MedicalResearch.com Interview with:
Maria L. Wei, M.D., Ph.D.
Associate Professor of Dermatology
Director, Melanoma Surveillance Clinic
Multidisciplinary Melanoma Program
University of California, San Francisco
Staff Physician
Veterans Affairs Medical Center, San Francisco
Medical Research: What is the background for this study?
Dr. Wei: Effective physician-patient communication is essential for optimal medical care. There are now many methods available to notify patients of their biopsy results: a clinic visit (the method traditionally preferred by patients), a telephone call, secure online patient portals to access medical charts, email and texts. In addition, there is variability from state to state in the guidelines regulating the release of biopsy results online. Until recently, some states did not allow the on-line release of biopsy results. There have been few systematic studies on patient preferences for communication of biopsy results. (more…)
MedicalResearch.com Interview with:
Marc Ryser PhD
Visiting Assistant Professor Department of Mathematics
Duke University Durham, North Carolina
Medical Research: What is the background for this studyDr. Ryser: Infection with the human papillomavirus (HPV) is responsible for approximately 5% of all cancers worldwide. In addition to cervical cancers, HPV is associated with various other female and male cancers, including cancers of the anus and oropharynx. Despite expansive screening and vaccination programs, HPV-related cancers remain a serious public health concern in the US and abroad. To further improve public health interventions against HPV, a thorough understanding of the underlying biology is critical.
The lifetime risk of getting infected with HPV is as high as 80%, yet most individuals remain asymptomatic and clear the virus after 1-2 years. However, if an infection with a high-risk type of HPV persists, the virus can interfere with the replication mechanism of the host cells, and initiate tumor growth. Even though our understanding is incomplete to date, clearance of HPV infections is primarily attributed to an effective immune response.
Interestingly, recent studies about the stem cell dynamics in epithelial tissues - the types of tissues that are affected by HPV - have shown that the fate of these stem cells is random: most of the time, a stem cell divides into a new stem cell and a differentiating daughter cell; however, every now and then, a stem cell divides either into two stem cells, or into two differentiating daughter cells. These dynamics have not been acknowledged by the HPV community, and our goal was to develop mathematical models to examine whether the random division patterns of stem cells could play a role in the clearance of HPV infections.
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MedicalResearch.com Interview with: Isao Saito, MD, PhD
Department of Basic Nursing and Health Science,
Ehime University Graduate School of Medicine
Toon, EhimeMedical Research: What is the background for this study? What are the main findings?
Response: Type 2 diabetes is a major lifestyle-related disease with a rapid increasing prevalence in Japan. One meta-analysis of six cohort studies showed that an increase in daily food intake of 1.15 servings of green leafy vegetables was associated with a 14% reduction in the incidence of type 2 diabetes. Therefore, it is evident to think that green and yellow vegetables have beneficial effects against type 2 diabetes. Nonetheless, the relationship of their nutritive content with insulin resistance is poorly understood.
We conducted the Toon Health Study initiated in 2009, which was a prospective cohort study of the Japanese general population. The cohort study was intended to characterize environmental risk factors related to incident diabetes and cardiovascular disease. Participants were recruited from the general population aged 30–79 years who were living in Toon City, Ehime Prefecture, Japan.
Of them, we investigated 951 Japanese men and women aged 30–79 years who were not undergoing treatment for diabetes and measured their serum β-carotene and retinol concentrations. A 75-g oral glucose tolerance test was performed and the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and the Matsuda Index were calculated as measures of insulin resistance.
Multivariable-adjusted odds ratios of the highest quartile of serum β-carotene compared with the lowest quartile for HOMA-IR >1.6 and Matsuda Index <4.9 were 0.56 (95% confidence interval, 0.34–0.94) and 0.62 (0.37–1.02), respectively. When stratified by sex and overweight status, these associations were observed for women and non-overweight individuals. Serum retinol concentration was not associated with either index. Furthermore, according to the nutritional survey, serum β-carotene concentration was associated with green and yellow vegetable intake (p = 0.01).
