Blog – Medical Research News and Interviews
27 Jan A Split Brain Has Two Perceptions But One Mind
Posted at 16:41h
in Author Interviews
MedicalResearch.com Interview with:
[caption id="attachment_31642" align="alignleft" width="200"]
Dr. Pinto[/caption]
DR. Y. (YAÏR) PINTO
Faculty of Social and Behavioural Sciences
Programme group Brain and Cognition
UvA
MedicalResearch.com: What is the background for this study?
Response: I've done research into patients in whom the corpus callosum was entirely removed surgically, at an adult age, to relieve epileptic seizures. The removal of the corpus callosum all but eliminates communication between both cerebral hemispheres. Therefore these patients are referred to as split-brain patients.
The canonical view of these patients is that their consciousness is split as well. That is, the notion, which is found in many textbooks and reviews, is that in a split-brain patient each hemisphere is an conscious agent, independent of the other hemisphere.
This notion is mainly based on the following key observation. When an image is presented to the left visual field, the patient indicates verbally, and with his right hand, that he saw nothing. Yet, with his left hand he indicates that he did see the object! Conversely, if a stimulus appears in his right visual field, he will indicate awareness of this stimulus when he responds verbally or with his right, yet with his left hand he will report that he saw nothing. This exactly fits the notion that in a split-brain patient the two separated hemispheres each become an independent conscious agent. The left hemisphere perceives the right visual field, controls language and the right side of the body. The right hemisphere experiences the left visual field and controls the left hand. This, and other discoveries on split-brain patients, earned Roger Sperry the nobel-prize in Medicine in 1981.
27 Jan Reduced Stem Cells Link Congenital Heart Disease To Impaired Brain Growth
Posted at 16:07h
in Author Interviews, Heart Disease, Neurological Disorders, Pediatrics, Science, Stem Cells
MedicalResearch.com Interview with:
[caption id="attachment_31564" align="alignleft" width="233"]
Children's National Research Team[/caption]
Paul D. Morton, Ph.D.
Research PostDoc and lead study author of “Abnormal Neurogenesis and Cortical Growth in Congenital Heart Disease.”
Children’s National Health System Washington, DC
Nobuyuki Ishibashi, M.D.
Director of the Cardiac Surgery Research Laboratory at Children’s National Health System and co-senior study author.
Vittorio Gallo, Ph.D.
Director of the Center for Neuroscience Research at Children’s National Health System and co-senior study author.
Richard A. Jonas, M.D.
Chief of the Division of Cardiac Surgery at Children’s National Health System and co-senior study author.
MedicalResearch.com: What is the background for this study?
Response: Congenital heart disease (CHD) is the leading birth defect in the United States and often results in an array of long-term neurological deficits including motor, cognitive and behavioral abnormalities. It has become increasingly clear that children with CHD often have underdeveloped brains. In many cases of complex CHD, blood flow to the brain is both reduced and less oxygenated, which has been associated with developmental abnormalities and delay. The cellular mechanisms underlying the impact of CHD on brain development remain largely unknown. We developed a preclinical chronic hypoxia model to define these mechanisms.
27 Jan Our Personality is Shaped By Wrinkles and Folds of Our Brain
Posted at 15:46h
in Author Interviews, Mental Health Research, Neurological Disorders, Psychological Science
MedicalResearch.com Interview with:
[caption id="attachment_31560" align="alignleft" width="180"]
Dr. Roberta Riccelli[/caption]
Dr. Roberta Riccelli
Magna Graecia University
Catanzaro, Italy
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In recent years, there has been a growing interest in personality neuroscience, an emergent field of research exploring how the extraordinary variety of human behaviors arise from different patterns of brain function and structure. According to psychologists, the extraordinary variety of human personality can be broken down into the so-called ‘Big Five’ personality traits, namely neuroticism (how moody a person is), extraversion (how enthusiastic a person is), openness (how open-minded a person is), agreeableness (a measure of altruism), and conscientiousness (a measure of self-control).
However, the relationships between personality profile and brain shape remains still poorly characterized and understood.
