Author: Marie Benz MD FAAD

15 Dec

Posted at 20:14h in Author Interviews
Bradley M. Gray, PhD American Board of Internal MedicineMedicalResearch.com Interview with: Bradley M. Gray, PhD American Board of Internal Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Gray: The American Board of Internal Medicine (ABIM) is committed to evaluating the impact its physician certification programs, including Maintenance of Certification (MOC). That motivated us to investigate the relationship between the MOC requirement and the practice patterns of internists subject to it. We looked to see whether the original MOC requirement was associated with health care costs and measures of hospitalizations drawn from Medicare claims. Our primary measure of hospitalizations was Prevention Quality Indicators, which were developed by the Agency for Health Care Research and Quality to measure impacts of primary care. These include such things as hospitalizations for an amputation due to diabetic complications. Our health care cost measure included outpatient and inpatient costs. To examine these associations, we took advantage of a natural experiment that occurred when one group of general internists who originally certified in 1991 were subject to the MOC requirement by 2001, while another group of internists, who originally certified just two years earlier in 1989, were grandfathered out of this requirement. In essence we can think of the 1991 required group of internists as a group treated by the effects of MOC and the 1989 grandfathered group as a control group in a natural experiment. We estimated associations with this requirement by comparing outcomes among Medicare beneficiaries treated by the required group of internists before and after the requirement took effect in 2001. Also before and after the 2001 requirement, we compared this difference to a similar difference in outcomes for a control group of beneficiaries treated by the grandfathered group of internists. At base line before 2001, these beneficiaries had almost identical characteristics and co-morbidities as the beneficiaries treated by the required group of internists. We did this to account for the natural increase in hospitalizations and health care costs that occur as beneficiaries age, as well as other important factors that might have been coincident with the MOC requirement.

15 Dec

Posted at 13:29h in Author Interviews, Stroke, Technology
Dr. Emmanuel Tsekleves Senior Lecturer in Design Interactions ImaginationLancaster LICA |Lancaster UniversityMedicalResearch.com Interview with: Dr. Emmanuel Tsekleves Senior Lecturer in Design Interactions ImaginationLancaster LICA |Lancaster University Medical Research: What is the background for this study? What are the main findings Dr. Tsekleves: The study was influenced by the anecdotal use of the Nintendo Wii in therapy in NHS physiotherapy clinics back in 2010/11. This led to the need for conducting a study with therapists and patients (33 questionnaires and 10 interviews were completed) to explore the current use of the Nintendo Wii console technology in physical rehabilitation programmes across four NHS Trusts in London. The study revealed that although respondents felt the Wii helped with rehabilitation, over half of them  reported difficulty using equipment (such as using the hand-held remote controls). Therapists believed use of standard Wii was limited due to the high level of dexterity, movement and coordination necessary to operate the system. Adapting Nintendo Wii To Enhance Stroke Rehabilitation The results of the aforementioned study informed the development of a personalised stroke treatment, using adapted Wii technology, for arm re-education post-stroke (that is reported in the article http://informahealthcare.com/doi/abs/10.3109/17483107.2014.981874). The developed system was tested for acceptability with three stroke survivors with differing levels of disability. Participants reported an overwhelming connection with the system and avatar. A two-week, single case study with a long-term stroke survivor showed positive changes in all four outcome measures employed (Fugl-Meyer Assessment, Nine Hole Peg Test, Motor Activity Log – Amount of Use  sub-scale] and the Modified Ashworth Scale), with the participant reporting better wrist control and greater functional use. Activities, which were deemed too challenging or too easy were associated with lower scores of enjoyment/motivation, highlighting the need for activities to be individually calibrated.

15 Dec

Posted at 13:07h in Author Interviews, Flu - Influenza, PLoS, Vaccine Studies
Adrian Egli, MD PhD Research Group leader Infection Biology Laboratory Department of Biomedicine University of Basel and University Hospital Basel Basel, SwitzerlandMedicalResearch.com Interview with: Adrian Egli, MD PhD Research Group leader Infection Biology Laboratory Department of Biomedicine University of Basel and University Hospital Basel Basel, Switzerland Medical Research: What is the background for this study? What are the main findings? Dr. Egli: Infections with influenza viruses are associated with a high morbidity and mortality. In particular, people with a weak immune system are at danger for more severe complications. This includes elderly people, pregnant women, patients after transplantation, patients with HIV infection, chronic diseases such as diabetes and many more. In these high-risk groups, annual vaccination is clearly recommended. However, due to the immunsuppressive condition the immune response to the influenza vaccine is often reduced. The seroconversion rate - a 4-fold antibody titer increase upon vaccination - is one of the key markers for a successful vaccination. In young adults the seroconversion rate is normally >85%; however, in patients with immunosuppression, this can be lower than 40%. Improving vaccine efficacy is one of the key focuses of my research group. We try to understand, how to improve vaccines and better protect the people at the highest risks for influenza-associated complications. In this study, we could show that an important cytokine, called Interferon lambda, is clearly associated with the vaccine induced antibody response upon influenza vaccination. We could show that genetic polymorphisms, in one of the Interferon lambda gene family (IFNL3), are modulating the expression of this gene. This strongly affects the cross talk between the innate and adaptive immune response in the context of vaccination. We observed that, the more Interferon lambda is present, the lower the antibody response is. People with a lower expression of Interferon lambda had a significant higher response to the vaccine. Therefore, we developed substances to block the effect of Interferon lambda. We could show in vitro, that due to the Interferon lambda blockade, the antibody production was improved.