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MedicalResearch.com Interview with: Alan J. Wolfe PhD, Professor
Department of Microbiology and Immunology
Stritch School of Medicine, Loyola University Chicago
Maywood, IL
Medical Research: What is the background for this study?
Dr. Wolfe: Several years ago, Dr. Brubaker and I began a conversation. As a urogynecologist, she was concerned about the general lack of improvement in diagnosis and treatment in her urogynecological practice and thus in clinical outcome. As a microbiologist, I was extremely skeptical of the dogma that urine in the bladder was sterile in the absence of a clinical infection. This skepticism was based upon my former work in bacterial motility and biofilm formation and on the knowledge that most bacteria are not cultured by the standard clinical microbiology urine culture method. With the goal of ultimately improving urogynecological practice, and with the help of our colleagues in the Loyola Urinary Education and Research Collaborative (LUEREC), we decided to test the sterile bladder hypothesis by seeking evidence of bacteria in urine taken directly from the bladder to avoid vulva-vaginal contamination. To detect bacterial DNA, we used high-throughput DNA sequencing technology. To detect live bacteria, we developed an Expanded Quantitative Urine Culture (EQUC) protocol. We applied these complementary approaches to women with and without urgency urinary incontinence (UUI) whose standard clinical urine culture was negative.
Medical Research: What are the main findings?
Dr. Wolfe: First and foremost, the bladder is not sterile. We can detect bacteria and/or bacterial DNA in most women whether they have urgency urinary incontinence (UUI) or not. Thus, the female bladder contains a resident bacterial community, which we call the female urinary microbiome (FUM). We found that bacterial members of the FUM are distinct from the bacteria that typically cause urinary tract infections (UTI). Thus, the bacteria that make up the FUM are not the bacteria that cause typical UTIs. Indeed, detection of the female urinary microbiome was associated with reduced risk of UTIs that often occur after instrumentation or surgery. We therefore hypothesize that the FUM or some members of the FUM could protect against UTI. We also saw that the FUM in women with UUI differs from the FUM in women without UUI and that certain bacterial species were considerably more common in women with urgency urinary incontinence than in women without urgency urinary incontinence . We hypothesize that some of these bacteria could be causative or contributory to UUI or they could be a consequence of urgency urinary incontinence.
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MedicalResearch.com Interview with:
Dr. Michele Jonsson Funk, PhDResearch Associate Professor, Dept of EpidemiologyDirector, Methods Core, Center for Women’s Health ResearchUniversity of North Carolina at Chapel Hill and
Dr. Wendy Camelo Castillo, MD, PhD
Post-doctoral fellow at the University of Maryland
Medical Research: What is the background for this study?
Response: Gestational diabetes is a condition that affects between 8-11% of pregnant women worldwide. In the United States, the prevalence of gestational diabetes has more than doubled since the 1990’s. Most women can control their blood glucose levels with changes in diet and exercise, but approximately 10% need to take medication during pregnancy. Over the last decade, the use of glyburide (a pill) to manage gestational diabetes has increased and it is now used more often than insulin (an injectable).
Medical Research: What are the main findings?
Response: Treatment with glyburide (compared with insulin) was associated with higher risks of admission to the neonatal intensive care unit (NICU) (by 41%), respiratory distress (by 63%), hypoglycemia in the newborn (40% ), birth injury (35% ) and being large for gestational age (43% ). The risk of NICU admission, large for gestational age and respiratory distress between glyburide and insulin treated women was increased by 3.0%, 1.4% and 1.1% respectively. (more…)
MedicalResearch.com Interview with:
Sayan Sen, PhDInternational Centre for Circulatory Health, National Heart and Lung Institute
Imperial College London
London, United Kingdom
Medical Research: What is the background for this study? What are the main findings?
Dr. Sayan Sen: Intra-aortic balloon pumps (IABP) are often used in Acute Myocardial Infarction, particularly in patients with cardiogenic shock. We analysed the available Randomized Controlled Trials (RCT) and observational studies, spanning 30 years, to establish the evidence for this use.
