Author: Marie Benz MD FAAD
24 Jul Genomics Aims To Refine Cancer Screening Programs
MedicalResearch.com Interview with:
Dr. Pam Marcus PhD
Epidemiology and Genomics Research Program
Division of Cancer Control and Population Sciences
National Cancer Institute
National Institutes of Health
Bethesda, MD 20892
MedicalResearch: Why do we need to consider targeted cancer screening?
Dr. Marcus: Cancer screening, the routine testing of asymptomatic individuals without a history of the disease of interest, is an important approach to cancer prevention and control. There is compelling evidence that screening for at least four cancers reduces disease-specific mortality, but population-based cancer screening also leads to unfavorable events. Only a minority of those screened will benefit, and many will have false-positive exams. Some screenees will experience undesirable sequelae, ranging from minor inconveniences to serious adverse events due to the exam itself or diagnostic evaluation.
MedicalResearch: What is the goal of targeted cancer screening in average-risk individuals?
Dr. Marcus: Targeted cancer screening attempts to segregate those who will benefit from screening from those who will not through use of information on disease risk. Average risk individuals are those not known to be at substantially elevated risk, including those without known inherited predisposition, without co-morbidities known to increase cancer risk, and without previous diagnosis of cancer or pre-cancer. The goal of targeted cancer screening in average risk individuals is to reduce the number of individuals who need to be screened while preserving the overarching benefit of reduced cancer-specific mortality in the general population. Targeted cancer screening is an example of precision medicine; visit http://www.nih.gov/precisionmedicine/goals.htm to learn more about the National Institute of Health’s Precision Initiative.
24 Jul Long Term Survival After Breast Cancer Diagnosis Has Increased For All Age Groups
MedicalResearch.com Interview with:
Mitchell H. Gail, M.D., Ph.D.
Senior Investigator
Biostatistics Branch
Division of Cancer Epidemiology and Genetics
National Cancer Institute National Institutes of Health
Rockville MD 20850-9780
Medical Research: What is the background for this study?
Dr. Gail: In the United States, breast cancer survival following diagnosis has been improving since the 1970s. We wanted to understand what might explain these shifts, to fully characterize the changes over time, and to explore whether tumor size and estrogen receptor status could help explain the trends in age- and stage-specific breast cancer death rates after diagnosis.
We evaluated survival from breast cancer from the date of diagnosis of all women diagnosed with invasive breast cancer in the US SEER Cancer Registries between 1973 and 2010. We excluded women with ductal or lobular carcinoma in situ. We analyzed separate age groups (<50, 50-69, 70+ years) and SEER stage of disease (local, regional, distant).
Medical Research: What are the main findings?
Dr. Gail: Between 1973 and 2010, breast cancer death rates after diagnosis in the United States have fallen for each age group of women diagnosed with local or regional stage disease, not only in the first five years after diagnosis, but also thereafter. For women under age 70, rates also fell for women with distant disease.
Changes in tumor size or estrogen-receptor status do not explain much of the improvement among women under age 70 years, but do explain roughly half the improvement in 70+ year old women in the first five years after diagnosis.
24 Jul Comparison of Surgical Techniques For Abdominal Aortic Aneurysm Repair
ate Abdominal Aortic Aneurysm rupture is more common after endovascular repair. This highlights the need for more research to prevent late rupture and highlights the need for patients to continue to undergo routine surveillance to detect problems that can potentially be fixed with a minimally invasive treatment....