14 Dec

Posted at 20:31h in Author Interviews, Dermatology, Nature, Sleep Disorders
Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, IllinoisMedicalResearch.com Interview with: Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology, Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Silverberg: Chronic itch related to childhood eczema has been shown to cause worsened sleep quality with shorter sleep duration, more frequent and prolonged awakening, and overall lower sleep efficiency. However, little is known about the sleep disturbances that occur in adults with eczema.

14 Dec

Posted at 15:09h in Author Interviews, CMAJ, HPV, McGill, Vaccine Studies
Leah M. Smith PhD Department of Epidemiology, Biostatistics, and Occupational Health (Smith, Kaufman, Strumpf) McGill University, Montréal, QuebecMedicalResearch.com Interview with: Leah M. Smith PhD Department of Epidemiology, Biostatistics, and Occupational Health  (Smith, Kaufman, Strumpf) McGill University, Montréal, Quebec   Medical Research: What is the background for this study? What are the main findings? Dr. Smith: The human papillomavirus (HPV) vaccine protects against types of HPV that cause cervical cancer and anogenital warts. The vaccine first became available in 2006. Since then, it has faced a great deal of controversy surrounding, in part, some of the unanswered questions about the real-world effects of the vaccine, especially on the young girls targeted for immunization. One issue that has received a great deal of public attention has been the concern that HPV vaccination might give girls a false sense of protection against all sexually transmitted infections that might lead them to be more sexually active than they would otherwise. As a result, some parents have been reluctant to have their daughters vaccinated. It is also reason why some religious groups have spoken out against the vaccine. This question is further important from a public health perspective because increases in risky sexual behaviour would inevitably also lead to increases in teen pregnancy and sexually transmitted infections (excluding anogenital warts), which would of course undermine the potential health benefits of the vaccine.  In this study, we directly addressed the question of whether HPV vaccination has led to increases in pregnancy and non-HPV-related sexually transmitted infections (both of which are proxies for risky sexual behaviour) among adolescent girls. In our study of over 260,000 girls, we did not find any evidence that the HPV vaccine had a negative impact on these outcomes.

14 Dec

Posted at 14:56h in Author Interviews, BMJ, Surgical Research
Dr Aneel Bhangu Clinical Lecturer in Surgery Queen Elizabeth Hospital, Edgbaston, Birmingham UKMedicalResearch.com Interview with: Dr Aneel Bhangu Clinical Lecturer in Surgery Queen Elizabeth Hospital, Edgbaston, Birmingham UK Medical Research: What is the background for this study? What are the main findings? Dr. Bhangu: Randomised clinical trials are widely regarded as the type of evidence in medical research most likely to change practice and improve patient care. However, they are challenging to perform, expensive to deliver and rely on patients’ willingness to participate for the benefit of their wider community. Results of these studies should be disseminated widely in order to promote new medical knowledge. Unfortunately, some clinical trials are terminated early or fail to reach publication after completion. This leads to lost data and wastage of finite resources. Clinical trials within surgical disciplines present unique challenges, which may further impact on dissemination of evidence. We aimed to investigate the fate of surgical trials. Disappointingly, we found that 1 in 5 surgical trials are terminated early before completion, most commonly due to poor recruitment of research participants. Of trials which do reach completion, 1 in 3 are not published, indicating a significant waste of resources. A systematic approach to contact trial investigators during the study proved largely unsuccessful, implicating further hidden barriers to identifying trial data.

14 Dec

Posted at 14:15h in Author Interviews, Pulmonary Disease, Vitamin C
Harri Hemilä, MD PhD Department of Public Health University of Helsinki, POB 41 Helsinki, FinlandMedicalResearch.com Interview with: Harri Hemilä, MD PhD Department of Public Health University of Helsinki, POB 41 Helsinki, Finland   Medical Research: What is the background for this study? What are the main findings? Dr. Hemilä: I have a two decade interest in the effects of vitamin C on respiratory symptoms and I am the first author of the Cochrane review on vitamin C and the common cold. Since there is very strong evidence that vitamin C is better than placebo, in the Cochrane review we encourage common cold patients to try if vitamin C helps them. In 2009, I was taking a look at the Cochrane review on vitamin C and asthma. I was puzzled with the text and figures since my own impression of the RCTs on vitamin C and asthma was quite different from what the review presented. Therefore I took a close look at the Cochrane review and I saw that it was sloppy. There were severe errors in data extraction and data analysis. For example, they used un-paired t-test when they should have used the paired t-test. That types of questions are very basic in biostatistics. I wrote a feedback to that Cochrane review and the review was withdrawn in 2013. It had been misleading readers for a decade. As a positive result of that incident, I became interested in the effects of vitamin C on asthma and I conducted a meta-analysis of three RCTs on vitamin C and exercise-induced bronchoconstriction (EIB). I calculated that vitamin C caused a 48% reduction (95% CI 33% to 64%) in the postexercise FEV1 decline. That study was published in BMJ Open in 2013 (http://www.ncbi.nlm.nih.gov/pubmed/23794586).