There is no identifiable group of patients with Acute Myocardial Infarction that have been demonstrated to derive a mortality benefit from insertion of an IABP. The studies, including over 17000 patients, have studied mortality in patients receiving IABP in comparison to mortality of patients that received no IABP in the era of no reperfusion, fibrinolysis and primary percutaneous intervention. This lack of mortality reduction with IABP in AMI is consistent in patients with and without cardiogenic shock across both RCTs and observational studies; questioning the continued use of this technology in Acute Myocardial Infarction.(more…)
MedicalResearch.com Interview with:
Dr. Mala Sachdeva MD
North Shore University Hospital, Long Island Jewish Medical Center
Assistant Professor, Nephrology, Internal Medicine
Hofstra North Shore-LIJ School of Medicine
Medical Research: What is the background for this study?
Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis.
Medical Research: What are the main findings?Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis.
Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths.
Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL. 75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient.
There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception.
So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.
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MedicalResearch.com Interview with: Benjamin Davis BA
CLF-Lerner Fellow at the Johns Hopkins Center for a Livable Future.
Medical Research: What is the background for this study? What are the main findings?
Response: The Food and Drug Administration banned the inter-state sale of raw (i.e. unpasteurized) milk in 1987. Currently 30 states still allow raw milk sales on local farms or in stores. We were requested by the Maryland General Assembly's Health and Government Operations Committee to conduct a review of the health benefits and risks of raw versus pasteurized milk in response to proposed legislation that would legalize raw milk in the state. After reviewing over 80 scientific articles we concluded that raw milk carries a substantially higher risk of foodborne illness when compared to pasteurized milk. However drinking raw milk may reduce allergies among children in rural settings. (more…)
MedicalResearch.com Interview with: Prof Xi-Chun Hu, Department of Oncology
Shanghai Medical College
Fudan University, Shanghai 200032, China
MedicalResearch: What is the background for this study? What are the main findings?
Prof. Hu: Triple-negative breast cancer (TNBC) is associated with higher rates of recurrence, shorter disease free survival, and poorer overall survival. Molecular targeting agents tried against Triple-negative breast cancer have nearly all failed. TNBC, concordant with BRCA-associated and basal-like breast cancer, has abnormal DNA repair and genome-wide instability, supporting the use of DNA-damaging agents such as platinum. However, platinum monotherapy is not very potent, combination with other agents, such as gemcitabine has a synergistic effect.
The GP regimen could be an alternative or even preferential first-line doublet chemotherapy strategy for patients with mTNBC.
(more…)
MedicalResearch.com Interview with:
Jorge E. Chavarro, M.D., Sc.D.
Assistant Professor of Nutrition and Epidemiology
Harvard T.H. Chan School of Public Health
Assistant Professor of Medicine
Harvard Medical School Boston, MA 02113
Medical Research: What is the background for this study?
Dr. Chavarro: Previous studies have shown that occupational exposure to pesticides is harmful to sperm production. However, whether the same is true for pesticide residues in our food, the most important source of exposure to pesticides for most people, is unclear.
Medical Research: What are the main findings?
Dr. Chavarro: Bottom line, men who consumed the greatest amounts of fruits and vegetables with large amounts of pesticide residues had significantly lower sperm counts and fewer morphologically normal sperm.
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MedicalResearch.com Interview with:
Dr. Jean-Luc Margot PhD
Professor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy,
University of California, Los Angeles
Medical Research: What is the background for this study? What are the main findings?
Dr. Margot: Some professionals who work in emergency rooms or maternity wards believe that the number of hospital admissions or human births is larger during the full moon than at other times. This belief is incorrect. Analysis of the data shows conclusively that the moon does not influence the timing of hospital admissions or human births.
Results of a new analysis have been published online in the journal Nursing Research. The Nursing Research article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. It reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. (more…)
MedicalResearch.com Interview with:
Catherine R. Lesko, MPH
Department of Epidemiology
UNC School of Global Public Health
Chapel Hill, NC
Medical Research: What is the background for this study? What are the main findings?
