Author Interviews, Exercise - Fitness, Parkinson's / 03.06.2015

Dr. Lori P. Altmann Department of Speech, Language, and Hearing Sciences Center for Movement Disorders and Neurorestoration University of Florida, Gainesville, FloridaMedicalResearch.com Interview with: Dr. Lori P. Altmann Department of Speech, Language, and Hearing Sciences Center for Movement Disorders and Neurorestoration University of Florida, Gainesville, Florida Medical Research: What is the background for this study? What are the main findings? Dr. Altmann: There are a multitude of studies from our labs and others examining the effects of doing a variety of different cognitive tasks while walking or while maintaining postural control, and the results across studies are consistent—motor performance usually declines.  These “dual task effects” are exaggerated in healthy older adults, and are even more pronounced in people with Parkinson disease (PD).  Our study investigated dual task effects during cycling in healthy older adults and people with Parkinson disease.  In contrast to most studies of this type which typically contrast dual task effects of two cognitive tasks, we used an array of 12 cognitive tasks of graded difficulty, from very very easy to extremely difficult.  One of our primary goals was to establish that the dual task effects were directly related to the difficulty of the cognitive task. Our primary findings were that, instead of cycling slower when doing various cognitive task, both groups of participants sped up, and the amount they sped up was directly related to the difficulty of cognitive tasks.  In the easiest task, cycling speed increased by an average of about 25%, With some participants actually doubling their single task speed. There was no evidence that this increase in cycling speed came as a result of prioritizing cycling over the cognitive tasks, as scores on the cognitive tasks either remained the same or got slightly better.  Interestingly, people with Parkinson disease still showed faster cycling during the easiest tasks, but did not benefit as much from the dual task as the healthy adults. We attribute our findings to arousal that is triggered by both the cycling and the cognitive tasks which increases attentional resources that can be used for both motor and cognitive processing.  We believe the findings haven’t been documented before because most studies use gait or balance as the motor tasks, and these are much more difficult tasks that demand more attentional resources, leading to the typical findings of dual task costs instead of dual task benefits. The decrease in dual task benefits experienced by people with Parkinson disease, we believe, is due to the effects of Parkinson disease on neurotransmitters.  Both cognitive and physiological arousal increase the production of dopamine and norepinephrine in the brain, and disease processes in Parkinson disease interfere with production of these neurotransmitters, thus limiting arousal-based increases in attentional resources. (more…)
Author Interviews, JAMA, Kaiser Permanente, Pain Research / 03.06.2015

Harley Goldberg, DO Physical Medicine and Rehabilitation Kaiser PermanenteMedicalResearch.com Interview with: Harley Goldberg, DO Physical Medicine and Rehabilitation Kaiser Permanente Medical Research: What is the background for this study? What are the main findings? Dr. Goldberg: This is the first large-scale randomized, double-blind, placebo-controlled clinical trial of oral steroids for acute radiculopathy, commonly called sciatica, associated with a herniated lumbar disk. Lumbar radiculopathy (or pain down the leg in a lumbar nerve root distribution) is a common source of pain and disability for many adults. It is thought that inflammation from a disk herniation is responsible for many of the symptoms, so giving a powerful anti-inflammatory, such as steroid medication, might help relieve sciatica symptoms quickly. Prior research has shown that lumbar diskectomy does not affect the one year outcome for most patients, and epidural steroid injections do not have strong support by clinical trials. If the use of epidural steroids injections is based on application of steroid anti-inflammatory to the affected nerve root(s), perhaps an oral steroid can have affect. Although oral steroids are used by many physicians and have been included in some clinical guidelines, no large-scale clinical trials of oral steroids for sciatica have been conducted before. Our study found that among patients with acute radiculopathy associated with a herniated lumbar disk, a short course of oral steroids resulted in only modest improvement in function and no significant improvement in pain. (more…)
ASCO, Author Interviews, Cancer Research, Chemotherapy, Genetic Research / 03.06.2015

