Author Interviews, Duke, Education, Heart Disease, JAMA / 22.07.2015

Carolina Malta Hansen, M.D Duke Clinical Research InstituteMedicalResearch.com Interview with: Carolina Malta Hansen, M.D Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Hansen: Approximately 300,000 persons in the United States suffer an out-of-hospital cardiac arrest every year and under 10% survive. Cardiopulmonary resuscitation (CPR) and defibrillation within the first few minutes of cardiac arrest can increase the chance of survival from under 10% to over 50%. In 2010, the HeartRescue program in North Carolina initiated statewide multifaceted interventions to improve care and outcomes for cardiac arrest patients in North Carolina. The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest. We found that following these four years of initiatives to improve care and outcomes for cardiac arrest patients, the proportion of patients who received bystander CPR and first responder defibrillation increased by more than 25% to approximately 50%, the combination of bystander CPR and first responder defibrillation increased from 14% to 23%. Survival with favorable neurologic outcome increased from 7% to 10% and this increase was only observed among patients who received bystander CPR. Finally, we found that compared to patients who received CPR and defibrillation by emergency medical services (EMS), patients who received bystander and/or first responder CPR, defibrillation, or both, were more likely to survive. The combination of bystander CPR and bystander defibrillation was associated with the best survival rates but remained low during the study period with no increase over time. (more…)
Author Interviews, Heart Disease, JACC, Outcomes & Safety, Surgical Research / 22.07.2015

Dr Scot Garg FRCP PhD (Hons) FESC Cardiology Department, Royal Blackburn Hospital United KingdomMedicalResearch.com Interview with: Dr Scot Garg FRCP PhD (Hons) FESC Cardiology Department, Royal Blackburn Hospital United Kingdom Medical Research: What is the background for this study? Dr. Garg: In contrast to other countries, in particular the United States, the UK has seen a vast expansion in the number of PCI centres operating without on-site surgical support. Part of the reason for this is that outcome data from these centres are from modest populations at short-term follow-up; consequently the ACC/AHA have failed to give delivery of PCI in centres without surgical back-up a strong endorsement. The study was ultimately driven therefore to show whether any differences existed in mortality between patients having PCI in centres with- and without surgical support at long-term follow-up in large unselected population cohort. Medical Research: What are the main findings? Dr. Garg: The study included the largest population of patients treated in centres without off-site surgical support (n=119,036) and main findings were that following multi-variate adjustment there were no differences in mortality for patients treated at centres with- or without surgical support at 30-days, 1-year or 5-year follow-up irrespective of whether patients were treated for stable angina, NSTEMI or STEMI. Furthermore, similar results were seen in a sensitivity analysis of a propensity matched cohort of 74,001 patients. (more…)
Author Interviews, Breast Cancer, Journal Clinical Oncology, Race/Ethnic Diversity / 21.07.2015

Helmneh Sineshaw, MD, MPH Senior Epidemiologist, Health Services Researcher American Cancer Society, Inc Atlanta, GA 30303MedicalResearch.com Interview with: Helmneh Sineshaw, MD, MPH Senior Epidemiologist, Health Services Researcher American Cancer Society, Inc Atlanta, GA 30303 MedicalResearch: What is the background for this study? Dr. Sineshaw: Male breast cancer is a rare disease, and its incidence rate is increasing. Younger black men have a higher breast cancer incidence than their white counterparts. Although black/white disparities in treatment receipt and survival among women with breast cancer have been widely documented in the literature, there have been few similar studies in men with breast cancer. Previous studies were based on smaller sample size, older databases, or using data from elderly patients. (more…)
Alzheimer's - Dementia, Author Interviews, NYU / 21.07.2015

Fernando Goni, PhD MS Adjunct associate professor Department of Neurology, Center for Cognitive Neurology NYU School of Medicine NYU Langone Medical CenterMedicalResearch.com Interview with: Fernando Goni, PhD MS Adjunct associate professor Department of Neurology, Center for Cognitive Neurology NYU School of Medicine NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Goni: It has been established that most neurodegenerative diseases including Alzheimer's, Lewy Body and other dementias, Parkinson's and prion diseases develop and progress along similar paths. In each disease, a particular protein undergoes a change in its shape from a soluble, physiologically functional protein to a protein that has lost the ability to perform its required tasks in the brain, starting off a chain reaction of binding to each other with little control. These aggregates become toxic to brain cells. We raised antibodies in mice against the common beta-sheet structures present in toxic oligomers of many neurodegenerative diseases including amyloid and tau in Alzheimer's; oligomeric forms of prions and oligomerized alpha-synuclein in Parkinson's. From that response, we produced monoclonal antibodies of the same characteristics. At least three of the monoclonals recognize pathological structures in histological samples of human brains from Alzheimer's disease, Parkinson's disease and GSS (human prionosis). They also recognized in vitro the oligomeric forms particular for each disease. In old animals of a mouse model of Alzheimer's, that already had pathology, the monoclonal antibodies could rescue behavior and reduced significantly the oligomers of Tau and Abeta. (more…)
Author Interviews, Breast Cancer, Radiology / 21.07.2015