Response: There is a lot of evidence out there that HIV-infected minorities, and in particular, African Americans, experience higher morbidity and mortality than do their white, HIV-infected counterparts. This study looked at whether there were still differences in mortality among treated, HIV-infected adults, which was a crude attempt to control for differences in access to HIV-testing, HIV-care, and antiretroviral therapy - all things previously shown to contribute to racial disparities among people infected with HIV. Even among people who had initiated HIV therapy, we still found that black patients had a 10-year risk of mortality that was 8 percentage points greater than white patients. Hispanic patients did marginally better than white patients, but not as much better as their non-HIV-infected counterparts.
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MedicalResearch.com Interview with:
Majuran Perinpam, BsC
Mayo Clinic
Rochester, Minn
MedicalResearch: What is the background for this study?Response: The four key urinary factors: Calcium, magnesium, oxalate and uric acid are all implicated in kidney stone formation. Age and sex are known to influence kidney stone risk and type (1). However the effects of demographics on excretion of the four key urinary factors are not clear. Since diet alters urinary excretions of the four factors, adjusting for this is important. During metabolic evaluation of kidney stone patients, these urinary factors are often measured in 24-hour urine samples. However, often a single adult reference range is used and the effect of demographics is rarely taken into account during the interpretation of results.
MedicalResearch: What are the main findings?Response: From a cohort of 709 healthy individuals we found a substantial influence of age and sex on the excretion of urinary calcium. Adjusted models showed that urinary calcium, magnesium, oxalate and uric acid were all less in females, possibly explaining why kidney stones are more dominant in males (1). Also a positive association of urinary uric acid excretion with Cystatin C eGFR, but not eGFR calculated from creatinine, suggests cystatin C to possibly being involved in inflammation and hyperuricemia. But further studies are needed to investigate this.
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MedicalResearch.com Interview with:
Gulshan Sharma, MD, MPH
Division of Pulmonary Critical Care and Sleep Medicine
University of Texas Medical Branch
Galveston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD).
Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke.
Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects.
Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury. (more…)
MedicalResearch.com Interview with:
Philip Riley
Cochrane Oral Health Group, School of Dentistry
The University of Manchester
Manchester, UK
Medical Research: What is the background for this study? What are the main findings?
Response: As tooth decay is still so prevalent worldwide, despite being entirely preventable, it is worth assessing the evidence for other adjunctive ways for the public to help prevent the disease. Manufacturers of xylitol products commonly make the claim that this natural sweetener prevents tooth decay, and we felt that the public deserved to know if the best quality evidence backs up such claims.
We found that there was a lack of evidence from randomised controlled trials (the best type of study design for testing the effects of interventions) to prove that xylitol products can prevent tooth decay. We found some low quality evidence suggesting that xylitol added to fluoride toothpaste may reduce tooth decay in children’s permanent teeth by 13% over a 3 year period when compared to fluoride toothpaste without xylitol. However, these findings should be interpreted with caution and may or may not be generalizable to other populations. There was insufficient evidence to conclude that xylitol in chewing gums, lozenges, candies/sweets, syrups and wipes can prevent tooth decay in children or adults
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MedicalResearch.com Interview with:
Tanush Gupta, MD
Department of Medicine, Division of Cardiology
New York Medical College, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.
We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.
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MedicalResearch.com Interview with:
Dr Anne K Detjen, MD
Child Lung Health ConsultantInternational Union Against Tuberculosis and Lung Disease
Medical Research: What is the background for this study? What are the main findings?Dr. Detjen: The bacteriological diagnosis of tuberculosis (TB) in children is challenging due to the difficulty in obtaining specimens such as sputum and the lack of an accurate and accessible diagnostic test. In most cases, diagnosis is made on clinical grounds based on a contact history and a combination of signs and symptoms. We included 15 studies in a systematic review and meta-analysis of Xpert for the diagnosis of pulmonary TB in children.