24 Jul Recessive Genes May Play Role in Coronary Artery Disease, Especially in Inbred Populations
MedicalResearch.com Interview with: Dr. Paraskevi Christofidou Department of Cardiovascular Sciences, University of Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Leicester UK MedicalResearch: What is the background for this study? Dr. Christofidou: Homozygosity arises when identical alleles are present on both chromosomes. Runs of homozygosity (ROHs) are very long segments of uninterrupted sequences of homozygous variants across the human genome. Runs of homozygosity represent "re-union" of pieces from DNA from parents in their children. The two DNA copies are identical because have been inherited from a common ancestor somewhere in the distant past. Runs of homozygosity are recognized signature of recessive inheritance, because they allow unmasking of recessive variants. Recessive variants only show their effect when present on both chromosomes of an individual's genome. Some of these ROHs may potentially harbor variants that exert their pathological effects in the homozygous recessive state. This is important because it helps us better understand the consequences of the recessive model of inheritance in relation to complex diseases. Coronary artery disease (CAD) is a terminal clinical manifestation of cardiovascular disease and is the leading cause of death worldwide and is the UK's single biggest killer. Nearly one in six men and one in ten women die from CAD. Coronary artery disease is a complex, multifactorial disorder originating from a complicated interplay of multiple genetic and environmental factors. Contributions of ROHs to the genetic architecture of CAD are not known. The primary goal of this project was a comprehensive analysis of association between genome-wide homozygosity measures and CAD in individuals of white European ancestry. A secondary aim was to explore the association of ROHs and gene expression in human monocytes and macrophages. MedicalResearch: What are the main findings? Dr. Christofidou: Our analysis of 24,320 individuals from 11 populations of white European ethnicity revealed statistically significant differences in homozygosity levels between individuals with Coronary artery disease and control subjects. On average, individuals with CAD had 0.63 ROHs more than control subjects. The average total length of ROHs was approximately 1046.92 kb greater in individuals with CAD than control subjects. We were able to qualify a measure of genome-wide homozygosity levels in relation to CAD - an estimated 13% increase in CAD per 1 standard deviation increase in the proportion of the autosomal genome covered by ROHs. Individual ROHs showed significant associations with monocyte and macrophage expression of genes located nearby. These associations suggest that many ROHs might be signatures of biologically active recessive variants with a potential to regulate transcription.24 Jul Menopausal Women Accumulate Fat…..Around Their Hearts
Posted at 01:00h
in Author Interviews, Heart Disease, JCEM, University of Pittsburgh, Women's Heart Health
MedicalResearch.com Interview with:
Samar R. El Khoudary, Ph.D., M.P.H.
Assistant professor
Graduate School of Public Health Department of Epidemiology
University of Pittsburgh
Medical Research: What is the background for this study?
Dr. El Khoudary: Cardiovascular disease is the leading cause of death in women, and it increases after age 50 - the average age when a woman is going through menopause. Weight gain in women during and after menopause has long been attributed to aging, rather than menopause itself. However, recent research identified changes in body fat composition and distribution due to menopause-related hormonal fluctuations.
No previous study had evaluated whether those changes in fat distribution during menopause affect cardiovascular fat. Increased and excess fat around the heart and vasculature can be more detrimental than abdominal fat, causing local inflammation and leading to heart disease. Doubling certain types of cardiovascular fat can lead to a more than 50 percent increase in coronary events. My team and I investigated whether there may be a link between menopause and cardiovascular fat using data from 456 women from Pittsburgh and Chicago enrolled in the Study of Women's Health Across the Nation (SWAN). The women averaged about 51 years of age and were not on hormone replacement therapy.
Medical Research: What are the main findings?
Dr. El Khoudary: Our study is the first to find that late- and post-menopausal women have significantly greater volumes of fat around their hearts than their pre-menopausal counterparts. As concentrations of the sex hormone estradiol - the most potent estrogen - declined during menopause, greater volumes of cardiovascular fat were found. The finding held even after my colleagues and I took into account the effects of age, race, obesity, physical activity, smoking, alcohol consumption, medication use and chronic diseases.
23 Jul Lipid in Butter and Whole Fat Milk May Decrease Risk of Pre-Diabetes
MedicalResearch.com Interview with:
Dr. Stephanie K. Venn-Watson
Doctor of Veterinary Medicine, MS
Director, Translational Medicine and Research Program
National Marine Mammal Foundation
Medical Research: What is the background for this study? What are the main findings?