MedicalResearch.com spoke with Dr. Jonathan Lancaster, MD, Ph.D. at the 2015 ASCO meeting in Chicago. Dr. Lancaster is the new Vice President of Medical Affairs for Oncology, Myriad Genetic Laboratories, at Myriad. Dr. Lancaster jointed Myriad in February 2015 after twelve years at the Moffitt Cancer Center. Prior to Moffitt, Dr. Lancaster was medical director of the Gynecologic Dysplasia Clinic at Duke University Medical Center in Durham, NC, where he also completed his residency and fellowship training.MedicalResearch.com spoke with Dr. Johnathan Lancaster, MD, Ph.D. at the 2015 ASCO meeting in Chicago. Dr. Lancaster is the new Vice President of Medical Affairs for Oncology, Myriad Genetic Laboratories, at Myriad. Dr. Lancaster jointed Myriad in February 2015 after twelve years at the Moffitt Cancer Center. Prior to Moffitt, Dr. Lancaster was medical director of the Gynecologic Dysplasia Clinic at Duke University Medical Center in Durham, NC, where he also completed his residency and fellowship training. MedicalResearch.com: Can you tell us a little more about your background? How did you come to work at Myriad? Dr. Lancaster: My background and interests lie at the intersection of patient care and the molecular and genetic understanding of cancer. I completed my MD and Ph.D. in molecular genetics at the University of Wales, and then came to Duke for a research fellowship and residency training in Obstetrics & Gynecology. I spent twelve years as a gynecology-oncology surgeon. At the Moffitt Cancer Center, I ran a research lab attempting to understand the molecular and genetic underpinnings of ovarian cancer development and progression. Our translation research attempted to identify markers, or microRNAs, that help predict ovarian tumors’ response to chemotherapeutic agents. I also have experience in the management and financial issues facing medicine and health care. While at Moffitt, I was president of the 350-member Moffitt Medical Group, deputy physician-in-chief and director of the Center for Women's Oncology. The opportunity at Myriad Genetics allows me to utilize my experience in all three interests, clinical care, research and management, to contribute to a broader mission of cancer treatment and prevention. MedicalResearch.com: What studies are being presented at ASCO this year by Myriad associated researchers? Dr. Lancaster: There are 19 abstracts presented by Myriad at ASCO 2015, which is a testament to the emphasis Myriad places on basic and translational research (Myriad reinvests $300-400 of the proceeds from every clinical test performed into research). The studies center around two main themes: 1: An enhanced panel of genes, called MyRisk, to test for increased risk of hereditary cancers. 2: The use of Homologous Recombination Deficiency (HRD) testing and score, called MyChoice, which helps clinicians determine which patients may respond best to some chemotherapeutic agents. MedicalResearch.com: What does the MyRisk panel offer over and above the information learned from BRAC1/2 testing? Why should a patient or clinician want this testing performed? Dr. Lancaster: The MyRisk panel tests for 25 state-of-the-art genes with the goal of determining who may be at increased risk for certain malignancies even if they are BRAC1/2 negative. The typical patient is one who has a family history of cancer but may have been told she doesn’t have the ‘breast cancer gene’ because she is BRAC1/2 negative. We now know that up to 50% of these patients may carry other genes that make them more susceptible to cancer. Panel testing allows clinicians to identify many more patients at risk for cancer who would have been missed with more traditional BRAC1/2 testing alone. (more…)
Author Interviews, Dermatology, JAMA, Melanoma / 03.06.2015

Catherine M. Olsen, PhD Population Health Department QIMR Berghofer Medical Research Institute Queensland, Australia MedicalResearch.com Interview with: Catherine M. Olsen, PhD Population Health Department QIMR Berghofer Medical Research Institute Queensland, Australia MedicalResearch: What is the background for this study? Dr. Olsen: Effective skin cancer control requires two strategies: regular sun protection to prevent new cancers from occurring and early detection assisted by periodic skin examinations. The aim of our study was to describe the prevalence and predictive factors for sun protection and skin examination practices of adults in Queensland, Australia, a region that experiences the highest rates of skin cancer in the world. We were particularly interested in whether sun protection and skin examination practices differed between those with and without a previously confirmed melanoma and/or treatment for other skin lesions. MedicalResearch: What are the main findings? Dr. Olsen: The prevalence of both sun protection and skin examination practices was generally high in this large cohort of people who experience high levels of ambient sun exposure. People who had been diagnosed with a melanoma or other skin lesion were more likely than those without to report sun protection practices including regular use of sunscreen and wearing hats. The strongest predictor of sun protection practices was having a sun-sensitive skin type, and the strongest predictor of skin examination practices was having many moles and/or a family history of melanoma. (more…)
Author Interviews, Cognitive Issues, Endocrinology, OBGYNE / 03.06.2015

Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, WisconsinMedicalResearch.com Interview with: Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin Dr. Gleason: In this response I refer to hormone therapy (HT), which was formally called hormone "replacement" therapy. In particular, we examined menopausal HT, i.e., the use of HT during the menopausal transition to address menopausal symptoms. Medical Research: What is the background for this study? What are the main findings? Dr. Gleason: The WHI Memory Study (WHIMS) suggested that HT was associated with cognitive harm for women age 65 and older. In contrast, we found that the cognitive performance of women randomized to receive menopausal hormone therapy did not differ from that of women randomized to receive the placebo. On a measure of mood states, women treated with conjugated equine estrogens showed improvements compared to those on placebo. (more…)
Accidents & Violence, Author Interviews, Emergency Care / 03.06.2015

dr-Huiyun-XiangMedicalResearch.com Interview with: Huiyun Xiang, M.D., M.P.H. Center for Pediatric Trauma Research The Research Institute at Nationwide Children’s Hospital Columbus, OH Medical Research: What is the background for this study? What are the main findings? Response: In the United States trauma system, the most severe injuries ideally should receive definitive treatment at level I or level II trauma centers, while less severe injuries should receive treatment at level III or nontrauma centers. “Undertriage” occurs when a severe injury receives definitive treatment at a lower level trauma center instead of a level I or level II trauma center. But no study had used nationally representative data to evaluate mortality outcomes of undertriage at nontrauma centers. Our study found detrimental consequences associated with undertriage at nontrauma centers. There was a significant reduction in the odds of emergency department (ED) death – by approximately half – in severely injured trauma patients who were properly triaged to a level I or level II trauma center versus those who were undertriaged to a nontrauma center. We also found that patients with moderate injuries may not have a reduction in the odds of ED death when triaged to a level I or level II trauma center instead of a nontrauma center. That suggests a possible threshold of injury severity when triaging trauma patients. (more…)
Author Interviews, Breast Cancer, JAMA, Leukemia / 03.06.2015