The accuracy of Xpert for diagnosing TB in children is suboptimal, and the majority of children will still have to be diagnosed clinically. However, in settings where it replaces smear microscopy Xpert will increase the likelihood of bacteriological confirmation of TB as well as MDR TB among children. Xpert does not increase the number of confirmed TB cases among culture-negative children. We also found that smear status highly impacted Xpert results, i.e. a higher yield among smear positive compared to smear negative children. Smear positivity increases with bacillary load and might be a proxy for disease severity. Unfortunately, we were not able to assess the performance among children with different stages of disease severity since this was not classified in any of the studies included.
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[caption id="attachment_13080" align="alignleft" width="199"] CDC Image: Cardiorespiratory Fitness[/caption]
MedicalResearch.com Interview with:
Susan G. Lakoski, M.D.
Assistant Professor of Medicine, Hematology/Oncology DivisionDepartment of Medicine...
MedicalResearch.com Interview with:
Professor Massimiliano Mazzone and Professor Hans Prenen
Lab of Molecular Oncology and Angiogenesis
VIB Vesalius Research Center
University of Leuven Leuven Belgium
Medical Research: What is the background for this study? What are the main findings?
Response: Monocytes are circulating cells with patrolling behaviour. In case of harmful situations, they go to the site of injury rapidly to ensure immune and wound-healing functions. Once in the inflammation site, they differentiate into macrophages which are versatile cells adopting different phenotypes according to the stimuli they are subjected to. We hypothesized that cancer cells might release signals and soluble factors that educate and change monocytes already when in circulation. In this work, we proved our hypothesis and found that soluble molecules released by colorectal cancer cells imprint a specific signature in the circulating monocytes. Now, by collecting these monocytic cells from the blood, we are able to determine if colorectal cancer cells are present in the body, either at the primary site (in the colon) or in distant organs (where cancer cells give rise to metastases). (M. Mazzone).
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MedicalResearch.com Interview with:
Thomas Perls, MD, MPH Professor
Boston University School of Medicine
Medical Research: What is the background for this study?
Dr. Perls: For years now, Gerontology scholars continue to state that 25% of what they interchangeably call aging, longevity, life expectancy and life span is genetic and 75% is due to the environment and health-related behaviors. This assertion is based on Scandinavian twins reared apart, but the oldest participants in those studies lived to their 70s and 80s. Part of the problem here is the lack of consistency in what people mean by the terms Aging, Life Span and Longevity.
In fact, the Seventh Day Adventists, who generally have a high prevalence of healthy behaviors (vegetarian, daily exercise, eat in moderation, abstain from tobacco and alcohol, and activities that help manage stress well) have an average live expectancy of approximately 88 years. Yet, 7th Day Adventists are ethnically and racially heterogeneous and thus it appears that those healthy behaviors explain the vast majority of the variation in how old these people live to be. This finding is consistent with the optimistic view of the twin studies, that much of living to one's 80's is in our hands. Living to only our 50s-70's is also in our hands (e.g. 75% behaviors) if we choose to smoke, eat red meat frequently, be obese, not exercise, be exposed to gun violence, have unsafe sex, do IV drugs, etc. So it is safe to say, in my opinion, that 75% of the variation in how old we live to be, is on average due to our behavior and exposure choices. The empowering and important point is that if we all lived like the Seventh Day Adventists, average life expectancy would increase almost 8 years and health costs would markedly decline because we would be getting to these older ages because we are healthier not because we are pouring more resources into more effectively treating diseases.