Alison L. Chetlen, D.O. Associate Professor, Department of Radiology Penn State Milton S. Hershey Medical Center Hershey, PA 17033MedicalResearch.com Interview with: Alison L. Chetlen, D.O. Associate Professor, Department of Radiology Penn State Milton S. Hershey Medical Center Hershey, PA 17033 Medical Research: What is the background for this study? Dr. Chetlen:  Breast cancer risk assessment provides a means of identifying women who are at risk for development of this disease.   Identifying individuals at high risk for breast cancer allows for genetic testing, supplemental breast cancer screening, possibly prophylactic surgery or chemoprevention in hopes of decreasing mortality from breast cancer.  Despite the advantages of cancer genetic risk assessment and testing, most individuals in the general population who would benefit from such services currently do not receive them.  Medical Research: What are the main findings? Dr. Chetlen:  After implementation of a specific high-risk recommendation within our standardized mammography report along with a letter written in “lay” language informing patients of their high-risk status, the number of referrals to our high-risk clinic increased only modestly.   Despite these specific recommendations to both physicians and patients, over 85% of high risk patients did not consult a high-risk provider regarding their elevated lifetime risk of breast cancer. (more…)
Author Interviews, Neurological Disorders / 21.07.2015

Dr Michael Lee PhD MPhty MChiro BSc Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney Clinical Neurophysiologist, The Brain & Mind Research Institute, The University of Sydney Research Affiliate, Neuroscience Research Australia Neurology Research Fellow, Institute of Neurological Sciences, Prince of Wales HospitalMedicalResearch.com Interview with: Dr Michael Lee PhD MPhty MChiro BSc Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney Clinical Neurophysiologist, The Brain & Mind Research Institute, The University of Sydney Research Affiliate, Neuroscience Research Australia Neurology Research Fellow, Institute of Neurological Sciences, Prince of Wales Hospital Medical Research: What is the background for this study? Dr. Lee: Our research team at the University of Sydney has previously shown that the functioning of peripheral nerves deteriorate following spinal cord injury (SCI). Using novel, non-invasive electrophysiological techniques (nerve excitability testing), we showed in this study that peripheral nerves below the level of spinal cord injury underwent dramatic functional reorganization. Peripheral nerve dysfunction will not only contribute to a number of undesirable medical complications including peripheral neuropathy and pain, it exacerbates muscle atrophy and can potentially limit the effectiveness of rehabilitative therapies that drive central plasticity. In this study, we were interested to see whether this secondary peripheral nerve dysfunction could be reversed with a short-term targeted peripheral nerve stimulation therapy. Medical Research: What are the main findings? Dr. Lee: We studied peripheral nerve function in both the upper (median nerve at the wrist) and lower limbs (peroneal nerve near the fibular head) in 22 patients with acute spinal cord injury (all within 6 months of injury). We then randomly assigned one upper limb and one lower limb nerve to a daily regimen of 30-min peripheral nerve stimulation for 6 week. All study participants continued with standard rehabilitation. The results from our nerve excitability studies showed that 6-weeks of daily stimulation reversed a number of nerve excitability abnormalities secondary to spinal cord injury, and in some cases normalized it to a level comparable to healthy age-matched subjects. The peripheral nerves in the opposite limbs remained dysfunctional over the 6-week period. The results of our study showed convincingly that the addition of peripheral nerve stimulation in the early stages of spinal cord injury is beneficial by ameliorating the downstream effects of spinal cord injury. Spinal cord injuries can be an unfortunate effect of being a car accident, causing serious issues for those who suffer from it whether financial or physical. Those who find themselves in this type of situation may look into contacting someone like these car accident injury lawyers near Sacramento who might be able to help them to get compensation for their accident, which could help with phisyotherapy and medical bills. (more…)
Aging, Author Interviews / 20.07.2015

Jessica Finlay M.A. Department of Geography, Environment and Society University of Minnesota MNMedicalResearch.com Interview with: Jessica Finlay M.A. Department of Geography, Environment and Society University of Minnesota MN Medical Research: What is the background for this study? What are the main findings? Response: Natural environments are known to promote physical, mental, and spiritual healing. People can attain health benefits by spending time outside, often in remote places to "get away from it all." Now research conducted by a University of Minnesota graduate student with a team in Vancouver, B.C., shows that green and "blue" spaces (environments with running or still water) are especially beneficial for healthy aging in seniors. The research team interviewed older adults aged 65 - 86 years who lived in Vancouver, B.C., Canada. All study participants were low-income, represented 8 different self-identified racial and ethnic groups, and experienced a range of chronic conditions and health status. Published in the journal Health and Place, the study - "Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older adults" - demonstrates that by incorporating smaller features, such as a koi pond or a bench with a view of flowers, public health and urban development strategies can optimize nature as a health resource for older adults. Throughout the research, green and blue spaces promoted feelings of renewal, restoration, and spiritual connectedness. They also provided places for multi-generational social interactions and engagement, including planned activities with friends and families, and impromptu gatherings with neighbors.  (more…)
Author Interviews, Connective Tissue Disease, Genetic Research, Rheumatology / 20.07.2015