Dr. Venn-Watson: Bottlenose dolphins, just like people, can develop a condition called metabolic syndrome. In humans, metabolic syndrome is also called prediabetes, which affects 1 in every 3 adults in the U.S.
Some human studies have suggested that eating a diet high in fish may lower the risk of developing metabolic syndrome. Other similar studies, however, have had inconsistent findings. To better understand how fish diets may be associated with dolphin metabolic health, we compared 55 fatty acids among 49 dolphins and their dietary fish.
We were surprised to find that the strongest predictor of lower, healthier insulin levels in dolphins was a saturated fat called, heptadecanoic acid (or C17:0). When we provided a diet higher in C17:0 to six dolphins over six months, their insulin, glucose, and triglycerides normalized. We also saw an immediate decrease in ferritin, a protein which - at high levels - may be a risk factor for metabolic syndrome.
In addition to some fish, C17:0 is present in dairy fat, including whole fat milk and butter. C17:0 was not present in nonfat dairy products. We hypothesize that movement towards nonfat dairy foods may be lowering human C17:0 blood levels, which may be contributing to the global rise in metabolic syndrome and type 2 diabetes.
23 Jul Almost A Third of Adults With Heart Disease or Stroke Don’t Take Aspirin Regularly
MedicalResearch.com Interview with:
Dr. Jing Fang Ph.D.
Epidemiologist
Center For Disease Control
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Fang: Although the effectiveness of aspirin for secondary prevention (e.g. people who already have coronary heart disease or have had an ischemic stroke) of cardiovascular disease has been determined, its prevalence as a preventive measure has varied widely across settings, data collection methods and U.S. states. As a result, we wanted to more closely examine aspirin use among U.S. adults with a history of coronary heart disease or stroke.
To determine these findings, we analyzed data from the 2013 Behavioral Risk Factor Surveillance System. Nearly 18,000 people from 20 states and the District of Columbia with a self-reported history of coronary heart disease or stroke were included in the annual telephone survey.
Overall, we found about 70 percent of U.S. adults with heart disease or stroke reported regularly taking aspirin – meaning every day or every other day. Out of that group, nearly 94 percent said they take aspirin for heart attack prevention, about 80 percent linked it to stroke prevention efforts, and approximately 76 percent said they use it for both heart attack and stroke prevention. However, four percent of respondents with pre-existing cardiovascular problems said they take aspirin for pain relief without awareness of its benefits for cardiovascular disease.
Aspirin use also differed by state and sociodemographic characteristics including gender, race/ethnicity and age. In general, men, non-Hispanic whites, individuals aged 65 and older, and people with at least two of four risk factors (hypertension, smoking, diabetes and high cholesterol) are more likely to use aspirin than other groups. By state, aspirin use ranged from 44 percent in Missouri to more than 71 percent in Mississippi.