The New England Centenarian Study, which I direct, and a number of other studies of nonagenarians (people in their 90s) have demonstrated via direct genetic studies as well as studies of family trees where at least some family members get to these very old ages, that with older and older ages of survival beyond age ~95 years, variations in genetic profiles explain a greater and greater proportion of the variation in how old people live to be at these ages. So much so that I believe the findings to date are consistent with the roles of genes and environment being reversed for survival to age 106+ years, that is, 75% genetics and 25% environment/behaviors. This supposition is based upon several observations:
(1) as people reach the age of 105+ years, they become more and more alike in terms of what age-related diseases they get and when they get them. Consistent with Jim Fries; "Compression of Morbidity" hypothesis, people who survive to ages 110+ (called supercentenarians) and who therefore approximate the limit of human lifespan are on average disease and disability-free up until the last 5 or so years of their lives. This increasing homogeneity, especially compared to the increasing heterogeneity in the rates of aging and incidences of age-related diseases at younger percentiles or ages of survival, suggests underlying genetic similarities (similar genetic profiles) amongst groups of these supercentenarians; and
(2) the New England Centenarian Study previously discovered genetic signatures (made up of longevity-associated variations of about 130 genes) that were associated with surviving to age 106+ years with 80% accuracy, but with only 60% accuracy for accurately picking out people living to ~100 years. This increasing accuracy with older and older ages also suggests a stronger and stronger genetic influence upon survival to these rarest percentiles of survival.
With the above background, we set out in this study and subsequent paper, to
(1) assess sibling relative risk using the largest-ever collection of validated pedigrees of centenarians,
(2) to assess the risk of a sibling achieving the same age as their very old sibling (e.g. ages 95, 100, or 105+ years) relative to average people born around the same time, and
(3) to look at how when a person was born (eg before or after 1890) made a difference in these relative risks.
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MedicalResearch.com Interview with:
Andrew Blauvelt, M.D., M.B.A.
President and Investigator
Research Excellence & Personalized Patient Care
Portland, OR 97223
Medical Research: What is the background for this study? What are the main findings?
Dr. Blauvelt: A2303E1 is a multicenter, double-blind, randomized withdrawal extension to the FIXTURE and ERASURE pivotal phase III studies. The purpose of this extension study was to collect additional long term efficacy, safety, and tolerability data on secukinumab (i.e., Cosentyx) in patients who demonstrated a PASI 75 response to Cosentyx at Week 52 of these core studies in moderate-to-severe plaque psoriasis.
In the extension phase, 995 patients who achieved Psoriasis Area Severity Index (PASI) 75 responses after 52 weeks of therapy received either Cosentyx 300 mg, Cosentyx 150 mg, or placebo for an additional year (Week 104). After two full years of therapy in patients treated with Cosentyx 300 mg, almost 9 out of 10 (88.2%) patients maintained their PASI 75 response, 7 out of 10 (70.6%) had clear or almost clear skin (PASI 90), and 4 out of 10 (43.9) had clear skin (PASI 100) at Week 104. For patients treated with Cosentyx 150 mg, 75.5% maintained their PASI 75 response, 44.6% had clear or almost clear skin (PASI 90), and 23.5% had clear skin (PASI 100) at Week 104. In addition, 94.8% of patients who initially received placebo (at the start of the extension), and were switched to receive Cosentyx 300 mg after relapse, were able to achieve PASI 75 and 70.3% achieved PASI 90 within 12 weeks of re-starting Cosentyx. (more…)
MedicalResearch.com Interview with:
Vijay R. Ramakrishnan, MD
Assistant Professor
University of Colorado
Department of Otolaryngology
Aurora, CO 80045
Medical Research: What is the background for this study? What are the main findings?Dr. Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.
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MedicalResearch.com Interview with:
Ryan Jeffrey Shaw, PhD, MS, RN
Assistant Professor School of Nursing
Center for Health Informatics
Center for Precision Medicine
Duke University
Medical Research: What is the background for this study? What are the main findings?
Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.
Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.
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MedicalResearch.com Interview with:
Dr Fiona McQuaid
Clinical Research Fellow
University of Oxford, United Kingdom
Medical Research: What is the background for this study?Response: Meningococcal B disease is a common cause of sepsis and meningitis
with significant mortality and morbidity. A multicomponent vaccine
against serogroup B meningococcus has been licensed for use in the
Europe, Australia, Canada and recently the USA (though only in the
10-25 years age group) but questions remain about how long the
bactericidal antibodies induced by infant vaccination persist and the
likely breath of strain coverage. This was a follow on study looking
at a group of children aged 5 years who had been vaccinated as infants
and a different group who were vaccinated for the first time at 5
years of age.