MedicalResearch.com Interview with: Dr. Changfu Kuo MD PhD Division of Rheumatology, Orthopaedics, and Dermatology School of Medicine, University of Nottingham, Nottingham, England Division of Rheumatology, Allergy, and Immunology Chang Gung Memorial Hospital, Taoyuan, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Kuo: Systemic lupus erythematosus (SLE) is a prototype of autoimmune disease with features like autoantibody production and multiple target organ damage. SLE can affect any part of the body and the course of the disease is highly diverse and unpredictable. SLE can occur at any age and affect both females and males with a sex ratio of 9 to 1. Familial predisposition has been recognised as a risk factor previously and heritability of SLE has been estimated to be 66%. However, previous reports are often based on less robust sampling strategies and case ascertainment which generally depend on hospital records, self-reported diagnosis and disease registries, therefore limiting generalisability. The previous estimates of heritability are overestimated, due to a lack of consideration of shared environmental contribution. This study utilised a unique health insurance database that provides information on the whole population of Taiwan and permits determination of spouse and first-degree relatives. Over 23 million people were included in this study. Furthermore, through inclusion of SLE status of the spouse in our analyses the study is also able to examine how much of familial clustering results from genetic versus shared environmental factors. Overall the familial relative risk is 16.92. The genetic contribution to SLE susceptibility is estimated to be 44%. In addition to SLE, other autoimmune diseases are also more prevalent in individuals with a family history of SLE. (more…)
Author Interviews, Cannabis, Orthopedics / 20.07.2015

Yankel Gabet, DMD, PhD Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University Tel Aviv IsraelMedicalResearch.com Interview with: Yankel Gabet, DMD, PhD Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel Medical Research: What is the background for this study? What are the main findings? Dr. Gabet: Cannabis affects the body via specific components that are able to binding to receptors in the brain and other tissues. The components include the well-known ?9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the major constituents of cannabis. The cannabinoid receptors in our body are activated by several molecules (‘endocannabinoids’) synthesized by different sorts of cells under specific conditions. These receptors can be activated by synthetic compounds (cannabinoid ligands) as well as by natural cannabis. The effect of endocannabinoids in bone metabolism has been studied before but this study is the first report on the actions of natural THC and CDB in bone fracture healing. This is particularly important in light of the high incidence of both cannabis use and bone fractures; it is likely that many patients suffering from bone fractures consume cannabis that may have beneficial or adverse effects on the healing process. Another important point is that the non-psychogenic CDB is enough to promote bone healing, so there is no need to be exposed to the euphoric effects of cannabis/THC to get the beneficial functions of CBD on bone. (You can buy cbd oil online to help with other conditions as well such as fibromyalgia and diabetes.) If you are interested in learning more about CBD/THC and its products there are places online where you can find information, for example, from an online cbd store, a CBD Blog and other resources. (more…)
Aging, Author Interviews, Sexual Health / 20.07.2015

Dr. Alan J. Gow PhD, CPsychol, CSci, AFBPsS, FHEA Associate Professor in Psychology School of Life Sciences Heriot-Watt University EdinburghMedicalResearch.com Interview with: Dr. Alan J. Gow PhD, CPsychol, CSci, AFBPsS, FHEA Associate Professor in Psychology School of Life Sciences Heriot-Watt University Edinburgh Taylor-Jane Flynn, who conducted the research is a recent graduate in psychology from Heriot-Watt, and is about to commence postgraduate training in Counseling Psychology at Glasgow Caledonian University Medical Research: What is the background for this study? What are the main findings? Dr. Gow: We were interested in exploring how sexual behaviours might be associated with quality of life in older adults. Ms. Taylor-Jane Flynn, who led on the research, noted "There is an abundance of research identifying factors that predict better health and well-being in later life, but sex is one that is under researched." We asked our participants to report the frequency with which they engaged in six sexual behaviours from touching or holding hands to sexual intercourse, and then to also rate how important the behaviours were to them. Our results suggested that how often older adults engaged in sexual behaviours was positively associated with the quality of their social relationships. Interestingly, the importance of these sexual behaviours was found to be positively associated with their psychological quality of life. Our recently published research on how sexual behaviours are associated with quality of life in older adults grew from Taylor-Jane’s work with older adults. She reflected "I found my inspiration for this study while working as a Health Care Assistant caring for older adults. In recent years, many of those who opened up to me on a personal level expressed their need and want to have intimacy and companionship in their lives. However, sex has generally been seen as a taboo subject, especially among older adults. Despite this, older adults shared in our conversations that they miss and want to engage in sexual behaviours, whether that be a kiss to intercourse, and for many these behaviours remained an important element in their life." We were therefore keen to use these anecdotal accounts as a foundation for studying sexual behaviours as one of the many and varied determinants of wellbeing. (more…)
Author Interviews, Probiotics, UC Davis / 20.07.2015

