MedicalResearch.com Interview with: Matheus Victorm PhD candidate Dr. Andrew Yoo's Lab Graduate Program in Neuroscience Washington University School of Medicine Medical Research: What is the...
MedicalResearch.com Interview with:
Alfredo Falcone MD
Chiara Cremolini Fotios Loupakis
University of Pisa and Azienda-Ospedaliero Universitaria Pisana
Italy
Medical Research: What are the main findings of the study?
Dr. Falcone: In the TRIBE study the main findings are that the use of an initial more intensive therapy with a triplet of cytotoxics (FOLFOXIRI) plus bevacizumab vs a doublet (FOLFIRI) + bevacizumab improves the outcome of metastatic colorectal cancer patients with unresectable metastases. In particular FOLFOXIRI + bevacizumab vs FOLFIRI+bevacizumab improved RECIST response-rate (65% vs 53%, p=0.006), progression-free survival which was the primary endpoint (median 12,1 vs 9,7 months, HR=0,75, p=0.003) and overall survival (median 31,0 vs 25,8 months, HR=0.79, p=0.054). These results, also compared to those reported in previous phase III studies in molecularly unselected patients, represent an important advance in the treatment of this disease.
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MedicalResearch.com Interview with:
Ilina and Medha Krishen
Michigan high school students and sisters Ilina and Medha Krishen, have developed screening tools using electronic stethoscopes to detect lung and heart disease. Their research was presented at the 2014 CHEST national meeting. Ilina and Medha have kindly agreed to discuss their work for the MedicalResearch.com audience.
Medical Research: Ilina, please tell us a little about you and the background for your study.
Ilina: I am a senior at Port Huron Northern High School in Fort Gratiot, Michigan. I was exploring the effects of air pollutants on lungs using frequency analysis of lung recordings. My goal was to see if I could pick up early changes in healthy smokers and firefighters.
Dr. Sridhar Reddy, a local pulmonologist and occupational medicine expert mentored me. He lent me his electronic stethoscope. I am a violinist and a clarinet player, so initially had a lot of fun analyzing music frequencies. Later, I moved to lung sounds (a little more difficult!).
I used a Thinklabs Electronic Stethoscope for recording lung sounds. The inventor, Mr. Clive Smith, helped me understand the stethoscope.
I used the MATLAB program for analyzing frequencies. Mr. Charles Munson, a graduate student at the University of Michigan, helped me write the software program for it.
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MedicalResearch.com Interview with:
Georg Loss, PhD
Dr. von Hauner Children’s Hospital
Ludwig Maximilians University of Munich
Munich, Germany
Medical Research: What are the main findings of the study?
Dr. Loss: In this large population based cohort study we observed that consumption of fresh unprocessed cow’s milk protected from respiratory infections, febrile illness and inflammation of the middle ear during the first year of life. The risk of developing these conditions was reduced by up to 30%, and the effect was diminished if the milk was heated at home before consumption. Conventionally pasteurized milk retained the ability to reduce the risk of febrile illness, while exposure to the higher temperatures used in UHT (Ultra-heat-treatment) processing eliminated the effect altogether. Importantly, the positive impact of fresh milk could be clearly separated from the confounding effects of other elements of the children’s nutrition. Furthermore, infants fed on unprocessed milk were found to have lower levels of the C-reactive protein, which is a measure of inflammation status.
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MedicalResearch.com Interview with:
Dr. Matthew Budoff, M.D.
Los Angeles Biomedical Research Institute
Torrance California
Medical Research: What are the main findings of the study?
Dr. Budoff: We evaluated whether patients undergoing coronary CT angiography (non-invasive angiography) had better outcomes than those treated without the test. We found survival was better with CT angiography. Finding atherosclerosis allows cardiologists and primary care doctors to treat the patient better, including more statin therapy, more anti-platelet therapy, more lifestyle modifications. Several small studies showed similar results, but this was by far the most significant and largest study of it’s kind.
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MedicalResearch.com: Interview with:
Jonathon Maguire MD MSc FRCPC
Pediatrician and Scientist Department of Pediatrics
Li Ka Shing Knowledge Institute
St. Michael’s Hospital University of Toronto
Medical Research: What is the background for this study? What are the main findings?
Dr. Maguire: One of the main health benefits of cow’s milk is vitamin D. We were interested to know if non-cow’s milk supports children’s vitamin D blood levels as well as cow’s milk.
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MedicalResearch.com Interview with:
Dr. John Cherrie PhD
Honorary Professor in Occupational Hygiene
Institute of Applied Health Sciences
Aberdeen, UK
Medical Research: What are the main findings of the study?
