MedicalResearch.com Interview with: Jennifer W. Bea, PhD Assistant Professor, Medicine Assistant Research Scientist, Nutritional Sciences University of Arizona Cancer Center Tucson, AZ 85724-0524 Medical Research: What is the background for this study? What are the main findings? Dr. Bea: The analysis was based on a subgroup of the largest study of post-menopausal women in the United States, Women's Health Initiative (WHI), which has been answering important questions about health and wellness among post-menopausal women since the 1990s. In the analysis, body mass index, a proxy for body fat, and actual body composition (i.e. fat and muscle mass) determined by an imaging technique called dual energy X-ray absorptiometry (DXA) were used to predict risk of death. In the younger post-menopausal women,  aged 50–59 years, higher body fat increased risk of death by more than 2 times and the highest muscle mass decreased risk of death by almost 60%. Importantly, the relationships were reversed among the older women, aged 70–79 years (P < 0.05). These results were true in spite of BMIs in these groups spanning nearly the full range of possible BMIs (16.4–69.1kg/m2). These data indicate that BMI does not estimate mortality risk as well as we would hope among post- menopausal women.
Author Interviews, Pediatrics, Sleep Disorders / 15.09.2015

Ana C. Krieger, MD, MPH, FCCP, FAASM Medical Director, Center for Sleep Medicine Associate Clinical Professor Departments of Medicine, Neurology and Genetic Medicine Weill Cornell Medical College - Cornell University Associate Attending NewYork-Presbyterian Hospital Rockefeller University HospitalMedicalResearch.com Interview with: Ana C. Krieger, MD, MPH, FCCP, FAASM Medical Director, Center for Sleep Medicine Associate Clinical Professor Departments of Medicine, Neurology and Genetic Medicine Weill Cornell Medical College - Cornell University Associate Attending NewYork-Presbyterian Hospital Rockefeller University Hospital   Medical Research: What is the background for this study? What are the main findings? Dr. Krieger: For many years, sleep researchers have been concerned about sleep deprivation in adolescents. Our study shows that high school students have shorter sleep duration on the nights following the spring Daylight Saving Time adjustment. This sleep loss was associated with a decline in daytime vigilance and cognitive performance on the week following DST.
Author Interviews, Chocolate, Heart Disease / 15.09.2015

PD Dr. med. Christian Heiß Sektion Angiologie Oberarzt, Facharzt für Innere Medizin und Angiologie Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf MedicalResearch.com Interview with: PD Dr. med. Christian Heiß Sektion Angiologie Oberarzt, Facharzt für Innere Medizin und Angiologie Klinik für Kardiologie, Pneumologie und Angiologie Universitätsklinikum Düsseldorf Medical Research: What is the background for this study? What are the main findings? Response:  There is an extensive body of research which has shown that cocoa flavanols can improve healthy blood vessel function. However, for the most part, these investigations have focused on high-risk individuals like smokers and people that have already been diagnosed with conditions like hypertension and coronary heart disease. The purpose of the FLAVIOLA HEALTH study, published in BJN, was to find out whether the beneficial cardiovascular effects of cocoa flavanols would hold true for the general population. The studies demonstrated that consumption of cocoa flavanols significantly improves several of the hallmarks of cardiovascular health, including increased flow-mediated vasodilation. Flow-mediated vasodilation is a sign of improved endothelial function and has been shown by some studies to be associated with decreased risk of developing cardiovascular disease. In addition, consuming flavanols decreased both systolic and diastolic blood pressure, and improved the blood cholesterol profile by decreasing total cholesterol, decreasing and increasing HDL cholesterol. The results demonstrate that flavanols are effective at mitigating age-related changes in blood vessels, and could thereby reduce the risk of cardiovascular disease in healthy individuals.
Aging, Author Interviews, Mental Health Research, Neurology / 15.09.2015

R. Scott Turner, MD, PhD Director of the Memory Disorders Program Georgetown University Medical CenterMedicalResearch.com Interview with: R. Scott Turner, MD, PhD Director of the Memory Disorders Program Georgetown University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Turner: The resveratrol trial originated from the extensive scientific literature demonstrating that caloric restriction (consuming only 2/3 usual calories) prevents or delays diseases of aging - including Alzheimer's disease (AD) in laboratory animals. The molecular mechanism is thought to involve sirtuins - a group of genes/proteins that sense energy balance to regulate gene expression. Sirtuins are activated by caloric restriction (a mild stressor) to express genes that promote resilience of the organism. Resveratrol is a potent activator of sirtuins - thus bypassing the requirement for caloric restriction. On the opposite side of the coin - caloric excess, midlife obesity, and diabetes are strong risk factors for Alzheimer's disease. And we have long-known that resveratrol is found in red grapes, red wine, and other foods that promote general health.
Author Interviews, Cognitive Issues, JAMA, Vitamin D / 15.09.2015

Joshua W. Miller, PhD Professor and Chair Dept. of Nutritional Sciences Rutgers The State University of New Jersey New Brunswick, NJ 08901 MedicalResearch.com Interview with: Joshua W. Miller, PhD Professor and Chair Dept. of Nutritional Sciences Rutgers The State University of New Jersey New Brunswick, NJ 08901  Medical Research: What is the background for this study? What are the main findings? Response: In recent years, there has been a growing scientific literature on the associations between low vitamin D status in older adults and risk of Alzheimer's disease/dementia, cognitive impairment and decline, and brain atrophy.  The vast majority of these studies have been conducted in predominantly white populations.  The relatively unique aspect of our study was that over half of the cohort consisted of African Americans and Hispanics.  What we found in our cohort (mean age ~75y, n=382 at baseline) was that participants with vitamin D deficiency (serum 25-hydroxyvitamin D <12 ng/ml) or vitamin D insufficiency (serum 25-hydroxyvitamin D between 12 ng/ml and <20 ng/ml) on average experienced faster rates of cognitive decline in episodic memory and executive function than participants with adequate vitamin D status.  Importantly, the association between vitamin D status and the rate of decline in cognitive function was independent of race/ethnicity.  However, the prevalence of low vitamin D status in the study participants was significantly higher in the African American and Hispanic participants compared with the White participants.  This is most likely due to the fact that darker skin pigmentation reduces the ability of sunlight to induce vitamin D synthesis in the skin.  It may also reflect differences in dietary intake of vitamin D and supplement use between the different race/ethnicity groups, though we did not assess this in our study.  Thus, though the rate of cognitive decline in African Americans and Hispanics does not seem to be more or less affected by low vitamin D status than in Whites, because African Americans and Hispanics have a higher prevalence of low vitamin D status, as subpopulations they may be more prone to rapid cognitive decline in old age.  Further studies addressing this possibility are needed.
Author Interviews, JAMA, Pain Research, Pediatrics, Race/Ethnic Diversity, Surgical Research / 14.09.2015

Monika Goyal, MD Pediatric emergency medicine Children’s National Hospital Washington, DC MedicalResearch.com Interview with: Monika Goyal, MD Pediatric emergency medicine Children’s National Hospital Washington, DC Medical Research: What is the background for this study? What are the main findings? Dr. Goyal: Appendicitis is a painful surgical condition and adequate analgesia, particularly with opioids, are considered one of the mainstays of management. We found that almost half of all children diagnosed with appendicitis did not receive any analgesia. Furthermore, among the patients that did receive analgesia, there were marked racial differences with black children having lower rates of opioid medication receipt than white children, even after we took pain scores or acuity level into account.