Maria L Marco, PhD Associate Professor Department of Food Science & Technology Davis, CA 95616MedicalResearch.com Interview with: Maria L Marco, PhD Associate Professor Department of Food Science & Technology Davis, CA  95616 Medical Research: What is the background for this study? What are the main findings? Dr. Marco: Probiotics encompass certain strains of bacteria and yeast that when administered alive and in sufficient amounts can confer specific health benefits. Probiotics are increasingly added to foods, beverages, and intestinal supplements for delivery to the digestive tract. (Fermented) dairy products are currently the most popular food carriers for probiotic strains in clinical studies and commercial products. Although microorganisms generally respond quickly and adapt to their surrounding environments (e.g. in foods), the importance of the carrier format on probiotic function in vivo has yet to be systematically and mechanistically investigated. To address this need, we performed a couple studies in rodents to (i) examine whether probiotic Lactobacillus casei produces different proteins during low temperature (refrigeration) incubation in milk and (ii) measure whether incubation in milk is required for L. casei protection against inflammation. We found by shot-gun proteomics that L. casei does adapt for growth and survival in milk by producing a variety of (extra)cellular proteins, even at low-temperatures used to store dairy products prior to consumption. Such exposure of L. casei to milk was also essential for reducing the severity of disease in a mouse model of Ulcerative Colitis (UC), an inflammatory bowel disease characterized by continuous inflammation in the large intestine. Consuming milk alone also provided some protection against weight loss and intestinal inflammation in the Ulcerative Colitis mouse model but was not as effective as L. casei and milk in combination. Lastly, the importance of dairy for L. casei in preventing Ulcerative Colitis was confirmed by our findings that L. casei mutants lacking the capacity to synthesize proteins which are selectively produced during low-temperature incubation in milk were also impaired in preventing inflammatory responses in the intestine. (more…)
Author Interviews, BMJ, Nutrition, Weight Research / 20.07.2015

Fumiaki Imamura Ph.D. MRC Epidemiology Unit University of CambridgeMedicalResearch.com Interview with: Dr. Fumiaki Imamura Ph.D. MRC Epidemiology Unit University of Cambridge Medical Research: What is the background for this study? What are the main findings? Dr. Imamura: Soft drink consumption is associated with risk of diabetes, but whether or not the association persists after controlling for obesity status is not known. Diet drinks and fruit juice may be good alternatives to soft drinks. However, while obese individuals may consume diet drinks or fruit juice instead of sugar-sweetened soft drinks, evidence was weak to determine whether or not consuming these beverages is associated with risk of diabetes. (more…)
Author Interviews, OBGYNE, Weight Research / 20.07.2015

Maya Tabet, MS Graduate Research Assistant Saint Louis University College for Public Health and Social Justice Department of Epidemiology St. Louis, MO 63104MedicalResearch.com Interview with: Maya Tabet, MS Graduate Research Assistant Saint Louis University College for Public Health and Social Justice Department of Epidemiology St. Louis, MO 63104 MedicalResearch: What is the background for this study? Response: The majority of women in the U.S. have an unhealthy weight before they start pregnancy, most of them being overweight or obese. It is well-known that having an unhealthy weight before pregnancy increases the likelihood of having adverse outcomes for the mother and baby. However, this study is the first to examine the likelihood of adverse outcomes in a second pregnancy among women who had an unhealthy weight before a first pregnancy that had no complications. MedicalResearch: What are the main findings? Response: Our study involved 121,049 women in Missouri who delivered their first 2 singleton pregnancies between 1989 and 2005. Findings revealed that women who were underweight before a first uncomplicated pregnancy had a 20% increased likelihood of having a shorter gestation and a 40% increased likelihood of having a small baby for gestational age in the second pregnancy, as compared to women who had a healthy weight before their first pregnancy. Also, women who were obese before a first uncomplicated pregnancy had a 55% increased likelihood of having a large baby for gestational age, a 156% increased likelihood of having preeclampsia, and an 85% increased likelihood of having a cesarean delivery. Babies born to these women also had a 37% increased likelihood of dying in the first 28 days of their life. (more…)
Author Interviews, Breast Cancer / 20.07.2015

Niels de Jonge, Ph.D Head of the Innovative Electron Microscopy group German Cancer Research Center (DKFZ) in Heidelberg University of FreiburgMedicalResearch.com Interview with: Niels de Jonge, Ph.D Head of the Innovative Electron Microscopy group German Cancer Research Center (DKFZ) in Heidelberg University of Freiburg Medical Research: What is the background for this study? What are the main findings? Response: HER2 membrane proteins play a special role in certain types of breast cancer: amplified levels of HER2 drive unrestricted cell growth. HER2-tailored antibody-based therapeutics aim to prevent cancer cell growth. However, two-thirds of HER2 positive breast cancer patients develop resistance against HER2-targeting drugs. The reason for this is not yet understood. We now found out, that HER2 dimers appeared to be absent from a small sub-population of resting SKBR3 breast cancer cells. This small subpopulation may have self-renewing properties that are resistant to HER2-antibody therapy and thus able to seed new tumor growth. (more…)
Author Interviews, Race/Ethnic Diversity / 20.07.2015

MedicalResearch.com Interview with: Francesco Acciai, Aggie J Noah and Glenn Firebaugh Department of Sociology Pennsylvania State University University Park, PA MedicalResearch: What is the background for this study? Response: Life expectancy in the United States varies greatly by race. Asian–Americans enjoy the greatest longevity, with a nearly 8 year mortality advantage on whites. This advantage can derive from two separate processes. One, from a more favorable allocation of causes of death (incidence effect); i.e. from the fact that Asians tend to die of causes that strike on average at older ages while avoiding causes of death that afflict the young. Two, they can die of the same causes of death, but at an older age (age effect). By using the age-incidence decomposition method we are able to distinguish and quantify these contributions to the 7.8 year gap in life expectancy between Asians and whites. MedicalResearch: What are the main findings? Response: Nearly 90% (or 6.9 years) of this gap is attributable to the fact that Asians tend to outlive whites regardless of the cause of death (age effect). The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). The incidence effect accounts for the remaining 0.9 years of the Asian-white gap in life expectancy. Moreover, sex-specific analyses show that men contribute somewhat more to the gap than women do (55% vs 45%), primarily because Asian–white differences in mortality are greater among men than among women with respect to suicide, traffic accidents and accidental poisoning. (more…)
Author Interviews, Genetic Research, Heart Disease, McGill / 20.07.2015

Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec CanadaMedicalResearch.com Interview with: Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec Canada Medical Research: What is the background for this study? What are the main findings? Response: There have been great advances in the field of genetics in recent years. Especially in cardiology, a number of genetic variants have been identified that are associated with cardiovascular disease. But it is not clear how useful these variants are in terms of predicting future evens in patients that have already suffered a myocardial infarction. What we found in our study is that a genetic risk score composed of the 30 most common genetic variants associated with cardiovascular diseases was not useful in predicting recurrent events in the first year after a patient suffered a myocardial infarction. (more…)
Author Interviews, Beth Israel Deaconess, Diabetes, Heart Disease, University of Michigan / 18.07.2015

MedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD, FACC, FASNC University of MichiganVenkatesh L. Murthy, MD, PhD, FACC, FASNC University of Michigan Dr. Ravi Shah MD Beth Israel Deaconess Medical Centerand Dr. Ravi Shah MD Beth Israel Deaconess Medical Center   MedicalResearch: What is the background for this study? Response: Recent changes recommend statin therapy for cardiovascular risk reduction in an increasingly large number of Americans. Conversely, a number of studies have identified an increased risk of diabetes with statin treatment. Thus, there is increasing need for tools to target statin therapy to those with a favorable risk-benefit profile. MedicalResearch: What are the main findings? Response: In our study, we analyzed data from 3,153 individuals from the Multi-Ethnic Study of Atherosclerosis who underwent CT scanning at baseline for assessment of calcium score. The CT scans were analyzed to assess liver attenuation as a measure of the amount of liver fat. We demonstrated that high liver fat doubled the risk of diabetes over a median of 9 years of follow-up. Importantly, statin therapy also doubled the risk of diabetes. The two together had an additive effect, even after adjusting for BMI, age, gender, family history of diabetes, waist circumference, lipids, hsCRP and exercise habits. As in prior studies, the risk of cardiovascular disease (CVD) events increased with increasing calcium score, as has previously been shown in MESA and in other studies. We then divided the cohort into six groups based on calcium score (0, 1-100 and >100) and liver fat (low/high). Using published data from meta-analyses of statin trials, we computed the number needed to treat to prevent one hard CVD event for statin therapy. Using data from our study, we computed the number needed to harm to cause one additional case of diabetes from statin therapy. The numbers needed to treat with ranged from 29-40 for calcium score of >100 to 218-252 for calcium score of 0. Conversely, the numbers needed to harm were approximately 63-68 for those with low liver fat versus 22-24 for those with high liver fat. Thus the combination of calcium score and liver fat assessment, from a single standard calcium score scan, allows for physicians to provide better assessment of risk and benefit of statins in discussion with their patients. (more…)
Author Interviews, Dermatology / 17.07.2015

Adam Friedman, MD, FAADAssociate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health ScienceMedicalResearch.com Interview with: Adam Friedman, MD, FAAD Associate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health Sciences Medical Research: What is the background for this study? What are the main findings? Dr. Friedman: Given pruritus is not only a hallmark symptom of atopic dermatitis, and in fact is even part of the diagnostic criteria, we sought to evaluate whether factors known to cause itch or inhibit said pruritogens in other disease states are over or under expressed in skin from patients diagnosed with atopic dermatitis. Over the past 10 years considerable attention has been paid to the complexity of the immune dysregulation and plethora of inflammatory and neurogenic factors involved in the activity and progression of this disease. Our study showed significant differences between atopic dermatitis skin and normal skin.  Specifically, we found significantly elevated levels of several well-known components of both the inflammatory and pruritus cascade including interleukin-2, BLT1 (the receptor for leukotriene B4, recently implicated in atopic dermatitis), 5-lipoxygenase and Matrix Metalloproteinase-7.  Interestingly, for the first time to our knowledge, α-2 macroglobulin, a ubiquitous protein found in the skin that binds a host of proteases, growth factors (TGF-b, PDGF, b-NGF) and inflammatory cytokines (TNF-α, IL-1b, IL-2, IL-6, IL-8), was found to be significant unregulated in atopic skin. Because it has a known an important role in the modulation of inflammation, as its binding acts to inhibit the majority of these mediators, this overexpression may in fact be a compensatory mechanism for ongoing disease. Importantly, when activated through chloramination by, for example, bleach, it can very effeectively scavenge these pro-inflammatory mediators. Thus leading to the second goal of this study. One of the driving forces for selecting the various "itch or anti-itch factors" is that all can be augmented by hypochlorous acid, which is what bleach disassociates into when mixed with water. Bleach baths have been used for years as an adjuvant to treatment in atopic dermatitis.  When mixed with water, sodium hypochlorite (NaOCL) produces hypochlorous acid (HOCl), a compound stable between pH 3 and 6. HOCl is known to have antimicrobial properties, and therefore it was believed that bleach baths lowered bacterial burden on the skin and prevented and treated localized skin infections and colonization by organisms such as Staphylococcus aureus. Recent studies have found that HOCl intact has potent anti-inflammatory properties, and therefore we sought to expand this data by evaluating whether factors augmented by HOCl are overexposed in atopic dermatitis skin, giving some insight into how bleach bathes or HOCl products may aid in disease and symptom management. (more…)
Author Interviews, Genetic Research, Ophthalmology / 17.07.2015

