Author Interviews, Chemotherapy, Colon Cancer / 13.11.2014

MedicalResearch.com Interview with: Xianglin L. Du, MB, MS, Ph.D.  Professor of Epidemiology, Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, TX 77030, USA. Medical Research: What is the background for this study? Dr. Du: Widespread use of screening and advances in screening strategies played a key role in colorectal cancer survival improvement. With the increasing evidence on the benefit of fecal occult blood test and sigmoidoscopy during 1990s, the U.S. Preventive Service Task Force for the first time in 1996 recommended the annual use of fecal occult blood test, periodic use of sigmoidoscopy, or routine use of both modalities for all persons aged 50 or older. Because colonoscopy is able to detect lesions in the entire colon and has a high sensitivity for lesions of over 10mm in size, Medicare began to cover colonoscopy since 2001 for individuals with average-risk of colorectal cancer. Advances in chemotherapy, particularly some new therapeutic regimens approved by Food and Drug Administration (FDA) over the past decades also played a key role in survival improvement for patients with colorectal cancer. However, the overall impact of newly approved chemotherapy regimens on survival in population-based elderly patients remains unclear. It is also unknown what proportion of survival improvement was attributable to changes in tumor stage and size due to screening, and what proportion was attributable to more effective chemotherapy regimens. Hence, we studied a large nationwide and population-based cohort of elderly colorectal cancer patients to examine the changes in tumor stage and tumor size from 1992 to 2009, and to further quantify the effects of changes in stage/size and chemotherapy regimens on improved survival over the two decades. (more…)
Author Interviews, Cancer Research, Omega-3 Fatty Acids / 13.11.2014

James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart InstituteMedicalResearch.com Interview with: James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart Institute Medical Research: What is the background for this study? What are the main findings? Dr. DiNicolantonio: Daily low-dose aspirin has been shown to decrease the risk for cancer in a meta-analysis of randomized controlled trials, which is likely attributable to its ability to modestly decrease the activity of cyclooxygenase-2 (cox-2), an enzyme which contributes importantly to the genesis and progression of adenocarcinomas. Adenocarcinomas are cancer of the glands, the most common type of breast cancer (invasive ductal carcinoma) is an adenocarcinoma, additionally many cancers of the lung, intestine, esophagus, colon are adenocarcinomas. We show that an ample dietary intake of long-chain omega-3 fats—the type prominent in fatty fish—would oppose cox-2 activity.  Additionally, we cite numerous evidence that a higher intake of long-chain omega-3 fats has been found to reduce the risk for numerous types of cancer - especially when looking at trials that excluded fried or preserved fish (or fish high in omega-6), excluded trials with a high background intake of omega-6, and included trials where the "high" intake group - actually ate 2 servings of fish or more per week. Additionally, basic science as well as randomized data showing that long-chain omega-3s can reduce the number and size of colon polyps supports this argument. (more…)
Author Interviews, Erasmus, Hepatitis - Liver Disease, JAMA / 12.11.2014

Dr. Adriaan J van der Meer Department of Gastroenterology and Hepatology Erasmus MC, University Medical Center Rotterdam, The NetherlandsMedicalResearch.com Interview with: Adriaan J. van der Meer, MD, PhD Department of Gastroenterology and Hepatology Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands Medical Research: What is the background for this study? What are the main findings? Dr. van der Meer: This study was performed in order to assess the association between the virological response to antiviral therapy and the long-term clinical outcome among patients with advanced liver disease, who have the highest risk of cirrhosis-related complications and death due to their chronic viral infection. At the time this study was initiated there was scarce data on the relation between a sustained virological response (SVR; sustained elimination of hepatitis C RNA) and reduced all-cause mortality, the most definite clinical endpoint. With our large international multicenter cohort study we were able to show this association. After 10 years of follow-up the cumulative mortality rate was 9% among patients with SVR as compared to 26% among patients without SVR after antiviral therapy (p<0.001). The current JAMA research letter concerns a related analyses, in which we compared the survival among patients included in our cohort with that of an age- and sex-matched general population. Importantly, the survival among patients with SVR was comparable to the general population, despite the fact that all these patients had histological proof of advanced hepatic fibrosis. In contrast, the survival among patients without SVR was markedly lower as compared to the general population. (more…)
Author Interviews, OBGYNE, Race/Ethnic Diversity, UCSF / 12.11.2014