14 Dec

Posted at 13:40h in Author Interviews, Breast Cancer, JNCI, Mayo Clinic
Dr. Matthew P. Goetz, MD Associate Professor of Pncology Mayo ClinicMedicalResearch.com Interview with: Dr. Matthew P. Goetz, MD Associate Professor of Pncology Mayo Clinic Medical Research: What is the background for this study? What are the main findings? Dr. Goetz: There has been conflicting data with regard to the importance of metabolism as measured by CYP2D6 genetic variation.   Two large “negative” studies were reported simultaneously in 2012 and these were referenced by guidelines that CYP2D6 should not be used to select hormonal therapy.   Our findings demonstrated that these studies were flawed in part based on analytical validity issues.  In short, the use of tumor tissue to derive CYP2D6 germline genotype leads to genotyping error in up to 45% of samples.

14 Dec

Posted at 13:01h in Author Interviews, Parkinson's
Filip Scheperjans MD Department of Neurology Helsinki University Central Hospital Department of Neurological Sciences University of Helsinki, Helsinki, FinlandMedicalResearch.com Interview with: Filip Scheperjans MD Department of Neurology Helsinki University Central Hospital Department of Neurological Sciences University of Helsinki, Helsinki, Finland Medical Research: What is the background for this study? What are the main findings? Dr. Scheperjans: In Parkinson’s disease (PD), the first neurodegenerative changes are seen in the olfactory bulb and enteric nervous system. Correspondingly, most Parkinson’s disease patients suffer from hyposmia and gastrointestinal symptoms, frequently years before motor symptoms evolve. Therefore, it has been suggested that an environmental factor acting through the nose or gut, could be involved in Parkinson’s disease. Interestingly, those two habitats are where our body gets mostly exposed to environmental agents, including microbes. Previous attempts to identify microbes related to Parkinson’s disease pointed to Helicobacter pylori and small intestinal bacterial overgrowth, but in the end had been somewhat inconclusive. But there possibly was a signal. We saw next generation sequencing approaches as a new opportunity to revisit the microbe theory in PD. Studies of gut microbiome composition in neurodegenerative disease have not been published before, although alterations in gut microbiota have been demonstrated in many other diseases and gut microbiota are in close interaction with the central nervous system. The fecal microbiome of Parkinson’s disease subjects clearly differed from that of matched controls and this difference was independent of the potential confounders that we assessed. The most significant finding was that the abundance of bacteria from the Prevotellaceae family was reduced by 78% in Parkinson’s disease patients. A low abundance of Prevotellaceae was 86% sensitive for PD, but rather unspecific. However, a combination of 4 bacterial families increased specificity for PD to 90%. So microbiome analysis performed quite well in distinguishing Parkinson’s disease patients from control subjects. Another interesting finding was that, within the Parkinson’s disease group, abundance of Enterobacteriaceae bacteria was related to the motor symptoms of patients. They were positively associated with the severity of postural instability and gait difficulty.

14 Dec

Posted at 12:54h in Author Interviews, Heart Disease, Mayo Clinic, Outcomes & Safety
Atsushi Sorita, MD, MPH Mayo Clinic, Division of Preventive Medicine Rochester, MN 55905.MedicalResearch.com Interview with: Atsushi Sorita, MD, MPH Mayo Clinic, Division of Preventive Medicine Rochester, MN 55905.   Medical Research: What is the background for this study? What are the main findings? Dr. Sorita: Prior studies have suggested that patients with heart attack who are admitted during off-hours (weekends, nights and holidays) have higher risk of death when compared with patients admitted during regular hours. In our study, we found that patients undergoing percutaneous coronary interventions for heart attack who were admitted during off-hours did not have higher mortality or readmission rates as compared with ones admitted during regular hours at a highly-integrated academic center in the United States.

14 Dec

Posted at 02:09h in Author Interviews, Cost of Health Care, Smoking
MedicalResearch.com Interview with: Darryl Konter Health Communications Specialist McNeal Professional Services Centers for Disease Control and Prevention Office on Smoking and Health Atlanta, GA 30341 Medical Research: What is the background for this study? What are the main findings? Darryl Konter:         Fifty years after the first Surgeon General’s report, tobacco use remains the nation’s leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking attributable costs in the U.S.         Data came from the 2006–2010 Medical Expenditure Panel Survey (MEPS) linked to the 2004–2009 National Health Interview Survey (NHIS). The MEPS is a nationally representative survey of civilian non-institutionalized families and individuals, their medical providers, and employers that collects information on individual healthcare utilization and medical expenditures.         By 2010, 8.7% of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year.  More than 60% of the attributable spending was paid by public programs, including Medicare, other federally-sponsored programs, or Medicaid.