Professor Robert E MacLaren MB ChB DPhil FRCOphth FRCS Nuffield Laboratory of Ophthalmology Nuffield Department of Clinical Neurosciences, University of Oxford Oxford Biomedical Research Centre, University of Oxford, Oxford, UK Moorfields Eye Hospital & UCL NIHR Biomedical Research Centre for Ophthalmology London, UK.MedicalResearch.com Interview with: Professor Robert E MacLaren MB ChB DPhil FRCOphth FRCS Nuffield Laboratory of Ophthalmology Nuffield Department of Clinical Neurosciences Oxford Biomedical Research Centre, University of Oxford, Moorfields Eye Hospital & UCL NIHR Biomedical Research Centre for Ophthalmology London, UK.
Medical Research: What is the background for this study? What are the main findings? Prof. MacLaren: The study shows that gene therapy can be used to release a protein in the eye that arrests the development of retinitis pigmentosa, a blinding disease caused by degeneration of the retina. The study was performed in mice which had a similar genetic defect to that found in humans with the disease. The mice also had fluorescent green “glow in the dark” light sensing cells known as cones, which we could see and count by looking into the eye – like counting stars in the night sky. By counting the green fluorescent cones we were able to work out the exact dose of gene therapy needed to keep these cells alive indefinitely. The study was funded by Fight for Sight, a UK charity that supports finding cures for eye diseases. (more…)
Author Interviews, Fertility, Genetic Research, Science / 17.07.2015

Stephen A. Krawetz, Ph.D. Associate Director C.S. Mott Center for Human Growth and Development, Charlotte B. Failing Professor of Fetal Therapy and Diagnosis, Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201MedicalResearch.com Interview with: Stephen A. Krawetz, Ph.D. Associate Director C.S. Mott Center for Human Growth and Development, Charlotte B. Failing Professor of Fetal Therapy and Diagnosis, Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201 Medical Research: What is the background for this study? What are the main findings? Dr. Krawetz: The current study developed over approximately the past 20 years of work in my laboratory.  In the mid 1990s, along with David Miller, we independently discovered that sperm contain RNA.  This was followed by our joint publication in The Lancet that began to describe the RNAs in normal fertile males along with our paper in Nature that showed that RNA was delivered to the oocyte at fertilization.  Following these studies we assessed the ability of RNAs to be used as markers of morphologically abnormal sperm (teratozoospermia).  My laboratory then had the opportunity to explore the complexity of the population of sperm RNAs using Next Generation Sequencing.   We recently began the translation of this work from the bench to bedside which takes us to the current paper in Science Translational Medicine that was a multi-institutional collaborative effort.  Members of the team include Dr. Meritxell Jodar, Edward Sendler, Robert Goodrich, from my laboratory, along with Dr. Clifford L. Librach, Dr. Sergey I. Moskovtsev, and Sonja Swanson - CReATe Fertility Center, University of Toronto; Dr. Russ Hauser -Harvard University and Dr. Michael P. Diamond, Georgia Regents University. Here we tackled the issue of idiopathic infertility, that is, unknown infertility, since the couple appears normal in all respects.  We specifically framed our study as the contribution of the male and female as a couple towards the birth of a healthy child focusing on male idiopathic infertility within the setting of a Reproductive Clinic.  Representative publications from my laboratory that outline this part of my research program appear below. 1)            Jodar, M., Sendler, E., Moskovtsev, S. Librach, C., Goodrich, R., Swanson, S., Hauser, R., Diamond, M. and Krawetz, S.A. (2015) Absence of sperm RNA elements correlates with idiopathic male infertility. Science Translational Medicine, 7(295):295re6. 2)            Sendler, E., Johnson, G.D., Mao, S., Goodrich, R.J., Diamond, M.P., Hauser, R., and Krawetz, S.A. (2013) Stability, Delivery and Functions of Human Sperm RNAs at Fertilization.  Nucleic Acids Research 41:4104-4117. PMID: 23471003 3)            Platts, A.E., Dix, D. J., Chemes, H.E., Thompson, K.E., Goodrich, R., Rockett, J. C., Rawe, V.Y., Quintana, S., Diamond, M.P., Strader, L.F. and Krawetz, S.A. (2007)  Success and failure in human spermatogenesis as revealed by teratozoospermic RNAs.  Human Molecular Genetics. 16:763-773.  PMID: 17327269 4)            Ostermeier, G.C., Miller, D., Huntriss, J.D., Diamond, M.P. and Krawetz, S.A. (2004) Delivering spermatozoan RNA to the oocyte.  Nature 429:154.  PMID: 15141202 5)            Ostermeier, G.C., Dix, D.J., Miller, D., Khatri, P. and Krawetz, S.A. (2002) Spermatozoal RNA profiles of normal fertile men. The Lancet. 360:773-777.  PMID: 12241836 (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC / 17.07.2015