23 Jul Melanoma: Lymph Node Radiation After Lymphadenectomy Did Not Improve Survival
MedicalResearch.com Interview with: Michael A Henderson MBBS BMedSc MD FRACS Professor of Surgery, University of Melbourne Deputy Director Division of Cancer Surgery Head Skin and Melanoma Service Division of Cancer Surgery Peter MacCallum Cancer Centre East Melbourne Victoria Australia Medical Research: What is the background for this study? What are the main findings? Dr. Henderson: A number of retrospective reviews of adjuvant radiotherapy after lymphadenectomy for patients at high risk of further lymph node field relapse had all suggested that the risk of lymph node field relapse was reduced but there was controversy about whether there was any impact on survival. In addition many clinicians were concerned about the side effects of radiotherapy and in the absence of a proven survival benefit were reluctant to recommend it. Previously a phase 2 trial of adjuvant radiotherapy conducted by one of our co-authors Prof Bryan Burmiester confirmed that the morbidity of lymph node field radiotherapy was limited and the risks of recurrence was reduced. On that basis the current ANZMTG TROG randomised multicentre trial was initiated. In summary this final report updates information on overall survival, lymph node field relapse etc and provides information for the first time on long term toxicity of treatment, quality of life and lymphedema. Adjuvant lymph node field radiotherapy for patients at high risk of further lymph node field relapse reduces the risk of further lymph node field relapse by 50% but it has no effect on survival. Although radiotherapy toxicity was common (3 in 4 patients), mostly involving skin and subcutaneous tissue it was mild-to-moderate in severity and had little impact upon the patient's quality of life as measured by the FACT-G quality of life tool. Specific regional symptoms were more common in the radiated group. Limb volume measurements confirmed a significant but modest increase for patients receiving inguinal radiation (15%) but not for axillary radiation. In the design of this trial, a decision was made to allow patients in the observation arm who developed an isolated lymph node field relapse to be salvaged by surgery and or radiotherapy. There were only two patients in the radiotherapy arm who developed an isolated lymph node field relapse and both died of metastatic disease. In the observation arm 26 patients developed an isolated lymph node field relapse and the majority (23) achieved lymph node field control with a combination of surgery and or radiotherapy. The five-year survival FROM development of a lymph node field relapse in this group was 34% which is comparable to the overall survival of the entire cohort (42% five-year overall survival). This information whilst a subset analysis suggests that if it would be reasonable in some patients to consider a policy of observation only, reserving further surgery and or radiotherapy for a second relapse.23 Jul Compliance With Guidelines Not Linked To Outcomes in Traumatic Brain Injury
MedicalResearch.com Interview with:
Aaron J. Dawes, MD
Fellow, VA/RWJF Clinical Scholars Program
Division of Health Services Research, University of California Los Angeles
Los Angeles, CA 90024
Medical Research: What is the background for this study? What are the main findings?
Dr. Dawes: In the fall of 2013, we formed the Los Angeles County Trauma Consortium, building upon a prior administrative relationship between LA County’s 14 trauma centers. We added health research researchers from UCLA and USC, and shifted the focus of the group from logistical issues to quality improvement. As a first project, our hospitals wanted to know if there was any variation in how traumatic brain injury patients are cared for across the county. Traumatic brain injury accounts for over 1/3 of all injury-related deaths in the U.S. and is the number one reason for ambulance transport to a trauma center in LA County.
When we looked at the data, we found widespread variation in both how these patients were cared for at different hospitals and what happened to them as a result of that care. After adjusting for important differences in patient mix, we found that mortality rates varied by hospital from roughly 25% to 55%. As we tried to explain this variation, we looked into how often hospitals complied with two evidence-based guidelines from the Brain Trauma Foundation, hoping that we could eventually develop an intervention to boost compliance with these recommended care practices. While compliance rates varied even more widely than mortality—from 10 to 65% for intracranial pressure monitoring and 7 to 76% for craniotomy—they did not appear to be associated with risk-adjusted mortality rates. Put simply, we found no connection between how often hospitals complied with the guidelines and how likely their patients were to survive.
23 Jul Study Evaluates Cannabis For Pain From Diabetic Neuropathy
MedicalResearch.com Interview with:
Mark S. Wallace MD
Department of Anesthesiology
School of Medicine
University of California, San Diego, California
Medical Research: What is the background for this study? What are the main findings?
Dr. Wallace: The study was funded by the center for medicinal cannabis research at the University of California San Diego. The center was funded by the state of California. The center was the first to fund a series of double-blind randomized controlled trials with inhaled cannabis for neuropathic pain. My trial is the first in diabetic peripheral neuropathy pain which is one of the most prevalent pain syndromes in our society with limited treatments. We found a dose dependent reduction in pain. However there was also a dose dependent increase in euphoria and sedation which may limit clinical use. Effects on neurocognitive functioning were minimal.