Dr. Cherrie: We set out to bring together measurements of fine particle levels in homes where smoking takes place, to compare these with smoke-free homes and then to estimate how much of these fine particles are inhaled by people at different stages in their life. We also wanted to look at the exposure to particles of non-smokers living with smokers and compare this with the exposure of people living in heavily polluted major cities around the world.
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MedicalResearch.com Interview with:
Professor Emrah Düzel
Director, Institute of Cognitive Neurology and Dementia Research, OvG Univ. Magdeburg, Germany
Institute of Cognitive Neuroscience
University College London
Medical Research: What are the main findings of the study?
Professor Düzel: We found that even in old age, intensive and long-term (3 months) aerobic exercise can improve blood flow in the hippocampus, a brain structure that is of critical importance for memory. The increase in blood flow is evident during a resting state and this means that the exercise improves the overall perfusion of the hippocampus. Such effects had previously only been reported in young adults. As previously observed in young adults, the change in blood flow after exercise is related to the improvement of specific memory skills. We found the closest relationship between improved blood flow and recognition memory for complex objects. This is interesting because this type of memory is likely to benefit from “pattern separation”, a process that in animal studies of exercise is tightly associated with hippocampal neurogenesis.
However, we also found that the exercise-related improvement in hippocampal blood flow and in recognition memory was absent in the older seniors of our study cohort. Those who were beyond 70 did not show any improvement. We reasoned that this may have been due to higher levels of stress in the older seniors. Therefore, we investigated whether elevated serum cortisol levels dampened the benefits of exercise in the older seniors. But this was not the case making it unlikely that stress levels can account for these findings.
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MedicalResearch.com Interview with
Dr. Harald Schmidt, MA, PhD
Assistant Professor, Department of Medical Ethics and Health Policy , Research Associate, Center for Health Incentives and Behavioral Economics, Perelman School of Medicine
University of Pennsylvania Philadelphia, PA 19104-3308
Medical Research: What are the main findings of the study?
Dr. Schmidt: We reviewed currently available policies for aligning cost and quality of care. We focused on interventions are similar in their clinical effectiveness, have modest differences in convenience, but pose substantial cost differences to the healthcare system and patients. To control health care costs while ensuring patient convenience and physician burden, reference pricing would be the most desirable policy. But it is currently politically unfeasible. Alternatives therefore need to be explored. We propose the novel concept of Inclusive Shared Savings, in which physicians, the healthcare system, and, crucially, patients, benefit financially in moving more patients to lower cost but guideline concordant and therapeutically equivalent interventions.
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MedicalResearch.com Interview with:
Carolyn J. Crandall, MD, MS
Professor of Medicine
David Geffen School of Medicine at University of California
UCLA Medicine/GIM Los Angeles, CA 90024
Medical Research: What are the main findings of the study?
Dr. Crandall: Clinical guidelines recommend that women aged ≥ 65 years should be screened for osteoporosis. However, for younger postmenopausal women aged between 50 and 64 years, the United States Preventive Services Task Force (USPSTF) recommends osteoporosis screening for women who have a 10-year predicted risk of osteoporosis fracture that is ≥9.3%. We tested the ability the USPSTF strategy, and two other strategies (called OST and SCORE), to distinguish between women who did and did not experience a fracture in the subsequent 10 years. We found that the USPSTF strategy did not identify the majority of who experienced osteoporotic fracture in the subsequent 10 years. Especially in women aged 50-54 years, the USPSTF strategy identified fewer than 5% of women who experienced fracture over 10-year follow-up.
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MedicalResearch.com Interview with:
Chitra Lal, MD. Assistant Professor
Medical University of South Carolina
Medical Research: What are the main findings of the study?
Dr. Lal: We studied the prevalence of cognitive problems in early postmenopausal women (age 45-60 years) with obstructive sleep apnea syndrome (OSAS+) and without obstructive sleep apnea syndrome (OSAS-) using a questionnaire called the Mail-In Cognitive Function Screening Instrument (MCFSI).
We found that the mean MCFSI scores after adjusting for depression were significantly higher in obstructive sleep apnea syndrome+ then the OSAS- group, indicating more self-reported cognitive difficulty in OSAS+ women
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MedicalResearch.com Interview with
Scott E. Hensley, Ph.D.
Assistant Professor, The Wistar Institute
Philadelphia, PA 19104
Medical Research: What are the main findings of the study?