Efrat Amitay, PhD, MPH School of Public Health University of Haifa Mount Carmel, Haifa, IsraelMedicalResearch.com Interview with: Efrat Amitay, PhD, MPH School of Public Health University of Haifa Mount Carmel, Haifa, Israel Medical Research: What is the background for this study? Dr. Amitay: Although childhood cancer is still rare, we are seeing an increase of around 0.9% annually in the incidence rate in the western world. In spite of advancements in treatment technologies, childhood cancer is a leading cause of death among children and adolescents in the western world – accounting for about 12.3% of all deaths among children age 1-14 years in the US. Childhood cancer is also emerging as a major cause of death in other parts of the world where death rates from communicable diseases are declining. Leukemia is the most common type of childhood cancer and accounts for about 30% of all childhood and adolescent cancers. Medical Research: What are the main findings? Dr. Amitay: The meta-analysis of all 18 studies indicated that compared with no or shorter duration of breastfeeding, breastfeeding for 6 months or longer was associated with a 19% lower risk for childhood leukemia (OR=0.81, 95% CI, 0.73-0.89). A separate analysis of 15 of those studies indicated that ever being breastfed compared with never being breastfed was associated with an 11% lower risk for childhood leukemia (OR=0.89, 95% CI, 0.84-0.94). All meta-analyses of other sub groups of studies have shown similar associations, indicating that 14%-19% of all childhood leukemia cases may be prevented by breastfeeding for 6 months or more. (more…)
Author Interviews, Cost of Health Care, University of Pittsburgh / 03.06.2015

Julie M. Donohue, Ph.D. Associate professor and Vice Chair for Research Graduate School of Public Health Department of Health Policy and Management University of PittsburghMedicalResearch.com Interview with: Julie M. Donohue, Ph.D. Associate professor and Vice Chair for Research Graduate School of Public Health Department of Health Policy and Management University of Pittsburgh Medical Research: What is the background for this study? What are the main findings? Dr. Donohue: We looked at data on medication use from January through September 2014 on 1 million Affordable Care Act-established marketplace insurance plan enrollees. Our analysis found that among people who enrolled in individual marketplaces, those who enrolled earlier were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending per person and were less likely to use most medication classes than patients enrolled in employer-sponsored health insurance. However, marketplace enrollees were much more likely to use medicines for hepatitis C and for HIV, which is particularly important given the general concerns about the rising costs of these medications for consumers. (more…)
Author Interviews, Diabetes, Surgical Research / 03.06.2015

MedicalResearch.com Interview with: Tom E. Robinson School of Population Health University of Auckland, New Zealand Medical Research: What is the background for this study? What are the main findings? Response: Diabetic foot disease affects up to 50% of people with diabetes and lower limb amputation is a serious complication that has a great impact both on patient quality of life and healthcare costs.  Foot complications are however potentially preventable with good diabetes and foot care and early intervention. There is international evidence of unexplained ethnic variations in the incidence of lower limb amputation.  This study found that ethnicity was strongly associated with risk of lower limb amputation. For example, New Zealand Maori people with diabetes have 63% higher rates of lower limb amputations and this increased risk is not altered by controlling for a range of demographic and clinical risk factors.  Asian New Zealander's have much lower risks of amputation but this may, at least in part, be explained by the 'healthy migrant effect'. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Transplantation / 03.06.2015

Paula Chatterjee, MD, MPH Department of Medicine, Brigham and Women’s Hospital Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with: Paula Chatterjee, MD, MPH Department of Medicine, Brigham and Women’s Hospital Harvard Medical School Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Dr. Chatterjee: Thousands of patients die every year due to organ shortages. Finding ways to address this public health issue is critical. States have designed a variety of strategies to promote organ donation and transplantation, however we don’t know if any of these strategies have been successful. The goal of our study was to try to figure out which strategies have been most successful in terms of increasing organ donation and transplantation. We found that states have implemented a wide and creative set of strategies, but unfortunately, it seems that these strategies have had almost no effect on increasing organ donation and transplantation. In states that adopted these strategies compared to those that did not, the rates of donation and transplantation increased at nearly the same rate over the past two decades. The only strategy that seemed to have a small effect was when states created revenue pools dedicated toward organ donation activities. (more…)
Author Interviews, Biomarkers, Breast Cancer / 03.06.2015

Daniel F. Hayes, M.D. Stuart B. Padnos Professor of Breast Cancer Research University of Michigan Comprehensive Cancer Center Ann Arbor MIMedicalResearch.com Interview with: Daniel F. Hayes, M.D. Stuart B. Padnos Professor of Breast Cancer Research University of Michigan Comprehensive Cancer Center Ann Arbor MI Medical Research: What is the background for this study? What are the main findings? Dr. Hayes: We have developed a circulating tumor cell endocrine therapy index that we hypothesize will identify patients with estrogen receptor positive metastatic breast cancer but who will not benefit from endocrine (anti-estrogen) therapy. We can now semi-quantifiably measure er as well as bcl2, her2, and ki67 in a highly accurate and reproducible fashion.  We are now conducting a multi-institutional prospective trial in North America (the Circulating Tumor Cell-Endocrine Therapy COMETI study) to determine if our hypothesis is correct. (more…)
Author Interviews, JAMA, Ophthalmology, Technology / 02.06.2015