Paula Braveman, MD, MPH Director, Center on Social Disparities in Health Professor, Family and Community Medicine University of California San Francisco San Francisco, CA 94118MedicalResearch.com Interview with: Paula Braveman, MD, MPH Director, Center on Social Disparities in Health Professor, Family and Community Medicine University of California San Francisco San Francisco, CA 94118 Medical Research: What are the main findings of the study? Dr. Braveman: There were a couple of striking findings from this study of preterm birth (PTB) among non-Latino White and Black women born in the U.S.. First, we found that women who were poor or socioeconomically disadvantaged in other ways (who had not or whose parents had not graduated from high school or who lived in neighborhoods (census tracts) with highly concentrated (25% or more of residents) poverty) had similarly high preterm birth rates.  In addition, we found that while preterm birth rates among White women consistently improved as their socioeconomic status (SES) improved, higher-SES Black women generally did no better –and sometimes did worse—than lower-SES Black women. (more…)
Author Interviews, Cancer Research, End of Life Care, JAMA / 12.11.2014

Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical SchoolMedicalResearch.com Interview with: Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Obermeyer: More patients with cancer use hospice today than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. We examined how hospice affects health care utilization and costs and found that, in a sample of elderly Medicare patients with advanced cancer, hospice care was associated with significantly lower rates of both health care utilization and total costs during the last year of life. Patients who did not enroll in hospice had considerably more aggressive care in their last year of life—most of it related to acute complications like infections and organ failure, and not directly related to cancer-directed treatment. Hospice and non-hospice patients had similar patterns of health care utilization until the week of hospice enrollment, when care began to diverge. Ultimately, non-hospice patients were five times more likely to die in hospitals and nursing homes. These differences in care contributed to a statistically-significant difference in total costs of $8,697 over the last year of life ($71,517 for non-hospice and $62,819 for hospice). (more…)
Author Interviews, Mediterranean Diet, Metabolic Syndrome, Nutrition / 12.11.2014

MedicalResearch.com Interview with: Dr. Markos Klonizakis Centre for Sports and Exercise Science Sheffield Hallam University, UK Medical Research: What is the background for this study? What are the main findings? Dr. Klonizakis: It is widely accepted that populations in the Eastern Mediterranean sea have historical lower rates of cardiovascular disease, diabetes and cancer. This has been attributed to a great extent, at following a diet based on dishes and ingredients, which are common in this region and are collectively known as “Mediterranean diet”.  Taking into consideration that cardiovascular disease is on the rise, particularly in the Western world, it did make sense to see if such a diet can be adapted for a population that has a largely different culinary tradition and what the results would be if this is combined with exercise of moderate-intensity. We therefore, designed and implemented an 8-week intervention, aiming at older, healthy but previously untrained people, comparing an exercise-only group vs one where exercise was combined with Mediterranean diet. Our work has shown that benefits of this intervention are still evident in the vascular function (measured by the function of the inner vein lining, called the endothelium) and the cardiopulmonary fitness, one year after the end of the intervention. (more…)
AHA Journals, Author Interviews, Diabetes, Heart Disease, Metabolic Syndrome, Weight Research / 12.11.2014

Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director, Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health, LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, LouisianaMedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana Medical Research: What is the background for this study? What are the main findings? Dr. Hu: Many previous studies had small samples, and thus lacked adequate statistical power when the analysis was focused on those who are extremely obese (BMI ≥40 kg/m2). In addition, most epidemiological studies only use a single measurement of BMI at baseline to predict risk of all-cause mortality, which may produce potential bias. The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2. (more…)
Author Interviews, Pediatrics, Toxin Research / 11.11.2014