Medical Research: What are the main findings?Response: The percentage of children with protective antibody levels who had
been immunized as infants fell in the 20 months since their last
immunization but this varied by the strain of meingococcus B tested
and by the different infant/toddler vaccination schedules.
The children who were vaccinated for the first time at 5 years of age
showed a good antibody response, but most reported pain and redness
around the site of vaccination and 4-10% had a fever.
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MedicalResearch.com Interview with:
Peter Muennig, MD, MPH
Columbia University
Mailman School of Public Health
NYC 10032
Medical Research: What is the background for this study? What are the main findings?Dr. Muennig: The Oregon Health Insurance Experiment (OHIE) is one of just two experimental investigations of the health benefits of medical insurance. The first was the Rand Health Insurance Experiment, which was conducted over 3 decades ago. The OHIE randomly assigned participants to receive Medicaid or their usual care. It found that Medicaid protected families from financial ruin caused by medical illness, that it reduced depression, and that it increased preventive screening tests. However, it produced no medical benefits with respect to high blood pressure, diabetes, or high cholesterol. Medicaid opponents suggested that this meant that we should get rid of Medicaid because Medicaid does not improve physical health. But Medicaid proponents suggested that too few participants enrolled to detect a benefit, and, regardless of the study’s flaws, reduced depression, financial protections, and improved screening were reason enough to continue.
We found that the Medicaid opponents were right. Medicaid actually didn’t produce any meaningful benefits with respect to blood pressure, diabetes, or cholesterol. But we also found that the Medicaid proponents were right. It’s impacts on depression alone rendered it cost-effective even if one does not account for the benefits of financial protections or medical screening.(more…)
MedicalResearch.com Interview with:
Mohammad Kazem Fallahzadeh Abarghouei, M.D.
Baylor University Medical Center, Dallas, TX
Medical Research: What is the background for this study?
Response: Uremic pruritus (itch) is a common problem in hemodialysis patients. No effective treatment exists for uremic pruritus due to its complex pathogenesis. Systemic inflammation and elevated serum levels of interleukin-2 (IL-2) are implicated in the pathogenesis of uremic pruritus. Senna is an herbal drug commonly used for treatment of constipation. Senna also has anti-inflammatory properties. We performed this randomized double-blind placebo-controlled trial to evaluate the effect of senna on reduction of uremic pruritus and serum levels of IL-2 in hemodialysis patients.
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MedicalResearch.com Interview with:
Wisit Cheungpasitporn, MD, Nephrology Fellow
Program director: Suzanne Norby, MD
Project mentors: Stephen B. Erickson, MD
and John C. Lieske, MD
Departments of Nephrology and Hypertension
Mayo Clinic, Rochester, MN
MedicalResearch: What is the background for this study? Dr.Cheungpasitporn: Kidney stones are very common urologic problems. In addition, once someone has a kidney stone, the likelihood of having another episode increases to 50% within 5 years. Increased fluid intake has been suggested as a simple strategy for kidney stone prevention. However the data on conclusions regarding the benefit, adherence and safety of high fluid intake for the primary or secondary prevention of stones were limited. Thus, we conducted this meta-analysis to evaluate the treatment effect of high fluid intake on the incidence of kidney stones, and to assess the compliance and safety of high fluid intake to prevent kidney stones. Our data presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings may help improve clinicians’ ability to manage kidney stones.
MedicalResearch: What are the main findings?Dr.Cheungpasitporn: Our meta-analysis included 9 studies with 273,954 patients. According to the findings of our study, individuals with daily high fluid intake (to achieve a urine volume of at least 2.0‒2.5 L per day) had lower risk of new kidney stones by approximately 50%. High fluid intake provided the same benefit in men and women. In addition, high fluid intake reduced the risk of recurrent kidney stones by 40%. Overall, high fluid intake is safe with low adverse events.
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MedicalResearch.com Interview with:
Dr. Tanjim Sultana MD
Department of Nephrology
Lenox Hill Hospital New York
Medical Research: What is the background for this study? What are the main findings?