Andrew Bastawrous, MRCOphth International Centre for Eye Health, Clinical Research Department London School of Hygiene and Tropical Medicine (LSHTM), London, EnglandMedicalResearch.com Interview with: Andrew Bastawrous, MRCOphth International Centre for Eye Health, Clinical Research Department London School of Hygiene and Tropical Medicine (LSHTM), London, England Medical Research: What is the background for this study? What are the main findings? Dr. Bastawrous: As part of my PhD with the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine, I led the follow-up of a major cohort study of eye disease [http://www.biomedcentral.com/1471-2415/14/60] following up 5,000 people in 100 different locations across the Great Rift Valley in Kenya. It was really challenging, two-thirds of the locations had no road access or electricity and we were carrying over £100,000 worth of fragile eye equipment and a team of 15 people in two vans to be able to carry out high quality measures of eye disease and answer some important questions for planning eye services. What we found was that in the most difficult to reach locations we would find lots of people waiting to see us who had been unnecessarily blind from preventable/treatable diseases. Despite the locations having no roads, electricity and often no water, nearly all the locations had good phone signal. Together with a brilliant team of developers, engineers and ophthalmologists we developed a suite of smartphone based tests to see if we could replace some of the standard equipment being used, in the hope that we could make it more portable and easier for non-specialists to perform so that ultimately the most high-risk individuals could be reached and treated. This paper describes one of those tests, the visual acuity test - Peek Acuity. Our field workers tested patients in their own homes using a standard card based Snellen chart (the type of vision test most non-ophthalmic healthcare workers are familiar with and has been the most commonly used acuity test for several decades now) and Peek Acuity. The same tests were repeated by the same healthcare worker in the clinic the following day as well as a reference standard vision test (LogMAR ETDRS) performed by an eye trained clinical officer. This allowed us to perform "test re-test", a measure of a tests repeatability. i.e. if you have the same test at two separate time points we would expect the the measures to be very close. We found that for both Peek Acuity and Snellen they were highly repeatable. An advantage of Snellen is the speed of the test, Peek Acuity came out slightly quicker overall. We also found when compared to the reference standard test, Peek Acuity was highly comparable and within a clinically acceptable limit of difference. (more…)
Author Interviews, Diabetes, Diabetologia, Imperial College, Nutrition / 02.06.2015

Dagfinn Aune, PhD student Norwegian University of Science and Technology and Imperial College LondonMedicalResearch.com Interview with: Dagfinn Aune, PhD student Norwegian University of Science and Technology and Imperial College London Medical Research: What is the background for this study? What are the main findings? Response: There are more than 360 million people worldwide that are affected by diabetes, and this number is projected to increase to more than 550 million by 2030, with serious consequences for the health and economy of both developed and developing countries. While previous research has found an association between increased dietary fibre intake and a reduced risk of developing type 2 diabetes, most of these data come from the United States, and amounts and sources of fiber intake differ substantially between countries. In this article the we evaluated the associations between total fiber as well as fiber from cereal, fruit, and vegetable sources, and new-onset type 2 diabetes in a large European cohort across eight countries, in the EPIC-InterAct Study (and included 12403 type 2 diabetes cases and 16835 sub-cohort members). We also conducted a meta-analysis where we combined the data from this study with those from 18 other independent studies from across the globe. We found that participants with the highest total fiber intake (more than 26 g/day) had an 18% lower risk of developing diabetes compared to those with the lowest total fiber intake (less than 19g/day), after adjusting for the effect of other lifestyle and dietary factors. When the results were adjusted for body mass index (BMI) as a marker of obesity, higher total fiber intake was found to be no longer associated with a lower risk of developing diabetes, suggesting that the beneficial association with fiber intake may be mediated at least in part by BMI. In other words, dietary fiber may help people maintain a healthy weight, which in turn reduces the chances of developing type 2 diabetes. In a meta-analysis of the EPIC-InterAct study and 18 other independent studies (>41000 type 2 diabetes cases) we found that the risk was reduced by 9% for each 10 g/day increase in total fiber intake and 25% for each 10 g/day increase in cereal fiber intake. There was no statistically significant association between fruit or vegetable fiber intake and diabetes. (more…)
Author Interviews, Heart Disease, JAMA, Surgical Research / 02.06.2015

Mark L. Friedell, MD, FACS Chairman Department of Surgery University of Missouri Kansas City School of Medicine Kansas City, MO 64108MedicalResearch.com Interview with: Mark L. Friedell, MD, FACS Chairman Department of Surgery University of Missouri Kansas City School of Medicine Kansas City, MO 64108 Medical Research: What is the background for this study? What are the main findings? Response: The controversial practice of administering pre-surgery beta-blockers to patients having noncardiac surgery was associated with an increased risk of death in patients with no cardiac risk factors but it was beneficial for patients with three to four risk factors, according to a report published online by JAMA Surgery. Pre-surgery β-blockade is a widely accepted practice in patients having cardiac surgery. But its use in patients at low risk of heart-related events having noncardiac surgery is controversial because of the increased risk of stroke and hypotension (low blood pressure). Because of the persistent controversy, researcher Mark L. Friedell, M.D., of the University of Missouri-Kansas City School of Medicine, and coauthors analyzed data from the Veterans Health Administration to examine the effect of perioperative β-blockade on patients having noncardiac surgery by measuring 30-day surgical mortality. The analysis included 326,489 patients: 314,114 (96.2 percent) had noncardiac surgery and 12,375 (3.8 percent) had cardiac surgery. Overall, 141,185 patients (43.2 percent) received a β-blocker. Of the patients having cardiac surgery, 8,571 (69.3 percent) received a β-blocker and 132,614 (42.2 percent) of the patients having noncardiac surgery got one. The unadjusted 30-day mortality rates among patients having noncardiac surgery for those not receiving β-blockers were 0.5 percent for patients with no cardiac risk factors, 1.4 percent for patients with one to two risk factors and 6.7 percent for patients with three to four risk factors. For those patients having noncardiac surgery who did receive β-blockers, the unadjusted 30-day mortality rates for patients with no cardiac risk factors, one to two risk factors and three to four risk factors were 1 percent, 1.7 percent and 3.5 percent, respectively, according to the results. The results suggest that among patients with no cardiac risk factors having noncardiac surgery, those patients receiving β-blockers were 1.2 times more likely to die than those not receiving β-blockers. The risk of death decreased for those patients with one to two risk factors but the reduction was not significant. However, for patients having noncardiac surgery with three to four cardiac risk factors, those receiving β-blockers were significantly less likely to die than those not receiving β-blockers, the authors found. The authors did not observe similar results in patients having cardiac surgery. “β-blockade is beneficial perioperatively for patients with three to four cardiac risk factors undergoing NCS [noncardiac surgery] but not in patients with one to two cardiac risk factors. Most important, the use of β-blockers in patients with no cardiac risk factors appears to be associated with a higher risk of death, which has, to our knowledge, not been previously reported,” the study concludes. (more…)
Author Interviews, Immunotherapy, Melanoma / 02.06.2015