Marcel J Casavant MD FACEP FACMT Chief of Toxicology, Nationwide Children's Hospita Medical Director, Central Ohio Poison Center Clinical Professor, The Ohio State University Colleges of Medicine & Pharmacy Columbus OH USA 43205-2696MedicalResearch.com Interview with: Marcel J Casavant MD FACEP FACMT Chief of Toxicology, Nationwide Children's Hospita Medical Director, Central Ohio Poison Center Clinical Professor, The Ohio State University Colleges of Medicine & Pharmacy Columbus OH USA 43205-2696 Medical Research: What is the background for this study? What are the main findings?  Dr. Casavant: Laundry detergent pods reached the US market shelves in early 2012; almost immediately parents started calling poison control centers about their children’s exposures to these products. Since then the CDC, the CPSC, the American Association of Poison Centers, and others have issued warnings about these products. Several papers and numerous abstracts have described injuries to various groups of children; we therefore chose to analyze and describe what happened to all US children with exposure to one of these products reported to a poison control center in 2012 and 2013. The main finding: these products are dangerous to children! Over those two years we found more than 17,000 young children exposed to pods, more than 6,000 seen in an emergency department, more than 700 admitted to a hospital, and among these, more than half required intensive care. Two young children died, both in 2013. Our study was published online on November 10, 2014 (http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Laundry-Detergent-Pods-Can-Be-a-Serious-Poisoning-Risk-in-Children.aspx) and will appear in the December 2014 print edition of Pediatrics (volume 134 number 6). (more…)
Author Interviews, Heart Disease / 11.11.2014

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016. Medical Research: What is the background for this study? What are the main findings? Dr. Bangalore: The evidence to support beta blocker use for patients with myocardial infarction stems from outdated studies performed in the era prior to modern reperfusion and modern medical therapy. It is not know if the mortality benefit of beta blockers for MI are seen in the modern era. Our data from randomized trials suggest a significant interaction between reperfusion era status and beta blocker benefit such that in the modern era beta blockers provide no mortality benefit when compared with controls. However, they are associated with short term (30-days) benefit for reduction in recurrent MI and angina but at the expense of increase in the risk of heart failure, cardiogenic shock and drug withdraw due to adverse events. The benefits were only short term (30-days). (more…)
Author Interviews, Ophthalmology / 11.11.2014

Dr. Andrea Russo Medico Chirurgo - Specialista in Oculistica Università degli Studi di Brescia Brescia ItalyMedicalResearch.com Interview with: Dr. Andrea Russo Medico Chirurgo - Specialista in Oculistica Università degli Studi di Brescia Brescia Italy Medical Research: What is the background for this study? What are the main findings? Dr. Russo: When I finished my residency program in Ophthalmology two years ago I realized that many patients were referred to me to assess and classify diabetic and hypertensive retinopathy. Therefore, I started wondering if there was an ophthalmoscopy method to make General Practitioners and Internist Physicians independent for these screening retinal assessments. I thought that we all own a personal computer connected with a (high quality) camera in our pocket and therefore smartphone ophthalmoscopy was feasible. Both the indirect and direct ophthalmoscopy techniques were suitable, however the latter was much easier to obtain. Furthermore, direct ophthalmoscopy can exploit smartphones’ autofocus and flash LED light making the required optics very simple and inexpensive. I purchased my 3D printer and started realizing very first working prototypes. A few months were required to improve the light path to eliminate internal and corneal reflections. Finally, I patented the optical solution and joined my partner Si14 S.p.A. (Padova, Italy) for the industrialization process. The main findings are that that smartphone ophthalmoscopy with the D-Eye system can accurately detect retinal lesions for grading diabetic retinopathy. Furthermore, we noticed an amazing convenience in the assessment of babies, since they seem to be spontaneously attracted by the non-disturbing light emitted by the device, making the fundus acquisition straightforward. The advantages of smartphone-based retinal image acquisition for remote, non-hospital settings include portability and immediate upload/analysis. Indeed, telemedicine has the potential to reach patients and communities that currently receive negligible or suboptimal eye care as a result of geographic or sociocultural barriers, or both. (more…)
Hepatitis - Liver Disease, Mayo Clinic / 10.11.2014