14 Dec

Posted at 01:39h in Author Interviews, MRSA, PNAS, UCLA, Vaccine Studies
Dr. Michael Yeaman Ph.D. Professor of Medicine, Infectious Disease Specialist Chief, Division of Molecular Medicine David Geffen School of Medicine at UCLA Los Angeles Biomedical Research Institute at Harbor-UCLA Medical CenterMedicalResearch.com Interview with: Dr. Michael Yeaman Ph.D. Professor of Medicine, Infectious Disease Specialist Chief, Division of Molecular Medicine David Geffen School of Medicine at UCLA Los Angeles Biomedical Research Institute Harbor-UCLA Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Yeaman: In the U.S. and around the globe, skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA) continue to endanger the health and lives of patients and otherwise healthy individuals. Treatment is difficult because MRSA is resistant to many antibiotics, and the infections can recur, placing family members and other close contacts at risk of infection. Infectious disease specialists at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center (LA BioMed) tested a new investigational vaccine, NDV-3, and found it holds new hope for preventing or reducing the severity of infections caused by the "superbug" MRSA. In the study, which was published Dec. 8 in the Proceedings of the National Academy of Sciences USA, the researchers reported that NDV-3, employing the recombinant protein Als3, can mobilize the immune system to fight off MRSA skin infections in an experimental model. The researchers found the vaccine works by enhancing molecular and cellular immune defenses of the skin in response to MRSA and other S. aureus bacteria in disease models. This is the first published study to demonstrate the effectiveness of a cross-kingdom recombinant vaccine against MRSA skin infections. NDV-3 is unique as it is the first vaccine to demonstrate it can be effective in protecting against infections caused by both S. aureus and the fungus Candida albicans. NDV-3 represents a novel approach to vaccine design that pioneers an approach termed convergent immunity.

13 Dec

Posted at 23:21h in Author Interviews, Imperial College, Sugar, Weight Research
MedicalResearch.com Interview with: Dr James Gardiner Reader in Molecular Physiology Imperial College Hammersmith Campus London 0NN Medical Research: What is the background for this study? What are the main findings? Response: It is well known that glucose is a preferred food and is consumed in preference to other nutrients. Food intake is controlled by the brain in part this it is regulated by part of the brain called the hypothalamus.   Glucokinase is an important component of glucose sensing and is expressed in the hypothalamus and specifically in the arcuate nucleus. A hypothalamic mechanism regulating glucose intake has not previously been identified. Using a rodent model we demonstrated that increasing glucokinase activity in the arcuate nucleus increased food intake and body weight. If glucose was available as separately then glucose intake is increased but not weight. Decreasing glucokinase activity in the arcuate nucleus had the opposite effect, reducing glucose intake when it was available.   Our results suggest that glucokinase controls glucose appetite and hence the amount of glucose consumed. This is the first time a mechanism controlling the intake of a specific nutrient has been described.

13 Dec

Posted at 23:08h in Author Interviews, BMJ, Heart Disease, Nutrition, Sugar, Weight Research
Dr James J DiNicolantonio PharmD Ithaca, New YorkMedicalResearch.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: Cardiovascular disease is the leading cause of premature mortality in the developed world, and hypertension is its most important risk factor. Controlling hypertension is a major focus of public health initiatives, and dietary approaches have historically focused on sodium. A reduction in the intake of added sugars, particularly fructose, and specifically in the quantities and context of industrially-manufactured consumables, would help not only curb hypertension rates, but would also help address broader problems related to cardiometabolic disease.

13 Dec

Posted at 22:59h in Author Interviews, Cognitive Issues, Genetic Research, JAMA
David H. Ledbetter, Ph.D., FACMG Executive Vice President & Chief Scientific Officer, Geisinger Health System Danville, PA 17822MedicalResearch.com Interview with: David H. Ledbetter, Ph.D., FACMG Executive Vice President & Chief Scientific Officer, Geisinger Health System Danville, PA 17822 Medical Research: What is the background for this study? What are the main findings? Dr. Ledbetter: One of the biggest challenges in clinical care and research of children with autism and related neurodevelopment disorders is the remarkable clinical variability between individuals. This heterogeneity is reduced, but still significant, when considering individuals who have neurodevelopment disorders due to the identical genetic mutation such as deletion 16p11.2. We proposed that family background, genetic or environmental, may contribute to the variability in cognitive, behavioral and motor performance profiles of children with a sporadic (new) mutation in 16p11.2. Our study confirmed that a significant portion of the clinical variability seen in these children is due to the performance level of their parents and unaffected siblings and suggested that this may be due in part to genetic background effects as these traits are all known to have very high heritability.

13 Dec

Posted at 22:39h in Author Interviews, Biomarkers, Heart Disease
MedicalResearch.com Interview with: Mette Bjerre, Associate Professor, PhD Medical Research Laboratory Aarhus University Hospital & Aarhus University Aarhus C Denmark Medical Research: What is the background for this study? What are the main findings? Dr.Bjerre: Recently, a connection between bone regulatory proteins and vascular biology has attracted attention, suggesting osteoprotegerin (OPG), a secreted glycoprotein that regulates bone resorption, as a possible mediator of vascular calcification. Indeed, we and others has shown that high levels of circulating OPG predicts long-term outcome in patients with cardiovascular disease (CVD). However, the mechanism remains poorly understood. In order to elucidate the role of OPG in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), our study aimed to evaluate the progression of OPG levels, in four consecutive blood-samples obtained pre-PCI, post-PCI, day 1 and day 2. OPG levels did indeed change during treatment. OPG levels peaked post-PCI and then decreased; mean concentrations (95% confidence interval) pre-PCI 2650ng/L (2315-3036ng/L), post-PCI 2778ng/L (2442-3363ng/L), day 1 2024ng/L (1775-2306ng/L) and day 2 1808ng/L (1551-2106), (repeated measures ANOVA, F=33.192, p<0.001). Additional, high OPG level is independently associated with impaired LVEF (LVEF < 40%). Adjustment for BMI and traditional cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes and current smoking) did not significantly impact the association between OPG response and reduced LVEF.