Prof. Johan Bosmans Interventional cardiologist University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, BelgiumMedical Research Interview with: Prof. Johan Bosmans Interventional cardiologist University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium MedicalResearch: What is the background for this study? What are the main findings? Prof. Bosmans : Transcatheter aortic valve replacement (TAVR) has become standard of care for patients who cannot undergo surgery. With this, it is important to ensure that the risks associated with TAVR be fully understood, and if possible prevented. Even at this stage of the adoption of TAVR, large trials continue to provide information to the clinician about how to select the right patients to ensure the best possible outcomes. The ADVANCE Study is a prospective, multicenter study that evaluated the use of TAVR in 1015 patients at 44 experienced TAVR centers, which was designed to reflect routine clinical practice. We know that the risk of serious adverse events, such as stroke or transient ischemic attack (TIA), in post-TAVR patients can vary based on the timing before and after the procedure. A patient’s baseline demographics and medical history can affect their risk of procedure-related events as well as long-term outcomes. The manipulations required crossing the aortic valve and appropriately positioning any type of TAV has been thought to be related to procedural stroke events. Therefore, we performed a multivariable analysis looking for predictors of stroke – or stroke and TIA at 3 unique time periods (periprocedural, early and late) following TAVR. The most striking result from our analyses was that we were not able to identify any predictors of periprocedural (either during the procedure or on the day after) stroke, illustrating this very multifactorial etiology. We were able to show that being female, experiencing acute kidney injury or a major vascular complication positively predicted stroke during the early (2-30 days post procedure) time period. When we combined the outcome of stroke or TIA, we found that a history of prior atrial fibrillation (AF) was also a predictor. The only late predictor (day 31-730 post-procedure) of stroke was a history of coronary artery bypass grafting, which could reflect the patients’ risk of vascular disease. (more…)
Author Interviews, Education, Electronic Records, PLoS, UCSF / 17.07.2015

Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of MedicineMedicalResearch.com Interview with: Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Lyles: In our commentary (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852), we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs).  This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider.  Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now.  Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits.  Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients.  Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations. However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites.  There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites.  There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency.  Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access. (more…)
Author Interviews, PLoS, Toxin Research, University of Pennsylvania / 17.07.2015

Reynold A. Panettieri, Jr., M.D. Robert L. Mayock and David A. Cooper Professor of Medicine Pulmonary, Allergy & Critical Care Division Director, Airways Biology Initiative Deputy Director, Center of Excellence in Environmental Toxicology Adjunct Professor, Wistar Institute Philadelphia, PA 19104-3413MedicalResearch.com Interview with: Reynold A. Panettieri, Jr., M.D. Robert L. Mayock and David A. Cooper Professor of Medicine Pulmonary, Allergy & Critical Care Division Director, Airways Biology Initiative Deputy Director, Center of Excellence in Environmental Toxicology Adjunct Professor, Wistar Institute Philadelphia, PA  19104-3413 Medical Research: What is the background for this study? What are the main findings? Dr. Panettieri: Over the past ten years in the US, unconventional gas and oil drilling (hydraulic fracturing) to generate natural gas has markedly increased.  In areas with hydraulic fracturing, there is a large increase in truck traffic, noise and potential air and water pollution.  Accordingly, residents may experience health consequences from such exposures.  We questioned whether proximity to active wells increases hospitalization rates in residents.  To address this question, we reviewed all hospitalizations in two counties in Pennsylvania, namely, Bradford and Susquehanna Counties, that experienced a meteoric increase in active wells.  In comparison, Wayne County, where there is a moratorium on hydraulic fracturing, is demographically identical to Bradford and Susquehanna Counties and served as a control population.  Having examined the 25 most common reasons for admission to the hospital, we determined that cardiovascular hospitalizations as well as neurologic, dermatologic and cancer hospitalizations were associated with living closer to active wells.  These data represent some of the first studies to associate active well drilling with hospitalizations in the United States. (more…)
Author Interviews, BMJ, Clots - Coagulation / 17.07.2015

MedicalResearch.com Interview with: Byung-Joo Park, MD, MPH, PhD Professor Department of Preventive Medicine Seoul National University College of Medicine Medical Research: What is the background for this study? What are the main findings? Response: Antidepressants and NSAIDs are each thought to increase the risk of abnormal bleeding.  However, previous studies found neither antidepressants nor NSAIDs alone to be associated with an increased risk of intracranial haemorrhage.  Our research found that combined use of NSADIs in antidepressant users showed the increased relative risk of intracranial haemorrhage risk within the initial 30-days of combined use. (more…)
AHRQ, Author Interviews, Cost of Health Care / 17.07.2015

  H. Joanna Jiang, Ph.D. Agency for Healthcare Research and QualityMedicalResearch.com Interview with: H. Joanna Jiang, Ph.D. Agency for Healthcare Research and Quality MedicalResearch: What is the background for this study? What are the main findings? Dr. Jiang: A large proportion of health care resources in the United States are consumed by a relatively small number of individuals, who have been dubbed super-utilizers. Approximately 25% of U.S. health care expenses are incurred by 1% of the U.S. population, and 50% of expenses are incurred by 5% of the population. Our study found that across all types of payers of medical care (Medicare, Medicaid, and private insurance), super-utilizers on average had approximately 4 times as many hospital stays as other patients, and the 30-day hospital readmission rate for super-utilizers was 4 to 8 times higher than for other patients. Among Medicaid and privately insured patients, super-utilizers had longer hospital stays and higher average hospital costs than other patients. We also found that patients with multiple chronic conditions, such as diabetes, hypertension, and congestive heart failure, accounted for a greater share of hospital stays among super-utilizers than among other hospitalized patients. Mental health and substance use disorders were among the top 10 principal diagnoses for super-utilizers aged 1 to 64 years regardless of payer. (more…)
Author Interviews, Lancet, Lymphoma / 17.07.2015