Surakit Pungpapong, M.D. Transplant Hepatologist Associate Professor of Medicine Mayo Clinic, Jacksonville, Fla.Medical Research.com Interview with: Surakit Pungpapong, M.D. Transplant Hepatologist Associate Professor of Medicine Mayo Clinic, Jacksonville, Fla.   Medical Research: What is the background for this study? What are the main findings? Dr. Pungpapong: This study reports our multicenter experience from Mayo Clinic’s three sites using sofosbuvir and simeprevir with/without ribavirin for 12 weeks to treat hepatitis C genotype 1 recurrence after liver transplantation. We found that this all-oral interferon-free antiviral regimen was very well tolerated with minimal to mild side effects. It required minimal dose adjustment of immunosuppression and no episode of acute rejection occurred. Overall, sustained virologic response rate was very high, more than 90 percent. (more…)
Author Interviews, Breast Cancer, Case Western, Chemotherapy / 10.11.2014

Ruth Keri, PhD, Professor and Vice Chair Department of Pharmacology Case Western Reserve University School of Medicine, and Associate Director for Basic Research in the Case Comprehensive Cancer Center Case Western Reserve UniversityMedicalResearch.com Interview with: Ruth Keri, PhD, Professor and Vice Chair Department of Pharmacology Case Western Reserve University School of Medicine, and Associate Director for Basic Research in the Case Comprehensive Cancer Center  Case Western Reserve University Medical Research: What is the background for this study? Dr. Keri: Over the last several decades, the discovery of targeted therapies for certain types of breast cancer, and their use in the clinic, have greatly improved the long-term outcome of patients. Yet some breast cancers don’t respond to these therapies, and ones that do often become resistant over time, resulting in patient relapse and metastatic disease. Why does resistance occur? There are many tricks a tumor employs to evade death. When a drug targets a certain protein or pathway the cancer cell relies on for survival, one potential route of resistance is the cancer cell’s ability to adapt and find another pathway to maintain growth. We reasoned that targeting two separate proteins or pathways important for cancer cell growth may be more effective at preventing or delaying this adaptation. (more…)
Author Interviews, Nutrition, Vegetarians / 10.11.2014

Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant Professor University of South Carolina; Arnold School of Public Health Department of Health Promotion, Education, and Behavior Columbia, SC 29208MedicalResearch.com Interview with: Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant Professor University of South Carolina; Arnold School of Public Health Department of Health Promotion, Education, and Behavior Columbia, SC 29208 Medical Research: What is the background for this study? What are the main findings? Dr. Turner-McGrievy: Several observational studies have examined differences in weight-related outcomes among individuals following vegan, vegetarian, pesco-vegetarian, semi-vegetarian, or omnivorous diets. These studies have found lower body weights and less weight gain over time among vegans as compared to other groups. However, no randomized controlled trials have tested the relationship between these diets and body weight. So the goal of our study was to determine the effect of varying plant-based diets on weight loss. Our study found that a similar relationship of weight loss was found among the five diet groups that has been observed in epidemiological studies, with weight loss going from greatest in the vegan group followed by vegetarian, pesco-vegetarian, semi-vegetarian, and omnivorous. At six months, the vegan group lost significantly more weight (-7.5 ± 4.5%) than the omnivorous (-3.1 ± 3.6%, P=0.03), semi-vegetarian (-3.2 ± 3.8%, P=0.03), and pesco-vegetarian (-3.2 ± 3.4%, P=0.03) groups. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Readmissions, Infections, University of Pennsylvania / 10.11.2014

Mark E Mikkelsen, MD, MSCE Assistant Professor of Medicine Hospital of the University of PennsylvaniaMedicalResearch.com Interview with: Mark E Mikkelsen, MD, MSCE Assistant Professor of Medicine Hospital of the University of Pennsylvania Medical Research: What is the background for this study? What are the main findings? Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized? We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice. (more…)
Author Interviews, Macular Degeneration, Radiology, Stanford / 10.11.2014

Daniel L. Rubin, MD, MS Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488MedicalResearch.com Interview with: Daniel L. Rubin, MD, MS  Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488 Medical Research: What is the background for this study? What are the main findings? Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives. (more…)
Author Interviews, Brigham & Women's - Harvard, Karolinski Institute, Nutrition / 10.11.2014