Response: Almost all dialysis patients are anemic. One quarter of patients requiring High dose Epogen have functional iron deficiency, which means they have adequate iron store but unable to utilize it. Vitamin C has been shown to mobilize iron from their storage and making it available to use in red blood cell production. Prior studies showed intravenous high dose vitamin C could increase hemoglobin levels and decrease epogen requirement. In our study we used daily low dose oral vitamin C in functional iron deficient patients to achieve the same goals. Patients taking daily low dose vitamin C for 3 months had significant decrease in their epogen dose compared to the control group.
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MedicalResearch.com Interview with: Dr. José L. Górriz
Department of Medicine and Nephrology
Valencia Hospital Universitario
Valencia. Spain
MedicalResearch: What is the background for this study? What are the main findings?Dr. Górriz: The background of the study is that several studies have reported on the high prevalence of vascular calcification in chronic kidney disease (CKD) patients not on dialysis. Vascular calcification (VC) has been associated with high cardiovascular mortality in patients on dialysis, but there are no studies in patients in stages before dialysis which analyse the prognostic significance of the presence of Vascular calcification assessed by simple X-ray.
Vascular calcification can occur in both the intima and media of the vessel wall. Intimal calcification is an indicator of atherosclerosis and is associated with ischemic heart disease and medial calcification is associated with arterial stiffness, systolic hypertension, and left ventricular hypertrophy.
Although Vascular calcification can be assessed by various methods, such as ultrasonography, tomography, and arteriography, simple radiology has the advantages of being simple, inexpensive, and commonly applicable in daily clinical practice.
OSERCE 2 is an observational, multicentre and 3-year prospective study performed in 39 Nephrology centres in Spain, which analyzes the presence of Vascular calcification in CKD patients stages 3 and 4 (eGFR between 15-59 ml/min/1,73 m2) and its effect on morbimortality (death, hospitalization and renal progression).
The main findings of the study were that Vascular calcification is highly prevalent in patients with chronic kidney disease, and Vascular calcification assessment using AS independently predicts death and time to hospitalization.
Therefore, it could be a useful index to identify patients with chronic kidney disease at high risk of death and morbidity as previously reported in patients on dialysis.
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MedicalResearch.com Interview with:
Michelle Wilkinson, MPH
Doctoral Candidate Epidemiology
The University of Texas Health Science Center at Houston School of Public Health
Houston, TX 77030Medical Research: What is the background for this study? What are the main findings?
Response: Cell phone use (CPU) while driving impairs visual awareness and reaction time, increasing frequency of near-collisions, collisions, and accidents with injuries. National prevalence estimates of driver cell phone use range from 5-10%. Medical and academic centers have large concentrations of young, ill, or elderly pedestrians and drivers, who are often unfamiliar with the congested environment. Drivers distracted by Cell phone use are a safety threat to pedestrians and drivers in these demanding environments. This study aimed to describe the prevalence and correlates of cell phone use among Texas drivers in major medical and academic centers, 2011-2013. This study found the overall prevalence of cell phone use while driving was 18%. The prevalence of Cell phone useand talking declined, while texting increased during the study period. Cell phone users were more likely to be female, <25 years old, and driving without a passenger.
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MedicalResearch.com Interview with:
Maria L. Wei, M.D., Ph.D.
Associate Professor of Dermatology
Director, Melanoma Surveillance Clinic
Multidisciplinary Melanoma Program
University of California, San Francisco
Staff Physician
Veterans Affairs Medical Center, San Francisco
Medical Research: What is the background for this study?
Dr. Wei: Effective physician-patient communication is essential for optimal medical care. There are now many methods available to notify patients of their biopsy results: a clinic visit (the method traditionally preferred by patients), a telephone call, secure online patient portals to access medical charts, email and texts. In addition, there is variability from state to state in the guidelines regulating the release of biopsy results online. Until recently, some states did not allow the on-line release of biopsy results. There have been few systematic studies on patient preferences for communication of biopsy results. (more…)