Prof. Ze'ev Ronai Ph.D Scientific Director Sanford-Burnham's La JollaMedicalResearch.com Interview with: Prof. Ze'ev Ronai Ph.D Scientific Director Sanford-Burnham's La Jolla Medical Research: What is the background for this study? What are the main findings? Prof. Ronai: There is an urgent need to find new approaches to treat melanoma in patients that are resistant to current therapeutic regimes—and this represents a significant percent of melanoma patients.  We used  samples from patients with drug resistant tumors  to study the molecular basis of resistance and screened for genes involved in the process. We have identified a new player in melanoma resistance to therapy—a molecular target, which provides the basis for clinical trials with drugs currently available to these targets. We found that JAK1 kinase is one target that  is upregulated in the resistant tumors. Inhibiting JAK1 kinase can effectively overcome such resistance.  (more…)
Author Interviews, Opiods, Orthopedics, Pain Research, Surgical Research / 02.06.2015

MedicalResearch.com Interview with: Winfried Meissner, M.D. Dep. of Anesthesiology and Intensive Care Jena University Hospital University Hospital Jena, Germany Medical Research: What is the background for this study? Dr. Meissner: Post-operative pain is managed inadequately worldwide. There are probably many reasons for this, one of which may be lack of evidence about outcomes of treatment in the clinical routine. PAIN OUT was established  as a  multi-national research network and quality improvement project offering healthcare providers  validated tools to collect data about pain-related patient reported outcomes and management after surgery. Patients fill in a questionnaire asking for pain intensity, pain interference and side effects of pain management. The questionnaire has now been translated into 20 languages. Data are collected electronically and clinicians are provided with feedback about management of their own patients, compared to similar patients in other hospitals.  Furthermore, the findings are used for outcomes and comparative effectiveness research. PAIN OUT is unique in that  outcomes of postoperative pain management can be examined internationally. PAIN OUT was created in 2009 with funds from the European Commission, within the FP7 framework and  has now been implemented in hospitals in Europe, USA, Africa and SE Asia. The findings allow us to gain insights as to how pain in managed in different settings and countries. For this particular study, we compared management of pain in the US to other countries. We assessed a large group of patients who underwent different types of orthopedic surgery and compared their patient reported outcomes and management regimens. We included 1011 patients from 4 hospitals in the USA  and 28,510 patients from  45  hospitals in 14 countries (“INTERNATIONAL”). Medical Research: What are the main findings? Dr. Meissner: Postoperative pain intensity of US patients was higher than in INTERNATIONAL patients; they felt more often negatively affected by pain-associated anxiety and helplessness, and more US patients stated they wished to have received more pain treatment. However, other patient-reported outcomes like time in severe pain or the level of pain relief did not differ. We found that treatment regiments of American patients differed compared to INTERNATIONAL patients. More US patients received opioids, and their opioid doses were higher compared to INTERNATIONAL patients. In contrast, INTERNATIONAL countries use more nonopioid medications intraoperatively and postoperatively. Thus, under-supply with opioids cannot explain our findings. Mean BMI of US patients was 30.3 while for INTERNATIONAL it was 27.4. However, insufficient evidence exists that this finding might account for differences in pain intensity. Routine pain assessment was performed in almost all US patients, in contrast to about 75% in the INTERNATIONAL group. Obviously, routine pain assessment, as practiced in the United States, fails to result in lower postoperative pain. Perhaps it has the opposite effect by directing patients’ attention to the pain. (more…)
ASCO, Author Interviews, Journal Clinical Oncology, Melanoma / 02.06.2015

Howard L. Kaufman, MD, FACS Rutgers Cancer Institute of New Jersey New Brunswick, NJMedicalResearch.com Interview with: Howard L. Kaufman, MD, FACS Rutgers Cancer Institute of New Jersey New Brunswick, NJ Medical Research: What is the background for this study? What are the main findings? Response: The study clearly demonstrated that advanced melanoma patients achieved a significant improvement in both response rate and durable response rate with Talimogene laherparepvec, or T-VEC. T-VEC is the first oncolytic virus to show a clinical benefit in a randomized phase 3 clinical trial for the treatment of cancer. Patients who received T-VEC also had an improved progress-free and overall survival with nearly 11% obtaining a complete response. T-VEC is an oncolytic virus that mediates anti-tumor activity by directly killing injected tumor cells and by initiating a systemic immune response. Treatment was also associated with few side effects, which were mostly low grade fever, fatigue, chills, nausea and pain at the injection site. (more…)
Author Interviews, OBGYNE, Pediatrics / 01.06.2015