Susanne Rautiainen, PhD From the Department of Institute of Environmental Medicine Karolinska Institutet, Stockholm, Sweden Divisions of Preventive Medicine Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MAMedicalResearch.com Interview with: Susanne Rautiainen, PhD From the Department of Institute of Environmental Medicine Karolinska Institutet, Stockholm, Sweden Divisions of Preventive Medicine  Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Rautiainen: Multivitamins are the most commonly used dietary supplement in the US and other developed countries and it has been shown that many take them with the goal of maintaining or improving their health. Multivitamins typically provide low-doses of essential vitamins and minerals to prevent deficiency. Yet many people who take multivitamins are not deficient. Despite the widespread use, limited number of studies have investigated how multivitamins are associated with major chronic diseases, including cardiovascular disease. We therefore examined how self-reported multivitamin use was associated with both short- and long-term risk of cardiovascular diseases in the Women’s Health Study which is a prospective cohort of 37,193 women aged ≥45 years and free of CVD and cancer at baseline. In this study of middle-aged and elderly women who were apparently healthy at baseline and followed for an average of 16.2 years, we observed that multivitamin use was not associated with neither short- nor long-term risk risk of major CVD events, including MI, stroke, or CVD death. Moreover, there was no significant association observed for women who had taken multivitamins for ≥10 years at baseline. There were some important indications that the association between multivitamin use and long-term risk of major CVD events may be modified by age and fruit and vegetable intake, suggesting that women who were older and had low fruit and vegetable intake may benefit more from multivitamin supplement use. However, these results should be interpreted with caution. Moreover, relying on self-reports of multivitamin use may be subject to misclassification, plus other unmeasured factors may have biased the results despite our best effort to account for everything. (more…)
Aging, Lipids / 10.11.2014

Sofiya Milman, M.D. Assistant Professor of Medicine Divisions of Endocrinology and Geriatrics Albert Einstein College of MedicineMedicalResearch.com Interview with: Sofiya Milman, M.D. Assistant Professor of Medicine Divisions of Endocrinology and Geriatrics Albert Einstein College of Medicine   Medical Research: What is the background for this study? What are the main findings? Dr. Milman: Aging is a major risk factor for many diseases, including cardiovascular disease, dementia, and diabetes. Yet, individuals with exceptional longevity delay the onset of most diseases and often escape from age-related illnesses altogether. Exceptional longevity is an inherited trait. A unique cholesterol profile has been previously associated with longevity and specific genetic variations. This profile included elevated levels of high-density lipoprotein (HDL) cholesterol or “good” cholesterol and large HDL particles. The present study explored whether elevated HDL cholesterol levels and genes that control HDL cholesterol can predict survival in individuals age 95 years or older. The study found that higher levels of HDL cholesterol were related to longer survival in women, but not in men. Higher HDL cholesterol level was also seen in individuals without cognitive problems and diabetes. On the other hand, both men and women with larger HDL particle size and higher levels of APOA1, a protein component of HDL cholesterol, exhibited longer survival. Variants in two genes, the CETP and APOA1, were related to higher HDL cholesterol levels. (more…)
Author Interviews, Electronic Records, Outcomes & Safety, Surgical Research, UCSD / 09.11.2014

MedicalResearch.com Interview with: Jamie Anderson MD MPH Department of Surgery University of California, San Diego Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population. Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel. With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements. We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records. (more…)
Author Interviews, Nutrition / 09.11.2014