Dr. Hensley: We found that H1N1 viruses recently acquired a mutation that abrogates binding of influenza antibodies that are present in a large number of middle-aged adults. We propose that this mutation lead to increased disease among middle-aged adults during the 2013-2014 influenza season.
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MedicalResearch.com Interview with:
Peter J. Mazzone, MD, FCCP MPH
Director of the Lung Cancer Program for the Respiratory Institute
Cleveland Clinic
Medical Research: What are the main findings of this study?
Dr. Mazzone: There were 2 parts to this study. In the first part we looked at how the breath collection instrument and sensor were performing and made adjustments to both in order to optimize its performance.
In the second part we used the improved device and sensor to see if we could accurately separate a sensor signal of our patients with lung cancer from those without lung cancer. We found good separation of lung cancer from non-cancer breath signals, and very good separation of signals of one type of lung cancer from another.
We have concluded that a colorimetric sensor array based breath test is capable of separating those with lung cancer from those without.
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MedicalResearch.com Interview with:
Dr. Iris L. Romero MD MS
Associate Professor of Obstetrics & Gynecology, Section of General Gynecology
The University of Chicago Medicine
Chicago, IL
Medical Research: What are the main findings of the study?
Dr. Romero: There is increasing epidemiologic and preclinical data indicating that the commonly used diabetic drug, metformin, may have anticancer effects. In ovarian cancer, in 2011 in Obstetrics & Gynecology we reported that in a retrospective cohort ovarian cancer patients that were using metformin had increased survival compared to those not using mefomrin. In this study, we expand on those findings by testing whether metformin can prevent ovarian cancer or improve response to chemotherapy in mouse models.
In a prevention study, we found that mice treated with metformin before cancer was initiated developed less tumor than those treated with placebo. In a treatment study, in vitro, metformin increased the cytotoxic effect of paclitaxel. In addition, using a genetic mouse model we show that the combination of paclitaxel plus metformin results in a greater tumor reduction than either drug used alone.
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MedicalResearch.com Interview with:
Edith A. Perez, MD
Mayo Clinic
Jacksonville, FL 32224
Medical Research: What are the main findings of the study?
Dr. Perez: Our joint analysis of two large prospective trials showed that adding one year of Trastuzumab to otherwise standard adjuvant chemotherapy significantly improved long term survival in women with resected HER2+ breast cancer.
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MedicalResearch.com Interview with:
Prof. David Whiteman
Group leader, Cancer Control Group
QIMR Berghofer
Herston, Queensland
Medical Research: What are the main findings of the study?
Dr. Whiteman: Mortality from melanoma has continued to rise in Queensland, Australia, the jurisdiction with the world’s highest incidence of this disease. We analysed more than 4000 deaths from melanoma over the last 2 decades, and calculated mortality rates according the thickness of the primary lesion.
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MedicalResearch.com: Interview with:
Edward I. Ginns, MD, PhD, Director
Program in Medical Genetics and
Lysosomal Disorders Treatment and Research Program
University of Massachusetts Medical School
Reed Rose Gordon Building, Room 137
Shrewsbury, MA 01545
Medical Research: What are the main findings of the study?
Dr. Ginns: Our study identified that sonic hedgehog signaling, an important brain pathway, is involved in bipolar affective disorder.
This finding shows a mechanism and provides new targets for drug development. It suggests that sonic hedgehog signaling can be modulated to help manage bipolar symptoms in adults by using drugs already being studied in clinical trials for other medical conditions.
The new findings were uncovered by decades of translational research in the Old Order Amish families of Pennsylvania, where in a few special families in the Amish Study there is a high incidence of both bipolar disorder and a rare genetic dwarfism, Ellis van‐Creveld (EvC) syndrome. No person with EvC had bipolar disorder despite forty years of documented research across multiple generations, suggesting that the genetic cause of this rare dwarfism was protective of bipolar affective disorder.
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MedicalResearch.com Interview with
David A. Fiellin, M.D.
Professor of Medicine, Investigative Medicine and Public Health
Yale University School of Medicine
Medical Research: What are the main findings of the study?
Dr. Fiellin: The main finding of our randomized clinical trial, conducted in primary care, was that among prescription opioid dependent patients, ongoing buprenorphine therapy resulted in better treatment retention and reduced illicit opioid use when compared to buprenorphine taper (detoxification).
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MedicalResearch.com Interview with:
David L. Katz, MD, MPH, FACPM, FACP
Director, Yale University Prevention Research Center
Griffin Hospital
Medical Research: What are the main findings of the study?
Dr. Katz: We did not see any adverse effects of short-term, daily egg ingestion in adults with established coronary artery disease.