13 Dec

Posted at 20:42h in Addiction, ADHD, Author Interviews
William Brinkman, MD, MEd, MSc Associate Professor of Pediatrics Director, Research Section, Division of General & Community Pediatrics Research Director, Cincinnati Pediatric Research Group James M. Anderson Center for Health Systems Excellence Cincinnati Children’s Hospital Medical CenterMedicalResearch.com Interview with: William Brinkman, MD, MEd, MSc Associate Professor of Pediatrics Director, Research Section, Division of General & Community Pediatrics Research Director, Cincinnati Pediatric Research Group James M. Anderson Center for Health Systems Excellence Cincinnati Children’s Hospital Medical Center MedicalResearch.com: What is the background for this study? Dr. Brinkman: Early onset of substance use is a significant public health concern as those who use substances before the mid-teen years are more likely to develop dependence than those who start later. The association of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) with tobacco and alcohol use has not been assessed in a young adolescent sample representative of the U.S. population.

13 Dec

Posted at 20:31h in Author Interviews, Brain Injury, NEJM
MedicalResearch.com Interview with: Dr. Brett E. Skolnick PhD Department of Neurosurgery Cushing Neuroscience Institute Hofstra North Shore–LIJ School of Medicine, Manhasset, NY Medical Research: What is the background for this study? What are the main findings? Dr. Skolnick: The experimental evidence for a role of progesterone is based on extensive non-clinical studies in non-primate species (4 animal species such as rat, mice) the majority of which indicate that progesterone has a variety of neuroprotective properties. The animal models of injury in traumatic brain injury (TBI) have included models of blunt trauma, fluid percussion injury, cortical aspiration but similar effects have been seen stroke models and models of spinal cord injury. In these experiments progesterone has been shown to reduce cerebral edema thus limiting the effects or preventing intracranial pressure increases which can lead to secondary injury. Progesterone has also been shown to exert anti-inflammatory, anti-apopotic and perhaps even anti-oxidant effects. All of these effect are postulated to work synergistically to prevent cell death which could result in improved functional outcomes. Two small single center clinical trials provided the support in traumatic brain injury patients that progesterone could have impact on functional outcomes in larger, properly powered trials.  The results of which are summarized in the NEJM article. In the current trial evaluated the Glasgow Outcome Scale and the extended version of the Glasgow Outcome scale at 6 months following injury. These scales are well validated scales that are used to determine the degree of recovery in terms of disability and handicap due to TBI rather than the degree of impairment. The GOS has 5 levels: death, vegetative state, severe disability, moderate disability and good recovery with death and vegetative state typically collapsed because they are considered equally undesirable. The Extended GOS takes the three best levels of recovery and subdivides these into a upper and lower category to increase the granularity of the outcome measure. Progesterone was administered within 8 hour of injury (loading dose followed by continuous infusions) for a total of 120 hours.  Careful assessments were performed to ensure optimal patient management during the trial to provide the best background to evaluate the impact of the addition of progesterone or placebo (1  to 1 randomization).  No effect was seen on the GOS or the extended GOS. In addition a fairly new approach of categorizing patients based on prognostic factors known at time of randomization (such as Age, baseline GCS, pupillary response, hypoxia, hypotension, Marshall Classification or presence/absence of subarachnoid hemorrhage) as developed by Hukkelhoven and colleagues was used. This was expected to tease out improvements, if they existed in subgroups of patients where perhaps progesterone could work better in the most severe or less severe traumatic brain injury patients. But again no effects were seen. The unfavorable outcomes (see NEJM paper for details) were essentially identical between progesterone and placebo groups whether they had the worst prognosis or the best prognosis.

13 Dec

Posted at 20:15h in Author Interviews, Genetic Research, NEJM, NIH
Dr. Constantine A. Stratakis, M.D., D.Sc National Institutes of Health, Clinical Research Center Bethesda, MD 20892-1862MedicalResearch.com Interview with: Dr. Constantine A. Stratakis, M.D., D.Sc National Institutes of Health, Clinical Research Center Bethesda, MD 20892-1862 Medical Research: What is the background for this study? What are the main findings? Dr. Stratakis: We have been working for years on the genetics of pituitary tumors in association with other conditions. A few years ago (attached), we studied for the first time a series of pediatric giants that we sequenced for then known genes. We found a few MEN1 and AIP mutations but all mutations were present in older kids with gigantism. This left out the youngest among the giants without any genetic defect. This was the first time I realized that I was dealing with a different disease. We started looking for additional genetic defects and when we found the Xq26 microduplications in 3 kindreds. We contacted the custodians of the largest series in the world - Dr. Beckers in Liege. He screened his cases, once we gave him the coordinates, and boom - it was there... The most significant thing here is that this is a new disease really: the early pediatric gigantism is almost exclusively due to Xq26 microduplications unless it is part of a family with another syndrome (AIP, MEN1, Carney complex). If there is no family history and you are dealing with a toddler with gigantism, based in these data, there is a more than 80% chance of having an Xq26 defect. This is pretty amazing! In addition, assuming that GPR101 is the responsible gene (which needs to be confirmed with additional studies) this identifies a new molecular pathway of increasing growth hormone secretion, most likely due to upregulation of GHRH - all of this needs to be confirmed in further human and animal studies. The Xq26 genomic micro-arrangements (which contain the GPR101, but also 3 other genes) is the big news here...