Punam Ohri-Vachaspati, Ph.D.,R.D Associate Professor, Nutrition Arizona State University School of Nutrition and Health Promotion College of Health Solutions Phoenix, AZ 85004 MedicalResearch.com Interview with Punam Ohri-Vachaspati, Ph.D.,R.D Associate Professor, Nutrition Arizona State University School of Nutrition and Health Promotion College of Health Solutions Phoenix, AZ 85004 Medical Research: What is the background for this study? What are the main findings? Dr. Ohri-Vachaspati: Fast food is heavily marketed to kids -- with the food industry spending over $700 million each year to market their products specifically to children and adolescents.  About half of this money goes towards premiums like toys given away with kids meals. And marketing works --exposure to food marketing is associated with higher fast food consumption among children.  Research has shown us that 2-18 year olds consume 13% of their total calories at fast food restaurants.  Children who eat at fast food restaurants are likely to have poor diets and worse health outcomes. In this study we wanted to examine which communities are more vulnerable to child-directed marketing on the interior and exterior of fast food restaurants. Over a three year  period (2010, 2011, and 2012) we sampled nearly 7000 restaurants from a whole spectrum of communities across the US.  Child-directed marketing measured inside fast food restaurants included indoor play area and display of kids’ meal toys, and on the exterior included advertisements with cartoon characters, advertisements with movie, TV or sports figures, and advertisements for kids’ meal toys among others.We found that more than a fifth of fast food restaurants used child-directed marketing on the inside or on the exterior of their premises. Middle-income communities, majority black communities and rural areas were disproportionately exposed to this type of child-directed marketing. (more…)
Author Interviews, Dartmouth, Lung Cancer, NEJM / 07.11.2014

William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756MedicalResearch.com Interview with: William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014. (more…)
Author Interviews, Biomarkers, Ophthalmology, Stanford / 07.11.2014

Theodore Leng, MD, MS , one of the article’s senior authors Byers Eye Institute at Stanford Stanford University School of Medicine Palo Alto, CA 94303MedicalResearch.com Interview with: Theodore Leng, MD, MS , one of the article’s senior authors Byers Eye Institute at Stanford Stanford University School of Medicine Palo Alto, CA 94303   Dr. Leng: What is the background for this study? What are the main findings? Medical Research: Age-related macular degeneration (AMD) is the leading cause of blindness and central vision loss among adults older than 65 years. 80-85% of patients have the dry, non-exudative, form of the disease, but the wet, exudative, form of advanced AMD is of primary concern as it accounts for a majority of severe vision loss in Age-related macular degeneration. In wet AMD, abnormal blood vessels grow under the retina and can leak blood and fluid. Until now, there has been no effective way to tell which patients with dry AMD are likely to progress to the wet stage. In our recent Investigative Ophthalmology & Visual Science article, we describe a new mathematical model that can predict which patients are likely to progress. The predictive model identifies likely progressors by analyzing 3D spectral domain optical coherence tomography (SD-OCT) retinal imaging data that’s routinely obtained during retinal encounters. We analyzed data from 2,146 SD-OCT scans of 330 eyes in 244 patients seen at The Byers Eye Institute at Stanford over a five-year period. We found that the area and height of drusen, the amount of reflectivity at the macular surface and the degree of change in these features over time, could be weighted to generate a patient’s risk score. Predictions from the model were compared with cases where patients actually progressed to wet Age-related macular degeneration. Our model accurately predicted every occurrence of progression within a year. There was a false positive rate of around 40%, but we thought this was a good tradeoff because we would not miss any potential progressors by using this sensitivity threshold. (more…)
Author Interviews, Cancer Research, Case Western, Dental Research, JAMA / 07.11.2014

MedicalResearch.com Interview with: Brendan J. Perry, BSc, MBBS Princess Alexandra Hospital Brisbane, Queensland, Australia MedicalResearch: What is the background for this study? What are the main findings? Dr. Brendan J. Perry: Oral cavity cancer is usually attributed to the “Five S’s” - smoking, spirits (alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice. This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth. In recent years, dentists have been recommending clients to get removable denture nyc to tackle down on discomfort. We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor. (more…)
Author Interviews, Blood Pressure - Hypertension / 07.11.2014

Heather M. Johnson, MD, MS Assistant Professor of Medicine Co-Director, UW Advanced Hypertension Program Department of Medicine, Cardiovascular Medicine Division University of Wisconsin School of Medicine and Public Health Madison, WI 53792MedicalResearch.com Interview with: Heather M. Johnson, MD, MS Assistant Professor of Medicine Co-Director, UW Advanced Hypertension Program Department of Medicine, Cardiovascular Medicine Division University of Wisconsin School of Medicine and Public Health Madison, WI 53792 Medical Research: What is the background for this study? Dr. Johnson: Our study addresses the public health burden that young adults have significantly lower hypertension control rates compared to middle-aged and older adults. The development of incident (new) hypertension is an important “teachable moment” to educate young adults about necessary lifestyle changes to lower blood pressure. (more…)
Author Interviews, Gender Differences, PLoS / 07.11.2014