The findings of our study highlighted that the personality type characterizing each person is connected to the brain shape of several regions implicated in emotional behaviors and control. We found that neuroticism, a personality trait underlying mental illnesses such as anxiety disorders, was linked to a thicker cortex (the brain's outer layer of neural tissue) and a smaller area and folding in some brain regions. Conversely, openness, a trait reflecting curiosity and creativity, was associated to thinner cortex and greater area and folding in the brain. The other personality traits were linked to other differences in brain structure, such as agreeableness being correlated with a thinner prefrontal cortex (which is linked to empathy and other social skills). Overall, all the traits characterizing this model of personality are related to some features (e.g. thickness, area and folding) of brain regions implicated in attention, salience detection of stimuli and emotion processing. This could reflect the fact that many personality traits are linked to high-level socio-cognitive skills as well as the ability to modulate ‘core’ affective responses.
27 Jan Stool DNA Tests (Cologuard ) Increases Colon Cancer Screening and Detection Among Previously Noncompliant Patients
MedicalResearch.com Interview with: [caption id="attachment_31554" align="alignleft" width="200"]
Dr. Mark Prince[/caption]
Dr. Mark Prince MD
USMD Health System
Arlington, TX 76017
MedicalResearch.com: What is the background for this study?
Response: This 12-month retrospective study conducted to determine the screening compliance rates for a noninvasive multitarget stool DNA (mt-sDNA) screening test (Cologuard) for colon cancer among a cohort of nearly 400 average-risk Medicare patients who had previously not complied with recommended screening. These were patients who had never had a colonoscopy, had been more than ten years since last colonoscopy, or had been more than one year since last stool testing for occult blood.
27 Jan Thyroid Hormone Treatment In Pregnant Women With Subclinical Hypothyroidism
MedicalResearch.com Interview with: [caption id="attachment_31551" align="alignleft" width="200"]
Dr. Spyridoula Maraka[/caption]
Dr. Spyridoula Maraka
Assistant professor of medicine
Division of Endocrinology and Metabolism
Center for Osteoporosis and Metabolic Bone Diseases
University of Arkansas for Medical Sciences and
Central Arkansas Veterans Health Care System
Little Rock Arkansas
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Subclinical hypothyroidism, a mild thyroid dysfunction, has been associated in pregnancy with multiple adverse outcomes. Our aim was to estimate the effectiveness and safety of thyroid hormone treatment among pregnant women with subclinical hypothyroidism.
Using a large national US dataset, we identified 5,405 pregnant women diagnosed with subclinical hypothyroidism. Of these, 843 women, with an average pretreatment TSH concentration of 4.8 milli-international units per liter, were treated with thyroid hormone. The remaining 4,562, with an average pretreatment TSH concentration of 3.3 milli-international units per liter, were not treated.
Compared with the untreated group, treated women were 38 percent less likely to experience pregnancy loss. However, they were more likely to experience a preterm delivery, gestational diabetes or preeclampsia. Moreover, the benefit of thyroid hormone treatment on pregnancy loss was seen only among women with higher TSH levels (4.1 to 10 mIU/L) before treatment. We also found that for women with lower levels of TSH (2.5–4.0 mIU/L), the risk of gestational hypertension was significantly higher for treated women than for untreated women.
27 Jan Racial Disparities in Use of Cardiac Resynchronization Therapy With ICD
MedicalResearch.com Interview with: [caption id="attachment_31473" align="alignleft" width="200"]
Dr. Lucas Marzec[/caption]
Lucas Marzec MD
Instructor of Medicine
Section of Cardiac Electrophysiology
Division of Cardiology
University of Colorado School of Medicine
Aurora, CO 80045
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The addition of cardiac resynchronization therapy (CRT) to an implantable cardioverter defibrillator (ICD) reduces the risk of mortality and heart failure events in select patients with left ventricular systolic dysfunction. Given these benefits, it is important to ensure patients who have a guideline recommendation for CRT are considered for this therapy at the time of ICD implantation. Previously, little data were available on the contemporary use of CRT among guideline eligible patients undergoing ICD implantation.
Although ICDs alone reduce the risk of mortality in patients with heart failure and reduced systolic function, prior work shows these devices are not uniformly provided to eligible patients and that rates of ICD implantation vary widely by hospital. Prior to our study, it was unknown whether similar variation in the use of the combination of ICD and CRT (CRT-D) exists.