Prof. Michael Breakspear MB BS, Ba(Hons), Bsc(Med), PhD QIMR Berghofer Medical Research Institute Royal Brisbane HospitalMedicalResearch.com Interview with: Prof. Michael Breakspear MB BS, Ba(Hons), Bsc(Med), PhD QIMR Berghofer Medical Research Institute Royal Brisbane Hospital Medical Research: What is the background for this study? What are the main findings? Prof. Breakspear: The first 72 hours following complicated full-term or premature delivery of a newborn represents a critical window in which survival and long term brain development hangs in the balance. During this window of time, there does not currently exist a reliable, non-invasive, real-time measure of neuropathology that provides neurologists and neonatologists prognostic indicators of clinical outcome. We developed a tool that draws on techniques in physics used to characterize naturally occurring phenomena, such as earthquakes and avalanches, to analyze brain activity recordings of preterm infants. Our tool allows early identification of preterm infants at significant risk of developing poor long-term neurodevelopmental outcomes, such as cerebral palsy and learning difficulties at two years of age. (more…)
Author Interviews, Nutrition, Prostate Cancer / 01.06.2015

Meng Yang, PhD MPH Research Fellow Harvard T. H. Chan School of Public HealthMedicalResearch.com Interview with: Meng Yang, PhD MPH Research Fellow Harvard T. H. Chan School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Yang: There are nearly 3 million American men living with prostate cancer. However, there is very little information for patients and clinicians about how to manage patients’ lifestyles, like diet, after prostate cancer diagnosis to decrease the risk of death due to this disease and improve their survivorship. The most important finding is that men initially diagnosed with prostate cancer without metastases whose diet was more “Westernized”, i.e. higher processed meats, refined grains, potatoes and high-fat dairy, had a significantly higher prostate cancer-related death and all cause mortality. Men whose diet was more “prudent”, i.e. higher intake of vegetables, fruits, fish, whole grains and healthy oils had a lower risk of death. (more…)
Author Interviews / 01.06.2015

Yuyuan Li, PhD Liaoning Provincial Key Laboratory of Brain Diseases Institute for Brain Disorders, Dalian Medical University College of Basic Medical Sciences, Dalian Medical University Dalian ChinaMedicalResearch.com Interview with: Yuyuan Li, PhD Liaoning Provincial Key Laboratory of Brain Diseases Institute for Brain Disorders, Dalian Medical University College of Basic Medical Sciences, Dalian Medical University Dalian China Medical Research: What is the background for this study? What are the main findings? Dr. Li: Traumatic brain injury (TBI) will become the leading cause of death and lifelong disability in the general population by the year 2020. Early determination of prognosis based on epidemiological data is the key to inform care of these patients. Neurobiochemical markers, like Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) have shown a prognostic value for outcome prediction. Recently, several studies have investigated the correlation between serum UCH-L1 concentrations and TBI, however the results thus far have been inconsistent. In the present study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of serum UCH-L1 concentrations after traumatic brain injury. Five studies (including 673 TBI and 1004 controls) were included in the meta-analysis and the overall results reveal that the serum UCH-L1 level was significantly higher in patients with traumatic brain injury compared to those of the control group. Importantly, there was no statistical evidence of a publication bias among the contributing studies from the result of Egger’s test either. (more…)
Author Interviews, Heart Disease, JACC, Weight Research / 31.05.2015

MedicalResearch.com Interview with: Christopher X Wong MBBS MSc PhD Clinical Research Fellow | Clinical Trial Service Unit, Oxford Clinical Senior Lecturer | Centre for Heart Rhythm Disorders, Adelaide Clinical Trial Service Unit, University of Oxford Roosevelt Drive, Oxford Medical Research: What is the background for this study? What are the main findings? Dr. Wong: Atrial fibrillation is an increasingly common heart rhythm disorder. This study demonstrates that even small increments in obesity are associated with a significantly increased risk of atrial fibrillation. Our data suggest that for every 1 unit reduction in body mass index there may be a 3-5% reduction in atrial fibrillation; for every 5 unit reduction, there may be 10-29% reductions. It should also be noted that this is likely to be a significant underestimate of the effect of weight reduction on atrial fibrillation rates as weight control has favourable effects on other risk factors for atrial fibrillation, such as hypertension and diabetes. Given the more than 45 million people with atrial fibrillation worldwide, even small but widespread reductions in obesity would thus help contain this ‘epidemic’ of atrial fibrillation. (more…)
Author Interviews, Biomarkers, Technology / 31.05.2015