13 Dec

Posted at 19:39h in Author Interviews, Ophthalmology, Weight Research
MedicalResearch.com Interview with: Rui Azevedo Guerreiro Centro Hospitalar de Lisboa Central Portugal Medical Research: What is the background for this study? What are the main findings? Response: This article aims to summarise the current state of understanding on the possible ophthalmic complications that can occur after a bariatric surgery. The main finding of this review article is that ophthalmic complications after bariatric surgeries are more frequent that we could thought initially, especially in patients not adherent to their vitamin supplements. In one study, the percentage of patients with vitamin A deficiency 4 years after the surgery reached up to 69%.

13 Dec

Posted at 14:07h in Author Interviews, Erasmus, JACC, Memory, Stroke
MedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD,and Ayesha Sajjad, MD Department of Epidemiology Erasmus University Medical Center, Rotterdam Rotterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The occurrence of cognitive impairment and dementia after a stroke event are already known. Since these neuro-degenerative processes and stroke share vascular pathways in their pathogenesis such as small vessel disease, we aimed to study whether early cognitive impairment can be predictive of stroke onset in the elderly. We also hypothesized that a higher cognitive reserve (due to higher education attainment) may mask early symptoms of memory loss and thus put these older individuals at a higher risk of stroke. We found that self-reported subjective memory complaints as answered by a single question: “ Do you have memory complaints?” was highly predictive of stroke especially in older persons who were highly educated. In comparison, objective measures of cognitive impairment such as MMSE did not show any association with the risk of stroke.

13 Dec

Posted at 13:54h in Author Interviews, Heart Disease, Imperial College, JACC
MedicalResearch.com Interview with: Dr. Jane A. Mitchell National Heart and Lung Institute Imperial College, London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: Anti-inflammatory drugs (NSAIDs) work by inhibiting the enzyme COX-2. COX-2 selective anti-inflammatory drugs, like Vioxx, were introduced to reduce gastrointestinal side effects associated with these drugs. However, COX-2 inhibitors as well as most older NSAIDs are associated with increased risk of heart attacks although the precise mechanisms underlying these side effects are not completely understood. The main findings of this study are: 1) COX-2 is highly expressed in the kidney where its genetic deletion leads to changes in more than 1000 genes. 2) Analysis of these genes revealed changes in 2-3 specific genes that regulate levels of ADMA, an endogenous inhibitor of the nitric oxide released by vessels, that can be reversed by giving more of the substrate for NO, L-arginine. 3) Further studies showed that ADMA was indeed increased in the plasma of mice where COX-2 gene was knocked out or in normal mice given a COX-2 inhibitor. 4) In mice where COX-2 was knocked out the release of nitric oxide from vessels was reduced and this could be reversed by supply L-arginine. 5) ADMA was also increased in human volunteers taking a COX-2 inhibitor

13 Dec

Posted at 13:31h in Author Interviews, Education, JAMA
MedicalResearch.com Interview with: John Hayes, MD Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin Medical Research: What is the background for this study? What are the main findings? Response: Prominent in the discussions about ABIM MOC and recertification has been an ongoing debate about the evidence that supports a relationship between recertification, MOC and patient care. Since many healthcare organizations use board certification as a criteria for employment consideration, the new status of “certified” but not meeting MOC throws considerable disarray into credentialing and hiring committees. We can now have ABIM labeling a physician who boarded eleven years ago as “not certified” but a physician who boarded 25 years ago as “certified” with an asterisk. And of course discussions like this bring employers and healthcare organizations back to the question: What is the additive value of MOC and recertification on patient care? The integrated Veterans Health Administration electronic health record generates performance reports for primary care physicians at regular intervals. In our study, we were able to observe for any difference based on certification groups. We reviewed ten industry-standard quality care measures in approximately 68,000 patients across 4 VA medical centers and found that internists holding time-unlimited certificates performed just as well as those holding time-limited certificates.

12 Dec

Posted at 19:27h in Author Interviews, Nutrition
Refaat Hegazi, MD, PhD, MS, MPH Medical Director at Abbott Nutrition and an author of the FeedM.E. study. Affiliate Research Associate Professor Department of Internal Medicine, Division of Gastroenterology Brody School of Medicine at East Carolina UniversityMedicalResearch.com Interview with: Refaat Hegazi, MD, PhD, MS, MPH Medical Director at Abbott Nutrition and an author of the FeedM.E. study.  Affiliate Research Associate Professor Department of Internal Medicine, Division of Gastroenterology Brody School of Medicine at East Carolina University Medical Research: What is the background for this study? What are the main findings? Dr. Hegazi: When we think about malnutrition, we don’t believe it can impact us and our families. But malnutrition is a widespread condition that can affect anyone, especially when sick or injured, and exists in every country of the world - both in emerging and developed nations. In fact, an estimated one in three patients who enter a hospital are malnourished and up to one out of two older adults are at risk for malnutrition. The consequences of malnutrition are serious and include increased complications, (pressure ulcers, infections, falls), longer hospital stays, frequent readmissions, increased cost of care and higher risk of mortality. However, the condition often goes undiagnosed despite being preventable and treatable if identified early. This is why we authored “Evidence-Based Recommendations for Addressing Malnutrition in Health Care: An Updated Strategy From the feedM.E. Global Study Group”. It aims to create a call to action for clinicians worldwide and provides a simple clinical nutrition care pathway that can be implemented in any health care setting, in any part of the world.