We analyzed data from the National Cardiovascular Data Registry (NCDR) ICD Registry to identify patient, provider, and hospital characteristics associated with CRT-D use and to determine the extent of hospital level variation in the use of CRT-D among patients eligible for CRT undergoing implantation of an ICD.
27 Jan Does Maternal BMI Affect Offspring’s Obesity Risk?
MedicalResearch.com Interview with: [caption id="attachment_31442" align="alignleft" width="150"]
Dr Rebecca Richmond[/caption]
Dr Rebecca Richmond PhD
Senior Research Associate in the CRUK Integrative Cancer Epidemiology Programme
MRC Integrative Epidemiology Unit
School of Social and Community Medicine
University of Bristol
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We have been involved in earlier work which applied the same methods used here (using genetic variants to provide causal evidence) and showed that higher maternal pregnancy body mass index (BMI) causes greater infant birth weight. The paper here aimed to build on that earlier research and asked whether maternal BMI in pregnancy has a lasting effect, so that offspring of women who were more overweight in pregnancy are themselves likely to be fatter in childhood and adolescence. Our aim was to address this because an effect of an exposure in pregnancy on later life outcomes in the offspring could have detrimental health consequences for themselves and future generations. However, we did not find strong evidence for this in the context of the impact of maternal BMI in pregnancy on offspring fatness.
27 Jan SYNTAX Score Predicts Better Results With Bypass Surgery For Type II Diabetes
MedicalResearch.com Interview with: [caption id="attachment_31599" align="alignleft" width="139"]
Dr. Fumiaki Ikeno[/caption]
Fumiaki Ikeno M.D.
Program Director (U.S.) Japan Biodesign
Stanford Biodesign
Medical Director/Research Associate
Experimental Interventional Laboratory
Division of Cardiology
Stanford University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We sought to determine whether the extent of coronary disease in terms of the number of lesions and their complexity in Type 2 Diabetes patients could predict major cardiovascular events, and hypothesized that revascularization would have greater effectiveness relative to medical therapy among patients with more number of lesions and higher complexity in coronary artery disease.
Coronary bypass surgery, catheter-based treatment, and medical therapy all had similar cardiovascular outcomes among patients with less complexity of coronary artery disease who had type 2 diabetes mellitus, stable ischemic heart disease, and no prior coronary revascularization. Among patients with mid or high complexity coronary artery disease, coronary revascularization with bypass surgery significantly reduced the rate of major cardiovascular events during 5 years of follow-up.
27 Jan Physical Activity and Abnormal Blood Glucose Among Healthy Weight Adults
Posted at 00:50h
in Author Interviews, Diabetes, Exercise - Fitness, Lifestyle & Health, Weight Research
MedicalResearch.com Interview with:
[caption id="attachment_31537" align="alignleft" width="139"]
Dr. Arch G. Mainous III[/caption]
Arch G. Mainous III, PhD
HSRMP Department Chair
Florida Blue Endowed Professor of Health Administration
University of Florida Health
MedicalResearch.com: What is the background for this study?
Response: As our post-industrial society becomes more and more sedentary, there is a concern that a lack of activity is associated with poor health outcomes like diabetes. At the same time, the medical community has a strong focus on determining whether patients are overweight or obese as a way to classify them as being at higher risk for poor health outcomes. However, individuals at a “healthy weight” in general, are considered to be at low risk. Some recent studies have shown that many individuals at “healthy weight” are not metabolically healthy. How then might we predict who at “healthy weight” would be unhealthy? We hypothesized that individuals at “healthy weight” who had a sedentary lifestyle would be more likely to have prediabetes or undiagnosed diabetes.
27 Jan Cognitive Behavior Therapy Most Effective Treatment for OCD, Anxiety and PTSD
[caption id="attachment_31445" align="alignleft" width="200"]
Prof. Mataix-Cols[/caption]
MedicalResearch.com Interview with:
David Mataix-Cols PhD
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council
Stockholm, Sweden
MedicalResearch.com: What is the background for this study?
Response: Exposure-based Cognitive Behavior Therapy (CBT) is the treatment of choice for patients with anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorders. Some patients do not respond sufficiently to such treatment. This has led researchers to find ways to augment (enhance) CBT with pharmacological agents, such as D-cycloserine (DCS).