Medical Research: What was most surprising about the results?
Dr. Katz: Eggs are routinely banned from 'heart healthy diets.' in particular eggs are always absent from cardiac care units, with egg beaters substituting. However, these same units routinely serve products with refined starch and added sugar. The scientific basis for excluding eggs from diets to improve cardiac health has long been suspect. Here, we show that in the short term at least, there are no discernible harms of daily egg ingestion even in adults with heart disease.
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MedicalResearch.com Interview with:
Dr. Brent M. Egan MD
Professor of Medicine
University of South Carolina School of Medicine Greenville
Senior medical director of the Care Coordination Institute
Greenville, South Carolina
Medical Research: What are the main findings of the study?
Dr. Egan: The study was undertaken to determine progress toward the Healthy People 2020 goals of controlling hypertension or high blood pressure in 61.2% of all adults with the condition. What we found is that hypertension control has changed very little from 2007 through 2012. In 2011-2012, an estimated 51.2% of all hypertensive adults were controlled, which is 10% below the 2020 goal. The analysis indicated that healthcare insurance and at least two healthcare visits yearly were related to both the likelihood that hypertension would be treated and controlled.
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MedicalResearch.com Interview with
Marie C. Leger, MD, PhD
Ronald O. Perelman Department of Dermatology
New York University School of Medicine, New York
Medical Research: What are the main findings of the study?
What was most surprising about the results?
Dr. Leger: Alopecia areata is a T-cell mediated autoimmune disease. As such, there was initially hope that inhibiting the helper T cell cytokine TNF-α could effectively treat this condition. This has not been shown to be the case—in fact, one open-label study of etanercept in 17 patients with moderate to severe alopecia showed no hair regrowth and even worsening of alopecia in several subjects. There have been many other case reports in the dermatologic literature of TNF-α inhibitors causing alopecia areata. In contrast, our case report presents a patient who very clearly grew hair on adalimumab—its strength lies in the fact that her hair loss and regrowth were replicated on withdrawal and rechallenge with the medication.
Our patient’s paradoxical response to adalimumab complements other literature suggesting that there are genetic variations in the way a patient’s immune system responds to TNF-α inhibitors. In different individuals, these medications can either treat or cause conditions such as psoriasis or lupus. It seems that this is also the case with alopecia areata.
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Dr. Huiyun Xiang, MD, MPH, PhD
Center for Injury Research and Policy
The Ohio State University College of Medicine, Columbus, Ohio
Jeb Phillips, BA
Project Specialist, Injury Research and Policy Staff
Nationwide Children’s Hospital, Columbus, Ohio
Medical Research: What are the main findings of the study?
Response: From 2002-2012, a child younger than 6 years old experienced an out-of-hospital medication error every 8 minutes. That’s a total of 696,937 during the study period, or 63,358 per year. Almost all happened at the child’s residence. The rate and number of errors decreased with increasing age.
Analgesics were the mostly commonly involved medications (25.2%), followed by cough and cold medications (24.6%). More than 1 in 4 (27%) of the errors happened when a child inadvertently took or was given medication twice. Errors also happened when children took or were given an incorrect dose, when medication measurements were confused, and when the wrong medication was taken or given.
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MedicalResearch.com Interview with:
Dr. Susanne Huijts
Research Physician at UMCU Julius Center for Health Sciences Pulmonary resident, UMC Utrecht Center
Utrecht, Netherlands
Medical Research: What are the main findings of the study?
Dr. Huijts: The CAPiTA trial evaluated the efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13) in adults of 65 years and older. In the per protocol analysis vaccine efficacy of 45.6% was demonstrated for the first episode vaccine type (VT) pneumococcal community acquired pneumonia (CAP); 45.0% for the first episode of non-bacteremic/ non-invasive (NB/NI) VT-CAP, and 75.0% for the first episode of VT-invasive pneumococcal disease.
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MedicalResearch.com Interview with:
Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen's University
Kingston, Ontario, Canada
Medical Research: What are the main findings of the study?
Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.
We also found that the risk increases in patients with more severe obstructive sleep apnea.
This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.
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MedicalResearch.com Interview with:
Arjumand Siddiqi, Sc.D., Assistant Professor
Departments of Epidemiology and Social and Behavioral Sciences
Dalla Lana School of Public Health
University of Toronto
Toronto, Ontario Canada
MedicalResearch: What are the main findings of the study?
Dr. Siddiqi: The main finding of the study is that, in a society with universal health insurance (Canada), racial disparities in access to primary care are drastically reduced, with some important exceptions.
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