12 Dec

Posted at 15:10h in Author Interviews, Breast Cancer, Yale
Dr. James Yu Yale School of Medicine Cancer Outcomes, Public Policy, and Effectiveness Research Center Yale School of Medicine Department of Therapeutic Radiology New Haven, Connecticut MedicalResearch.com Interview with: Dr. James Yu Yale School of Medicine Cancer Outcomes, Public Policy, and Effectiveness Research Center Yale School of Medicine Department of Therapeutic Radiology New Haven, Connecticut Medical Research: What is the background for this study? What are the main findings? Response: Hypo fractionated radiation has been shown to be safe and effective, and more convenient for women with early stage breast cancer after lumpectomy.  It also has been identified by ASTRO as a practice that physicians can adopt to reduce healthcare expenses for patients and for society.  We looked at the National Cancer Database, a database created by the American College of Surgeons for trends in the use of hypo fractionated radiation for breast cancer through 2011.  We found that the use of hypofractionated radiation had increased to 22.8% in 2011.  I found this remarkable as it predated the ASTRO choosing widely guidelines, and indicated to me that physicians were already thinking of ways of making treatment more convenient and affordable for patients and insurers.

12 Dec

Posted at 14:54h in Author Interviews, Diabetes, Nature, Weight Research
MedicalResearch.com Interview with: Prof. Dr. Patrice D. Cani PhD, Research Associate FRS-FNRS Louvain Drug Research Instiute, Metabolism and Nutrition WELBIO, Walloon Excellence in Life sciences and BIOtechnology NeuroMicrobiota lab, European Associated Laboratory (INSERM/UCL) and Dr Amandine Everard Université Catholique de Louvain, Louvain Drug Research Institute, WELBIO (Walloon Excellence in Life sciences and BIOtechnology), Metabolism and Nutrition Research Group, Brussels, Belgium Medical Research: What is the background for this study? What are the main findings? Response: Our intestine harbors more than 100 trillions of bacteria. This huge number of bacteria permanently interacts with our own human cells. Among the systems involved in this crosstalk, the immune system plays a key role in these interactions. We previously showed that specific gut bacteria are able to control energy metabolism, harmful inflammation associated with obesity, body weight gain and type-2 diabetes. However mechanisms involved these effects of gut bacteria on the host during obesity and type-2 diabetes were poorly understood. We identify the essential role of the intestinal immune system in the onset of obesity and type-2 diabetes both induced by a high dose of fat in the diet. This discovery highlights an unexpected mechanism for the control of energy metabolism during obesity and type-2 diabetes. We demonstrate for the first time that the inactivation of a part of the intestine immune system (more specifically the protein MyD88), which is overstimulated by a diet rich in fat, allows to induce weight-loss and to reduce type-2 diabetes associated with obesity. When we tune the immune system by disabling the protein MyD88 specifically in cells covering the intestine, we are able to limit the adipose tissue development induced by the diet rich in fat, to slow down diabetes, to reduce harmful inflammation associated with obesity, to reinforce gut barrier function assumed by our intestine to avoid the inappropriate translocations of bacteria compounds from our intestine in our body. We reveal various mechanisms explaining the partial protection against obesity induced by the inactivation of this protein of the immune system. Among them, we point out that mice that do not have this protein of the immune system (i.e. MyD88) in their intestine are partially protected against obesity because they spend more energy than other obese mice. Moreover, our study shows that this protein of the immune system is able to shape the composition of the gut microbiota residing in our intestine under a high-fat diet. These changes observed in mice deleted for this protein also explain their protection against obesity because when we transfer intestinal bacteria of these mice into other mice that are axenic (without flora), these latest mice are also partially protected against obesity. In conclusions, our studies published in the scientific journal Nature Communications, demonstrated that during consumption of fat food, the intestinal immune system plays an important role in fat storage regulation in the body and is capable to modify the composition of intestinal bacteria (including some which are still unidentified), confirm the implication of intestinal bacteria in the onset of obesity.

12 Dec

Posted at 14:28h in Accidents & Violence, Author Interviews, Pediatrics
Dr. Gary A. Smith Center for Injury Research and Policy Nationwide Children’s HospitalMedicalResearch.com Interview with: Dr. Gary A. Smith Center for Injury Research and Policy Nationwide Children’s Hospital   Medical Research: What is the background for this study? What are the main findings? Dr. Smith: The study found that from 1990 through 2011, an estimated 3,278,073 children younger than 18 years of age were treated in United States emergency departments for toy related injuries. The annual injury rate per 10,000 children increased by nearly 40% during that time period. The increase was largely associated with ride-on toys, particularly foot-powered scooters. Ride-on toys accounted for 34.9% of all injuries and 42.5% of hospital admissions. The study is the first to comprehensively investigate toy-related injuries among children using a nationally representative data set, the National Electronic Injury Surveillance System (NEISS).