23 Jul Change in PAP Smear Guidelines Unintentionally Means Fewer Chlamydia Tests
Posted at 00:09h
in Author Interviews
MedicalResearch.com Interview with:
Allison Ursu, MD
Department of Family Medicine
University of Michigan Medical School
Ann Arbor
Medical Research: What is the background for this study? What are the main findings?
Dr. Ursu: This study was the result of a trend I noticed in clinical practice when in 2009 ACOG recommended that screening for cervical cancer =not begin until age 21 and it seemed that chlamydia screening could be easily missed. When a PAP test is done for cervical cancer screening it is very easy to send another swab for chlamydia screening. Our main findings are two years after the 2009 guideline change the rates of PAP tests decreased significantly which was appropriate but there was an unintended consequence of a significant decrease in chlamydia screening despite no change to the recommendation of chlamydia screening for females age 16-24.
22 Jul Investigational Drug Shows Promise In Treating Marburg Hemorrhagic Fever
MedicalResearch.com Interview with: Alison E. Heald, M.D Harborview Medical Center Seattle, WA 98104 MedicalResearch: What is the background for this study? What are the main findings? Dr. Heald: Marburg virus causes a very serious, potentially fatal infection in humans for which there is currently no licensed or approved treatments or vaccines. We demonstrated that AVI-7288, an investigational drug specifically directed against Marburg virus, is effective in preventing death in monkeys exposed to Marburg virus in an experimental model, and that AVI-7288 raises no safety concerns in parameters measured in the healthy human volunteers dosed at or above the estimated efficacious dose. Importantly, taken together, these results have allowed us to predict a dose that could be expected to protect humans exposed to Marburg virus.22 Jul No Association Between Kidney Stones and Osteoporosis or Fractures in Women
MedicalResearch.com Interview with:
Monique Bethel, MD
Subspecialty Service, Department of Veterans Affairs Medical Center,
Department of Medicine, Section of Rheumatology
Georgia Regents University
Augusta, GA
MedicalResearch: What is the background for this study?
Dr. Bethel: Osteoporosis and kidney stones share several risk factors, including elevated calcium in the urine (hypercalciuria), low potassium intake, and possibly, diets high in sodium. Accordingly, several studies have shown a significant relationship between kidney stones and osteoporosis in men. However, it is unclear if this relationship is also true for women. Previous studies examining this association have been small and inconclusive. With the Women’s Health Initiative, we had data available from approximately 150,000 postmenopausal women in the US. Using this database, we were able to study the relationship between kidney stones and changes in bone mineral density and fractures.
MedicalResearch: What are the main findings?
Dr. Bethel: We found no association between the presence of kidney stones and changes in bone mineral density over time at the hip, lumbar spine, or the whole body. Also, there was no association between the presence of kidney stones and fractures. We also found that 14% of women who had a history of kidney stones upon entering the studies had another one occur during the course of the study (approximately 8 years).
22 Jul Oral Anticoagulation Medications Have Led To More Patients Treated For Atrial Fibrillation
Posted at 21:48h
in Author Interviews
MedicalResearch.com Interview with:
Geoffrey Barnes, MD, MSc
Clinical Lecturer
Cardiovascular Medicine and Vascular Medicine
University of Michigan Health System
Medical Research: What is the background for this study? What are the main findings?
Dr. Barnes: While warfarin has been the primary oral anticoagulant used for over 60 years, a new class of anticoagulants known as ‘direct oral anticoagulants’ (including dabigatran, rivaroxaban and apixaban) have been introduced within the last 5 years. These newer medications were developed to be easier for patients and physicians to use. While early data suggested quick adoption of these medications, there had not been a nation-wide assessment of their use and how specific diseases influenced the use of specific oral anticoagulants.