Because CBT is such a powerful treatment for most patients, we suspected that the effects of DCS would probably be small. This means that very large samples of patients are needed to show statistically significant differences between groups. Previous studies and meta-analyses were underpowered to detect such small effects. Combining the raw data from all available studies to date gave us the power we needed to address the question of whether DCS is an efficacious augmenting strategy, over and above CBT.
We also had a second research question. Previous research from our group had suggested that there may be undesirable interactions between DCS and antidepressants, whereby patients taking both types of drugs would have significantly worse outcomes (see Andersson et al JAMA Psychiatry. 2015 Jul;72(7):659-67.
doi: 10.1001/jamapsychiatry.2015.0546).
27 Jan Obstructive Sleep Apnea: Task Force Finds Insufficient Evidence To Screen All Adults
MedicalResearch.com Interview with: [caption id="attachment_31527" align="alignleft" width="133"]
Dr. Alex Krist[/caption]
Dr. Alex Krist, MD MPH
Task Force member
Associate Professor
Fairfax Family Medicine Residency
Co-director, Ambulatory Care Outcomes Research Network
Virginia Commonwealth University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Obstructive sleep apnea (OSA) has been found to be associated with serious health conditions, including heart disease and diabetes. Additionally, OSA can cause excessive daytime sleepiness, which can significantly impact a person’s quality of life, increase involvement in motor vehicle crashes, and lead to an increased risk of death. Estimates show that OSA affected between 10 and 15% of the U.S. population in the 1990s, and rates may have increased over the past 20 years, so the Task Force wanted to examine the evidence on screening adults without symptoms or symptoms for obstructive sleep apnea.
26 Jan Intestinal and Blood-Brain Barrier Alterations Linked to Autism Spectrum Disorders
Posted at 16:42h
in Author Interviews, Autism, Brigham & Women's - Harvard, Gastrointestinal Disease, Microbiome
MedicalResearch.com Interview with:
[caption id="attachment_31521" align="alignleft" width="135"]
Dr. Maria Rosaria Fiorentino[/caption]
Maria Rosaria Fiorentino, PhD
Assistant Professor at Harvard Medical School
Molecular Biologist at Mucosal Immunology and Biology Research Center
Massachusetts General Hospital East
Charlestown, MA 02129-4404
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Autism Spectrum Disorders (ASD) refers to complex neurodevelopmental disorders arising from the interaction of genes and environmental factors. There are no defined mechanisms explaining how environmental triggers can lead to these conditions. One hypothesis based on the gut-brain axis connection suggests that inappropriate antigens trafficking through an impaired intestinal barrier, followed by passage of these antigens through a permissive blood-brain barrier (BBB), can be part of the chain of events leading to the disease.
Many Autism Spectrum Disorders children experience co-morbid medical conditions, including gastrointestinal (GI) dysfunctions whose underlying nature is poorly understood. Several clinical observations describe increased intestinal permeability in ASD with often conflicting findings. Permeability to neuroactive food antigens derived from the partial digestion of wheat (gliadorphins) and cow’s milk (casomorphins) has been reported in ASD. However, while evidence of a permeable gut barrier in ASD is increasingly reported, no information is available concerning a similar breach for the BBB. The BBB is a critical line of defense in the Central Nervous System, limiting the access of circulating solutes, macromolecules, and cells that could negatively impact neuronal activity. Dysfunctions of the BBB have been associated with numerous inflammatory neurologic disorders, such as stroke, epilepsy, multiple sclerosis, Parkinson’s and Alzheimer’s disease.
26 Jan Transcranial Stimulation Reduced Bulimia Symptoms
MedicalResearch.com Interview with: [caption id="attachment_31517" align="alignleft" width="200"]
Dr. Maria Kekic[/caption]
Dr Maria Kekic PhD
Research Worker | The TIARA study:
Transcranial magnetic stimulation and imaging in anorexia nervosa
Section of Eating Disorders | Department of Psychological Medicine
Institute of Psychiatry, Psychology & Neuroscience | King’s College London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Bulimia nervosa is an eating disorder characterised by repeated episodes of binge-eating and inappropriate compensatory behaviours. It is associated with multiple medical complications and with an increased risk of mortality. Although existing treatments for bulimia are effective for many patients, a sizeable proportion remain symptomatic following therapy and some do not respond at all.