MedicalResearch.com Interview with: Prof. Roberto Lent Diretor, Instituto de Ciências Biomédicas Centro de Ciências da Saúde, Bloco K, sala 2-35 Universidade Federal do Rio de Janeiro Rio de Janeiro, Brasil Medical Research: What is the background for this study? What are the main findings? Prof. Lent: Our group has been studying the absolute numbers of cells in the human brain, using a novel technique that we have developed. We have done it for the whole male brain, and arrived at a figure of 86 billion neurons and 85 billion glial cells, 15% less than the round number that became a neuromyth (one hundred billion neurons). We did it also for the demented brain, in this case working with females, and showed that it is dementia that is associated with a loss of neurons, because people with alzheimer, but no dementia, displayed normal numbers of neurons. The present paper focuses on sexual dimorphism in the olfactory bulb, and revealed that women have around 40% more neurons and glial cells than men, what correlates with their superior performance in many olfactory abilities. (more…)
Author Interviews, CDC, Infections, Pediatrics, Vaccine Studies, Vanderbilt / 07.11.2014

MedicalResearch.com Interview with: Marie R Griffin MD MPH Director, Vanderbilt MPH Program Department of Health Policy Vanderbilt University Medical Center Nashville TN 37212 Marie R Griffin MD MPH Director, Vanderbilt MPH Program Department of Health Policy Vanderbilt University Medical Center Nashville TN 37212 Medical Research: What is the background for this study? What are the main findings? Dr. Griffin: In Tennessee, the introduction in 2010 of a new pneumococcal vaccine for infants and young children was associated with a 27 percent decline in pneumonia hospital admissions across the state among children under age 2. The recent decline in Tennessee comes on top of an earlier 43 percent decline across the United States associated with the introduction in 2000 of the first pneumococcal vaccine for children under 2 years of age. (more…)
Author Interviews, JAMA, Metabolic Syndrome, Weight Research / 07.11.2014

MedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology (Nuclear Medicine and Cardiothoracic Imaging Divisions), University of Michigan, Ann Arbor, Michigan and Dr. Ravi Shah MD Cardiology Division, Department of Medicine Massachusetts General Hospital, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: Prior studies in Framingham, MESA and other cohorts have demonstrated that obesity is an important risk factor for the metabolic syndrome. However, the observations that many non-obese individuals develop metabolic syndrome and diabetes and, conversely, that not all obese individuals develop these complications has motivated the search for better markers of risk than BMI. More recently, it has been shown that the location of adipose tissue is an important factor. The amount of visceral fat, which is thought to be more harmful from a metabolic perspective, can be accurately quantified with CT imaging. In many prior studies, waist circumference has been used as an approximate measure of visceral adiposity. For this study, we analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA). We found that the amount of visceral fat (as quantified by CT) was an important predictor of metabolic syndrome, even after adjusting for weight, waist circumference, gender, race, smoking, exercise, serum lipids and glucose. Each additional 100 cm2/m of height of visceral fat was associated with a 29% increase in the risk of developing metabolic syndrome. In contrast, subcutaneous fat burden (also quantified by CT) was a much weaker predictor. One of the very novel findings of our study arises from an analysis of subjects who had multiple CTs longitudinally in MESA. Using these data, we found that change in visceral fat burden was associated with a corresponding 5% increase in the risk of metabolic syndrome. In part, this is because very small changes in weight could result in very large changes in visceral fat. (more…)
Author Interviews, Breast Cancer / 06.11.2014