Using a national sample of office visits, we generated national estimates of oral anticoagulant use for patients between 2009 and 2014. The primary finding is that total number of office visits where an anticoagulant was used increased from 2.05 million to 2.83 million between 2009 and 2014, largely driven by a rapid increase in the use of the direct oral anticoagulant medications. Specifically among patient visits for atrial fibrillation, the total number of visits where an oral anticoagulant was used increased from 52% to 67%. This is important because there has long been concern about “under treatment” of atrial fibrillation and the risk of stroke for patients who do not receive anticoagulation. This study suggests that the direct oral anticoagulants may be helping to protect more patients with atrial fibrillation from strokes.
22 Jul Prolonged Standing Associated With Musculoskeletal Disorders and Health Problems
MedicalResearch.com Interview with: Maria-Gabriela Garcia Ph.D candidate Sensory-Motor Systems Lab, ETH Zurich Zurich, Switzerland and Dr. B.J. Martin University of Michigan, Ann Arbor Medical Research: What is the background for this study? What are the main findings? Response: Many workers are required to stand for prolong periods of time at their workplace. Several investigations have associated prolonged standing with back pain, and musculoskeletal disorders. The accumulation of muscle fatigue is assumed to lead to such disorders. However, the long-lasting effects of fatigue in the lower limbs induced by prolonged standing work have received little attention. Our main findings indicate that 5 hours of standing work including regular seated rest breaks lead to a significant long-term fatigue in the lower leg muscles. The objective measures showed that the effects persisted at least 30 min after a seated recovery period while they were not subjectively perceived. Thus, subjective evaluations may not be sensitive to the long-term effects of fatigue. In addition, fatigue was not observed after 2 hours of standing work.22 Jul Prenatal Factors and Unhealthy Lifestyle Contribute To Risk of Type 2 Diabetes
MedicalResearch.com Interview with:
Lu Qi, MD, PhD, FAHA
Associate Professor of Medicine
Harvard Medical School
Assistant Professor of Nutrition
HarvardSchool of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Lu Qi: Most previous studies focus on the effects of either lifestyle or prenatal malnutrition on diabetes risk; no study has assess these two types of risk factors in combination.
22 Jul Elevation of Both apoB and nonHDL-C Imply Greater Atherosclerosis Risk in Type 1 Diabetes
MedicalResearch.com Interview with:
Petter Bjornstad, MD
Fellow in Pediatric Diabetes & Endocrinology
Children's Hospital Colorado & Barbara Davis Center for Childhood Diabetes
Aurora, CO 80045
MedicalResearch: What is the background for this study?
Dr. Bjornstad: Apolipoprotein B (apoB) and non-high density lipoprotein-cholesterol (nonHDL-C) have been proposed to be superior indicators of cardiovascular (CV) risk than total cholesterol and/or low density lipoprotein-cholesterol (LDL-C). Some authors argue that while nonHDL-C and apoB correlate, they are not necessarily interchangeable, and may in fact provide unique information about cardiovascular risk. However, there are insufficient data on the concordance between apoB and nonHDL-C in adults with type 1 diabetes mellitus (DM) across a wide range of risk factors for cardiovascular disease.
MedicalResearch: What are the main findings?
Dr. Bjornstad: Adults with type 1 diabetes and elevated apoB (≥90mg/dL) and nonHDL-C (≥130mg/dL) had greater odds of coronary artery calcification progression compared to adults with type 1 diabetes and normal apoB and nonHDL-C (OR: 1.90, 95% CI 1.15-3.15), and compared to adults with type 1 diabetes with elevated apoB alone (OR: 2.86, 95% CI 1.43-5.74) adjusting for age, sex, duration, HbA1c and statins. We also obtained similar results with elevated apoB and nonHDL-C defined as ≥ the cohort means. Accordingly, we concluded that elevated apoB and nonHDL-C carry a greater risk of atherosclerosis than elevated apoB in the absence of elevated nonHDL-C in adults with type 1 diabetes.