Evidence shows that bulimia is underpinned by functional alterations in certain brain pathways, including those that underlie self-control processes. Neuroscience-based techniques with the ability to normalise these pathways may therefore hold promise as treatments for the disorder.
One such technique is called transcranial direct current stimulation (tDCS) – a form of non-invasive brain stimulation that delivers weak electrical currents to the brain through two electrodes placed on the head. It is safe and painless, and the most common side effect is a slight itching or tingling on the scalp.
26 Jan Sepsis Linked To High Rate of Hospital Readmissions
Posted at 00:45h
in Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, University of Pittsburgh
MedicalResearch.com Interview with:
[caption id="attachment_31417" align="alignleft" width="100"]
Dr. Yende[/caption]
Sachin Yende, M.D., M.S., Associate professor
University of Pittsburgh School of Medicine’s departments of
Critical Care Medicine and Clinical and Translational and
Vice president of Critical Care at the VA Pittsburgh.
[caption id="attachment_31418" align="alignleft" width="66"]
Dr. Mayr[/caption]
Florian B. Mayr, M.D., M.P.H.
Faculty member in University of Pittsburgh
Department of Critical Care Medicine and the
Center for Health Equity Research and Promotion
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body's response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs.
25 Jan Many CT Scans Can Be Avoided During ER Evaluation of Head Trauma
Posted at 23:13h
in Author Interviews, Brain Injury, Cost of Health Care, CT Scanning, Electronic Records, Emergency Care, Kaiser Permanente
MedicalResearch.com Interview with:
[caption id="attachment_31510" align="alignleft" width="156"]
Dr. Adam Sharp[/caption]
Adam L. Sharp MD MS
Research Scientist/Emergency Physician
Kaiser Permanente Southern California
Kaiser Permanente Research
Department of Research & Evaluation
Pasadena, CA 91101
MedicalResearch.com: What is the background for this study?
Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known.
The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging.
Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention.
25 Jan Thyroid Care Collaborative Improves Adoption of Thyroid Cancer Clinical Guidelines
MedicalResearch.com Interview with: [caption id="attachment_31505" align="alignleft" width="133"]
Dr. Ilya Likhterov[/caption]
Ilya Likhterov, MD
Assistant Professor, Otolaryngology
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As our understanding of thyroid cancer improves, the way these patients are diagnosed and treated is changing. It is difficult for clinicians to incorporate every individual scientific study into their practice. These studies are numerous and the results can be conflicting.
To address this difficulty, organizations such as the American Thyroid Association (ATA) create summary recommendations that account for the latest research and translate it into a format that is easily usable for physicians. Such clinical practice guidelines are available not just for thyroid cancer care, but in many other fields. The difficulty however, is how to ensure that clinicians have access to the guidelines and incorporate the recommendations into their practice.
There are a number of barriers to actually using the guidelines in practice, and we attempt to identify strategies on how to overcome these.
25 Jan Maternal Mortality and Morbidity Increased on Weekends
Posted at 21:31h
in Author Interviews, Baylor College of Medicine Houston, OBGYNE, Outcomes & Safety
MedicalResearch.com Interview with;
Dr. Amirhossein Moaddab
Postdoctoral Research Fellow at Baylor College of Medicine
Houston, Texas
MedicalResearch.com: What is the background for this study?
Response: Based on data from the Centers for Disease Control and Prevention, the United States maternal mortality ratio is three to four times higher than that of most other developed nations. Previous studies from the demonstrated a possible association between weekend hospital admissions and higher rates of mortality and poor health outcomes.
We investigated differences in maternal and fetal death ratios on weekends compared to weekdays and during different months of the year. In addition we investigated the presence of any medical and obstetrics complications in women who gave birth to a live child and in their offspring by day of delivery.