R. Kenneth Marcus, FRSC & FAAAS Professor of Chemistry Clemson UniversityMedicalResearch.com Interview with: R. Kenneth Marcus, FRSC & FAAAS Professor of Chemistry Clemson University Medical Research: What is the background for this study? What are the main findings? Prof. Marcus: We had previously shown that chromatographic columns formed from aligned capillary-channeled polymer (C-CP) fibers were highly effective in analytical scale and preparative separations of proteins from diverse media.  The C-CP fibers are extracted from commodity fibers such as polyester, nylon, and polypropylene.  The key aspects in using the C-CP fibers are very high bed porosity and rapid protein-surface mass transfer, this allows for very rapid separations.  Packing of the fibers in narrow-bore polymer tubing (0.8 mm id x 1 cm long) allows them to be fixed to the end of a micropipette tip.  Urine samples of 10 microliter-to-milliliter volumes can be spun through on a microcentrifuge, washed with DI-water, and then eluted with a solvent.  Thus the proteins are isolated and pre-concentrated on the fiber surface.  The elution solvent can be chosen based on the analytical method employed (e.g., MALDI- or ESI-MS).   (more…)
Author Interviews, Heart Disease, JACC, Toxin Research / 31.05.2015

MedicalResearch.com Interview with: Dr. Renjie Chen PhD and Dr. Haidong Kan, PhD School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China MedicalResearch: What is the background for this study? What are the main findings? Response: Although several previous studies in developed countries with cleaner air have reported health benefits due to air filtration, no such interventional studies were conducted in a developing country with much severer air pollution problems. Our main findings suggested that even a short-term intervention (2 days) could significantly reduce indoor air pollution and improve cardiopulmonary health among healthy young adults. (more…)
Author Interviews, Diabetes, Genetic Research, Lipids, PLoS / 31.05.2015

Dr. Yann C Klimentidis, PhD Assistant professor of Epidemiology and Biostatistics Mel and Enid Zuckerman College of Public Health University of Arizona Medical CenterMedicalResearch.com Interview with: Yann Klimentidis Ph.D. Assistant Professor Mel and Enid Zuckerman College of Public Health University of Arizona Medical Research: What is the background for this study? What are the main findings? Dr. Klimentidis: Previous studies have hinted at the possibility that genes which are associated with higher triglyceride levels may also be associated with lower type-2 diabetes. We set out  to test this hypothesis in multiple prospective cohort studies, in European-Americans and in African-Americans. We found that on a collective basis, the alleles which are associated with higher triglycerides are also associated with reduced type-2 diabetes risk. We also identified some individual genetic variants which are driving this trend. (more…)
ASCO, Author Interviews, Breast Cancer, Cancer Research, NEJM, Surgical Research, Yale / 31.05.2015

Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FRCS(C), FACSAssociate Professor, Department of Surgery Director, The Breast Center -- Smilow Cancer Hospital at Yale-New Haven Assistant Director -- Global Oncology, Yale Comprehensive Cancer Center Program Director, Yale Interdisciplinary Breast Fellowship Yale University School of Medicine Breast Centerm New Haven, CT 06510MedicalResearch.com Interview with: Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FRCS(C), FACS, Associate Professor, Department of Surgery Director, The Breast Center -- Smilow Cancer Hospital at Yale-New Haven, Assistant Director -- Global Oncology, Yale Comprehensive Cancer Center Program Director, Yale Interdisciplinary Breast Fellowship Yale University School of Medicine Breast Centerm New Haven, CT, Medical Research: What is the background for this study? What are the main findings? Response: Every year in the US, nearly 300,000 women are diagnosed with breast cancer -- the majority of these will have early stage breast cancer, and will opt for breast conserving surgery to remove their disease.  The goal of this operation is to remove the cancer with a rim of normal tissue all the way around it (i.e., a margin), but sadly, 20-40% of women will have cancer cells at the edge of the tissue that is removed, often mandating a return trip to the operating room to remove more tissue to ensure that no further disease is left behind.  No one likes to go back to the operating room -- so we asked the question, "How can we do better?".  Surgeons have debated various means of obtaining clear margins.  Some have advocated taking routine cavity shave margins -- a little bit more tissue all the way around the cavity after the tumor is removed at the first operation.  Others have argued that this may not be necessary; that one could use intraoperative imaging of the specimen and gross evaluation to define where more tissue may need to be removed (if at all) -- i.e., selective margins.  We conducted a randomized controlled trial to answer this question.  We told surgeons to do their best operation, using intraoperative imaging and gross evaluation, and removing selective margins as they saw fit.  After they were happy with the procedure they had performed and were ready to close, we opened a randomization envelope intraoperatively, and surgeons were either instructed to close as they normally would ("NO SHAVE"), or take a bit more tissue all the way around the cavity ("SHAVE"). Patients in both groups were evenly matched in terms of baseline characteristics.  The key finding was that patients who were randomized to the "SHAVE" group half as likely to have positive final margins and require a re-operation than patients in the "NO SHAVE" group.  On their postoperative visit, we asked patients, before they knew which group they had been randomized to, what they thought of their cosmetic results.  While the volume of tissue excised in the "SHAVE" group was higher than in the "NO SHAVE" group, the distribution of patient-perceived cosmetic outcomes were identical in both groups.  Complication rate was also no different between the two groups.  We will be following patients for five years for long-term cosmetic and recurrence outcomes. (more…)
ASCO, Author Interviews, Cancer Research / 31.05.2015