22 Jul Blacks are Significantly Younger Than Whites At Time of Cardiac Arrest
MedicalResearch.com Interview with:
Dr. Sumeet Chugh MD
Pauline and Harold Price Professor of Cardiac Electrophysiology
Associate director of the Cedars-Sinai Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Response: Research studies performed in the past 2 decades suggest that there is a higher burden of sudden cardiac arrest in black americans compared to whites. However there are no studies that explore the reasons for this phenomenon. Our study confirmed that these observations hold true in the current era. There are two additional novel findings. Firstly, we uncovered the disturbing fact that blacks are significantly younger than whites at the time of their cardiac arrest. The majority of blacks are under the age of 65 and the majority of whites were over 65. Furthermore, blacks who suffered sudden cardiac arrest were more likely to have diabetes, high blood pressure and chronic kidney disease.
22 Jul High Risk Plaques Account for Only Half of Acute Coronary Events
MedicalResearch.com Interview with:
Dr. Jagat Narula MD, PhD
Associate Dean For Global Affairs
Professor Medicine, Cardiology and Radiology
Mt. Sinai Hospital, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Narula: The cardiovascular diseases remain number one cause of mortality in men and women and in high as well as middle and low income countries. It is important that we identify those who are likely to die of preventable causes. Identification of the vulnerable plaques that are likely to result in acute events has been an interesting focus of investigators, and numerous intravascular imaging and noninvasive imaging strategies have been employed. CT angiography has offered fairly attractive accuracy. We were the first to establish the features of high-risk plaques (Motoyama, Narula JACC 2007) and their short-term prognostic implications (Motoyama, Narula JACC 2009). In this new paper in a large population we present intermediate- to long-term follow-up that critically analyzes the role of plaque characterization and puts it in perspective. Should we keep chasing plaques or should we treat the patient? Does the answer lie in high risk plaque busting or prevention be the mainstay?
From the previous studies from us and others we have known that computed tomography angiography (CTA)-based plaque characteristics identify high-risk plaque (HRP) that predict short-term risk of acute coronary syndrome (ACS). We in this study wanted to evaluate whether plaque characteristics by CTA would predict intermediate- to long-term likelihood of acute events. The presence of high-risk plaque characteristics were evaluated in more than 3000 patients undergoing CTA and plaque progression (PP) in additional 450 patients who had two CTA one year apart. We recorded fatal and nonfatal acute events and outcomes during follow-up: mean about 4 years and maximum up to 10 years. Acute Coronary Syndrome occurred in about 40 of ~300 (16%) with high risk plaque and 40 (less than 1.5%) of the remaining patients with non high risk plaques. In patients with serial CTA, plaque progression also was an independent predictor of ACS, with HRP (27%) and without HRP (10%) compared with patients without plaque progression (0.3%).
22 Jul Bystander CPR Programs Can Save Lives After Cardiac Arrest
MedicalResearch.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.
22 Jul No Difference in PCI Stent Surgery Mortality Performed With/Without Surgical Support
MedicalResearch.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.
21 Jul Younger Black Men With Breast Cancer Have Higher Mortality Rate
Posted at 21:12h
in Author Interviews, Breast Cancer, Journal Clinical Oncology, Race/Ethnic Diversity
MedicalResearch.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.
21 Jul Precision Antibodies Target Defective Protein in Alzheimer’s and Parkinson’s Model
MedicalResearch.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.
21 Jul Despite Notification, Most High Risk Patients Do Not Seek Further Breast Cancer Evaluation
MedicalResearch.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.
21 Jul Peripheral Nerve Stimulation Improves Motor Nerve Function After Spinal Cord Injury
MedicalResearch.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.
20 Jul Aging Adults Benefit From Exposure To Green and Blue Spaces
MedicalResearch.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.
20 Jul Family History of Lupus Is Strong Risk Factor For Lupus and Other Autoimmune Diseases
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.20 Jul Non-Psychotropic Cannabis Extract May Promote Bone Healing
MedicalResearch.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.
20 Jul Older Sexually Active Adults Report Better Quality of Life
MedicalResearch.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.