12 Dec

Posted at 14:05h in Author Interviews, Breast Cancer, Cancer, Duke

Rachel Blitzblau, M.D., Ph.D. Butler Harris Assistant Professor Department of Radiation Oncology Duke University Medical Center Durham, NC 27710MedicalResearch.com Interview with: Rachel Blitzblau, M.D., Ph.D. Butler Harris Assistant Professor Department of Radiation Oncology Duke University Medical Center Durham, NC 27710

Medical Research: What is the background for this study? What are the main findings? Dr. Blitzblau: Radiation reduces the risk of loco-regional recurrence. Data from the CALGB 9343 study suggests that the local benefit from adjuvant radiation is less in older women with small, . The potential acute and late toxicities of radiotherapy, patient inconvenience and healthcare costs must be considered given the small clinical benefit associated with adjuvant radiotherapy in this patient group. We looked at rates of radiotherapy in women fitting the entry criteria of this trial before and after publication of 5 year results of the CALGB trial. We found an approximately 5% decrease in use of radiotherapy overall, and noted that there seemed to be a small but significant shift in the type of radiotherapy used for these patients. Less patients received standard whole breast radiotherapy, and more received a short course of treatment to just the tumor bed plus margin called accelerated partial breast irradiation. We concluded that the publication of the trial therefore had only a very small impact on practice patterns.

12 Dec

Posted at 02:57h in Author Interviews, NYU/NYMC, Surgical Research

Ganesh Sivarajan, MD Department of Urology New York University Langone Medical CenterMedicalResearch.com Interview with: Ganesh Sivarajan, MD Department of Urology New York University Langone Medical Center

  Medical Research: What is the background for this study? What are the main findings? Dr. Sivarajan: The surgical robot was designed to facilitate laparoscopic surgery. The surgeon sits at a console several feet away from the patient and is linked to a multi-armed robot which translates the surgeon’s movements from the console to surgical instruments inside the patient’s insufflated abdomen. The robot is equipped with a high resolution three dimensional camera which improves visualization over traditional open surgery and allows the manipulation of instruments in directions and angles which are difficult in traditional open surgery. In light of these apparent advancements, the robot was rapidly adopted for use during radical prostatectomy. The outcomes data for men undergoing robotic versus open prostatectomy, however, have not demonstrated any clear advantage of robotic surgery, with some studies demonstrating benefit and other demonstrating harm. This fact coupled with the relatively high cost of the robot and its disposable equipment have led many to criticize robotic surgery and its rapid adoption. Partial nephrectomy is a procedure performed for renal cancer in which just the malignant tumor is excised while the remaining healthy kidney is saved. It is increasingly considered to be preferable to the previous gold standard operation – radical nephrectomy or removal of the entire kidney largely secondary to the benefits accrued from preserving renal function. Despite actual changes in the treatment guideline recommending increased use of partial nephrectomy it remains vastly underutilized nationwide likely because of the technical challenges associated with its performance. It has been suggested that the surgical robot facilitates the performance of partial nephrectomy, but this has not been definitively demonstrated in a model which controls for important variables as the effects of changing guidelines, secular trends supporting increased utilization over time and a variety of other hospital-level characteristics. We sought to determine whether acquisition of the surgical robot was independently associated with increased utilization of partial nephrectomy – a guideline-supported procedure. If true, it would suggest that the acquisition of the surgical robot may have improved the quality of care of renal cell carcinoma patients.

11 Dec

Posted at 20:52h in Aging, Author Interviews, FASEB

MedicalResearch.com Interview with: Jane Tarry-Adkins BSc Biochemistry Research Assistant University of Cambridge · Institute of Metabolic Science

Medical Research: What is the background for this study? What are the main findings? Response: From epidemiological and animal studies, it has been known for several years that a suboptimal in utero environment that causes low birth weight combined with accelerated postnatal growth is strongly linked to increased risk of cardiovascular disease (CVD). However underlying molecular mechanisms for this phenomenon, known as ‘developmental programming’ are still unknown. In this study, we used a rat model where animals are born small because their mother ate a low protein diet during pregnancy but grow quickly during lactation when they are suckled by a control diet fed mum. These ‘recuperated’ rats displayed indices of accelerated aortic cellular aging and damage which was associated with a deficit in coenzyme Q (CoQ); (the most abundant endogenous antioxidant in the body), compared to offspring of a normal birth-weight. When these ‘recuperated’ offspring were supplemented with a clinically relevant dose of coenzyme Q, this corrected these markers of aortic cellular aging and aortic damage. Importantly, measurement of CoQ in white blood cells (WBCs) a clinically accessible tissue demonstrated a coenzyme Q deficit in these ‘recuperated’ offspring. Importantly, this strongly correlated with aortic CoQ levels. Furthermore, we also showed a highly significant relationship between CoQ levels and aortic telomere length in WBCs, suggesting that low WBC CoQ levels can predict short aortic telomeres, and therefore susceptibility to aortic disease.