MedicalRDr Yeow Tee Goh Department of Haematology Singapore General Hospital Republic of Singaporeesearch.com Interview with: Dr Yeow Tee Goh MBBS Department of Haematology Singapore General Hospital Republic of Singapore Medical Research: What is the background for this study? What are the main findings? Dr. Goh: Relapsed or refractory peripheral T-cell lymphoma after conventional chemotherapy is associated with a very poor prognosis and there is currently no recommendation on the standard approach to helping these patients. Novel targeted treatments for relapsed or refractory peripheral T-cell lymphoma such as romidepsin, pralatrexate, belinostat, and brentuximab vedotin has been approved by the US Food and Drug Administration (FDA) based on the results of their Phase II studies. With the exception of the remarkable efficacy of brentuximab vedotin in systemic anaplastic large cell lymphoma (86% of patients responding to treatment), the efficacy of romidepsin, pralatrexate, and belinostat in relapsed or refractory peripheral T-cell lymphoma is only modest with objective response rates between 25% and 29%. To our knowledge, no other clinical study has reported on the use of novel combination of targeted agents in in relapsed or refractory peripheral T-cell lymphoma. In our study, Of 23 patients assessable for responses, 10 (43%, 95% CI 23–63) patients had an objective response, of which 5 were complete responses. The combined proteasome and histone deacetylase inhibitor treatment shows promising activity for patients with peripheral T-cell lymphoma. (more…)
Author Interviews, Heart Disease, Lifestyle & Health / 17.07.2015

Carl "Chip" Lavie MD, FACC FACP, FCCP Medical Director, Cardiac Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular DiseasesMedicalResearch.com Interview with: Carl "Chip"  Lavie MD, FACC FACP, FCCP Medical  Director, Cardiac  Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner Heart and Vascular Institute Professor of Medicine Ochsner Clinical  School-UQ School of Medicine Editor-in-Chief, Progress in Cardiovascular Diseases Medical Research: What is the background for this study? What are the main findings? Dr. Lavie: This was a review of the literature on this topic.The main findings are that various lifestyle choices, including obesity,  hypertension, metabolic syndrome/diabetes, obstructive sleep apnea , moderate and  high alcohol intakes, and sedentary lifestyle but also very high exercise doses are all associated with increased risk of atrial fibrillation (AF). (more…)
Author Interviews, Genetic Research, Surgical Research, Yale / 17.07.2015

John A. Elefteriades, MD William W.L. Glenn Professor of Surgery Chief of Cardiothoracic Surgery Director, Aortic Institute at Yale-New Haven Yale University School of MedicineMedicalResearch.com Interview with: John A. Elefteriades, MD William W.L. Glenn Professor of Surgery Chief of Cardiothoracic Surgery Director, Aortic Institute at Yale-New Haven Yale University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Elefteriades: The race to map the human genome was declared completed in 2003, at a cost of 3 billion dollars for the international collaborative university group and 300 million dollars for Craig Venter at Celera. Whole exome sequencing can now be performed at a cost of only several thousand dollars per individual. So, whole exome sequencing (also called Next Generation Sequencing) can now be applied to understand and treat diseases of many organ systems. In this study, we applied whole exome sequencing to study over 100 patients with thoracic aneurysm. In the late 1990s, both Dr. Diana Milewicz in Texas and our group at Yale had determined that many thoracic aortic aneurysms were genetically transmitted. Dr. Milewicz went on to identify many of the causative mutations. In this study, we were able to look, by whole exome sequencing performed on saliva, for all 21 mutations known to cause thoracic aortic aneurysm--all at one time in one comprehensive genetic test. We were able to protect patients with the most serious discovered mutations by early surgery, the need for which could not otherwise have been apparent.  (more…)
Author Interviews, Obstructive Sleep Apnea / 17.07.2015

Sunil Sharma, M.D Associate professor of pulmonary medicine Sidney Kimmel Medical College at Thomas Jefferson UniversityMedicalResearch.com Interview with: Sunil Sharma, M.D Associate professor of pulmonary medicine Sidney Kimmel Medical College at Thomas Jefferson University Medical Research: What is the background for this study? What are the main findings? Dr. Sharma: Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant cardiovascular implications. In this condition the patient may repeatedly quit breathing during sleep, sometimes hundreds of times, leading to loss of oxygen and frequent arousals throughout the night. OSA has been associated with high blood pressure, congestive heart failure, coronary artery disease, arrhythmias and stroke, among other conditions. While overall awareness is improving, the condition is under-recognized in hospitalized patients. Due to multiple co-morbid conditions these patients may be at higher risk for complications. Recent studies have also shown that early recognition of OSA in hospitalized patients may reduce readmission rates. In our study, we used a simple and cost-effective clinical pathway to determine high-risk patients. Of the 149 patient's determined to be high risk by our protocol, 128 (87%) were confirmed with the diagnosis by a polysomnography (gold standard test). Furthermore, data derived from a simple and cost-effective oxygen measuring device (pulse-oximeter) was found to co-relate well with the polysomnography.  (more…)