Tanguy Seiwert, MD Assistant Professor, Dept. of Medicine Associate Director, Head and Neck Cancer Program Section of Hematology/Oncology Fellow, Institute for Genomics and Systems Biology Speciality Chief Editor, Frontiers in Head and Neck Cancer University of Chicago Chicago, IL 60637MedicalResearch.com Interview with: Tanguy Seiwert, MD Assistant Professor, Dept. of Medicine Associate Director, Head and Neck Cancer Program Section of Hematology/Oncology Fellow, Institute for Genomics and Systems Biology Speciality Chief Editor Frontiers in Head and Neck Cancer University of Chicago Chicago, IL 60637 Medical Research: What is the background for this study? Dr. Seiwert: Recurrent/metastatic Head and Neck Squamous Cell Cancer (HNSCC) remains poorly treatable with a median OS of 10-13 months There is evidence of a  prominent immune escape observed in squamous cell carcinoma of the head and neck (SCCHN) suggesting that anti-PD1 agents (similar to e.g. melanoma) may be active. Medical Research: What are the main findings? Dr. Seiwert:
  • One in four patients with Head/Neck cancer treated with pembrolizumab showed marked tumor shrinkage (so called – partial/complete responses), and 57% of patients experienced any decrease in the size of their tumors.
  • Pembrolizumab is broadly active in both HPV(-) and HPV(+) types of squamous cell carcinoma of the head and neck.
  • Pemborliuzmab treatment is active in heavily pretreated squamous cell carcinoma of the head and neck patients.
  • Responses seem to be durable è 86% of responding patients remain in response.
Treatment overall was well tolerated with less than 10% of patients experiencing severe side effects (≥Grade 3). (more…)
Author Interviews, Pediatrics / 31.05.2015

MedicalResearch.com Interview with: David Katz, MD Divisions of Cardiology, and Neonatology, University of Colorado School of Medicine Aurora, Colorado Medical Research: What is the background for this study? What are the main findings? Dr. Katz: Sudden infant death syndrome (SIDS) is the leading cause of infant mortality in the US between 1 month and 1 year of life.  This is the first large study to demonstrate an association between high altitude and SIDS.  In particular there is a doubling of risk above 8,000 feet of elevation relative to below 6,000 feet. Medical Research: What should clinicians and patients take away from your report? Dr. Katz: There is an association between high altitude residence and Sudden infant death syndrome (SIDS).  The reason for this association is still unknown, but hypoxia may be the common link.  While the population living above 8000 feet is small in the US, it is large worldwide.  Better understanding this association is of great medical importance. (more…)
Author Interviews, Heart Disease, JACC, NIH, Race/Ethnic Diversity / 31.05.2015

Dr. Samson Y. Gebreab, Ph.D., M.Sc. Lead Study Author and Research Scientist National Human Genome Research Institute Bethesda, MarylandMedicalResearch.com Interview with: Dr. Samson Y. Gebreab, Ph.D., M.Sc. Lead Study Author and Research Scientist National Human Genome Research Institute Bethesda, Maryland Medical Research: What is the background for this study? Dr. Gebreab: It is well known that African Americans hold a commanding lead in cardiovascular disease (CVD) mortality and morbidity compared to whites and other ethnic groups.  Furthermore, the risk for developing CVD begins early in life and extends over a lifecourse.  Previous studies have indicated the influence of both childhood and adult socioeconomic status (SES) on CVD risk. However, the impact of lifecourse socioeconomic status (both childhood and adulthood) on CVD risk in African American population is not fully understood.  The purpose of our study was to investigate the associations of different measures of lifecourse socioeconomic status with cardiovascular disease risk in African Americans and whether the associations were modified by sex and/ or age after controlling for known cardiovascular disease risk factors.  We analyzed 10-year follow-up data of African American adults who were participating in Jackson Heart Study, Jackson, MS. Medical Research: What are the main findings? Dr. Gebreab: Our findings highlights that among those of lower socioeconomic status,  women and younger (<=50 years old)  African Americans are at increased risk of CVD, including heart disease and stroke compared to their counterparts of higher socioeconomic status groups.          African American women in the lowest socioeconomic status, had more than twice the risk of developing cardiovascular disease than those in the highest socioeconomic status group.          African Americans of 50 years and younger in the lowest socioeconomic status group had more than three times higher risk of experiencing a cardiovascular disease event than those in the highest socioeconomic status group. (more…)
Anesthesiology, Author Interviews, Blood Pressure - Hypertension, Surgical Research / 31.05.2015

Prof. Dr. Robert Sanders MD Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION) Department of Anesthesiology University of Wisconsin, Madison, WIMedicalResearch.com Interview with: Prof. Dr. Robert Sanders MD Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION) Department of Anesthesiology University of Wisconsin, Madison, WI Medical Research: What is the background for this study? What are the main findings? Dr. Sanders: While it is known that chronic raised blood pressure exerts important effects on long term health outcomes, it is unclear how pre-operative blood pressure levels effect risk from surgery. In this study we show that after adjustment for other diseases, high blood pressure does not increase perioperative risk. Rather low blood pressure is associated with an increase in risk of death following surgery and anesthesia. (more…)
Author Interviews, Breast Cancer, General Medicine / 31.05.2015

MedicalResearch.com Interview with: Bruno M. Heleno MD The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Medical Research: What is the background for this study? What are the main findings? Dr. Heleno: False positive mammography causes psychological distress. Several observational studies have shown this, and their results have been summarized in systematic reviews. However, it was unclear whether women requiring invasive tests (needle or surgical biopsy) were more distressed than women only requiring non-invasive procedures (clinical examination or imaging). Contrary to previous research, we found that these two groups of women were equally distressed during the 36 months of follow-up in our cohort. The best estimate for the difference for 12 related measures of distress was always close to zero. (more…)