Antoine E. Karnoub, Ph.D. Assistant Professor of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Center for Life Science 0634 Boston, MA 02215MedicalResearch.com Interview with: Antoine E. Karnoub, Ph.D. Assistant Professor of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Center for Life Science 0634 Boston, MA 02215 Medical Research: What are the main findings of the study? Dr. Karnoub: The main findings of the study are: (1) that the metastatic propensities of cancer cells can be remarkably modulated by otherwise ‘normal’ mesenchymal stem/stromal cells found in their vicinity; (2) that generation of highly malignant tumor-initiating cells can be significantly triggered by microenvironmental cues; (3) that repression of the gene FOXP2 by a miR-199a-led microRNA network enables the propagation of cancer stem cell and metastatic traits in otherwise weakly metastatic cancer cells; and (4) that such a signaling axis appears to forecast poor patient outcome. (more…)
Accidents & Violence, Author Interviews, General Medicine / 06.11.2014

Christopher J. Ferguson PhD. Associate Professor and Chair of Psychology Department of Psychology Stetson University DeLand, FL MedicalResearch.com Interview with: Christopher J. Ferguson PhD. Associate Professor and Chair of Psychology Department of Psychology Stetson University DeLand, FL Medical Research: What is the background for this study? What are the main findings? Dr. Ferguson: People have debated whether media violence contributes to societal violence for centuries.  A lot of individual laboratory experiments have tried to answer this question, but results have always tended to be inconsistent.  Not too much data had yet looked at concordance between media violence and societal violence.  In the current study I examined levels of movie violence across the 20th century, and video game violence in the latter part of the 20th, into the 21st century.  Results generally indicted that it was not possible to demonstrate that media violence consumption correlated with increased crime in society. (more…)
Author Interviews, Orthopedics, Pediatrics, Rheumatology / 06.11.2014

Professor Flavia Cicuttin School of Public Health and Preventive Medicine Monash University and Alfred Hospital Melbourne, AustraliaMedicalResearch.com Interview with: Professor Flavia Cicuttin School of Public Health and Preventive Medicine Monash University and Alfred Hospital Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Prof. Cicuttin: Previous research found that low birth weight and preterm birth have been linked to hypertension, cardiovascular disease, insulin resistance and reduced bone mass in adulthood.  Given these adverse outcomes related to birth weight and preterm birth we set out to investigate if low birth weight and preterm birth also played a role in increase risk of joint replacement surgery as adults. We found that  low birth weight and preterm birth were associated with a 2-fold increased risk of hip but not knee replacement surgery. (more…)
Author Interviews, Genetic Research, Nature, NYU / 06.11.2014

Leslie Mitchell, PhD New York University Langone Medical Center Boeke Lab, Institute for Systems Genetics NY NY, 10016MedicalResearch.com Interview with: Leslie Mitchell, PhD New York University Langone Medical Center Boeke Lab, Institute for Systems Genetics NY NY, 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: One of our major interests is building synthetic chromosomes. Typically we construct synthetic chromosomes using a bottom-up approach, first designing the sequence in silico and then synthesizing and piecing together the DNA to build the designer molecule. While eukaryotic chromosomes are usually linear in structure, oftentimes we build our designer synthetic chromosomes as circular molecules to take advantage of cloning technologies available in E. coli, an organism that tolerates only circular chromosomes. We developed the telomerator as a means by which to convert circular synthetic chromosomes into linear molecules, which more closely resemble the native chromosomes found in eukaryotic cells. We discovered that the telomerator is an extremely effective tool for generating linear derivatives of circular synthetic chromosomes. There are two main reasons for this.
  • First, the action of the telomerator can be assessed using a simple phenotypic assay so it is easy to differentiate cells that encode linear synthetic chromosomes from those with the circular format.
  • Second, the telomerator encodes ‘telomere seed sequences’ that are exposed and recognized by the cell upon linearization, thus the ends of a newly linearized chromosome are protected, which ensures its stability over generations. We put the telomerator to the test by integrating it in 54 different positions on a circular synthetic yeast chromosome called synIXR (Dymond et al. 2011). In 51 of the 54 positions we could successfully linearize the synIXR chromosome and recover viable cells, however many of the different linear derivatives conferred growth defects. We determined the mechanism underlying both the growth defects and lethality associated with linearization to be telomere position effect. In other words, when essential genes were re-positioned near telomeres their reduction in expression due to subtelomeric silencing was detrimental to the cell.
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