25 Jan Younger Colon Cancer Patients Receive More Chemotherapy But No Greater Survival Benefit
MedicalResearch.com Interview with: Kangmin Zhu, PhD, MD John P. Murtha Cancer Center, Walter Reed National Military Medical Center Professor at the Uniformed Services University of the Health Sciences in the Department of Preventive Medicine and Biostatistics Bethesda, Maryland MedicalResearch.com: What is the background for this study? Response: An article published on JAMA Surgery in 2015 showed more utilization of chemotherapy among young colon cancer patients. To demonstrate the study findings, we analyzed the data from the Department of Defense healthcare system, in which all members have the same level of access to medical care and therefore the potential effects of insurance status and types on research results can be reduced. MedicalResearch.com: What are the main findings? Response: The main findings were that young and middle-aged colon cancer patients were 2 to 8 times more likely to receive postoperative chemotherapy and 2.5 times more likely to receive multiagent regimens, compared with their counterparts aged 65 to 75 years. However, no matched survival benefits were observed for the young and middle-aged among patients who received surgery and postoperative chemotherapy.25 Jan Marked Increase in Number of US Patients With Kidney Stones
MedicalResearch.com Interview with: Li Hao Richie Xu MD Division of Mineral Metabolism University of Texas Southwestern Medical Center Dallas, Texas, United States MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the past three decades, the prevalence of the kidney stones has escalated in the United States. Changes in dietary patterns, increasing body weight and obesity likely contributed to this significantly higher prevalence of kidney stone. In this study, we explored temporal changes in stone composition, demographic characteristics, and in serum and urinary kidney stone risk profile in kidney stone forming population for the last 35 years. The proportion of uric acid stones has been almost doubled during this period. Although age and body mass index (BMI) increased over time in both uric acid and calcium stone formers, uric acid stone formers were consistently older, had higher BMI, and lower urinary pH than calcium stone formers. In addition, over time, the proportion of female vs. male increased in calcium stone formers, but not in uric acid stone formers. The most significant urinary parameter differentiating uric acid stone formers from calcium stone formers is 24-hour urinary pH.25 Jan Low Glucose Target in Critically Ill Children May Be Counterproductive
Posted at 13:18h
in Author Interviews
MedicalResearch.com Interview with:
Dr. Michael Agus MD
Pediatric critical care specialist and endocrinologist
Boston Children’s Hospital and Harvard Medical School and
Dr. Vinay Nadkarni, MD
Pediatric critical care specialist
Children’s Hospital of Philadelphia and
University of Pennsylvania School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Controlling the blood sugar of a critically ill child while sick in the ICU has been the matter of much debate since the first trial appeared in 2001 suggesting there was substantial benefit in certain adult populations. Retrospective data in adults and children consistently and convincingly associate hyperglycemia with poor outcomes across a wide range endpoints, however, the question remains whether normalizing glucose levels changes those outcomes. As the data emerged from prospective trials specifically in children, the answer became less clear.
We performed a large study of glucose control in critically ill children who had not had cardiac surgery, as this was group in which questions about best practice lingered.
Our study showed that critically ill infants and children do not gain additional benefit from controlling their elevated blood sugars down to a lower target range of 80-110 mg/dL compared to a higher target range of 150-180 mg/dL. Patients treated in both target ranges had similar outcomes in virtually every parameter studied, including the primary outcome of ICU-free days up to day 28 (mortality-adjusted length of ICU stay), where both groups had the same number at 19.4 days. There were differences in severe hypoglycemia (<40 mg/dL) related to the protocol where those with the lower target range had a rate of 3.7% compared to 0.3% in the higher target range, and an increased rate of catheter-associated bloodstream infections (CABSI’s) was noted in the lower target range with 1.94 infections per 1,000 catheter days compared with none in the higher target range.
On the other hand, empiric antibiotic use was significantly higher in the higher target range, at 96.8%, compared with 93.4% in the lower target range. No other intergroup differences were detected in mortality, severity of illness, seizures, or the need for CPR, ECMO, renal replacement therapy or transfusion.
25 Jan Does Limiting Weight Gain in Pregnancy Reduce Complications?
MedicalResearch.com Interview with: [caption id="attachment_31480" align="alignleft" width="128"]
Dr. Alan Peaceman[/caption]
Alan Peaceman, MD
Professor and Chief of Maternal Fetal
Department of Obstetrics and Gynecology
Northwestern Feinberg School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Excess maternal weight gain during pregnancy is very common in the United States, and has been associated with a number of pregnancy complications, including gestational diabetes, maternal hypertension, excess fetal size, and cesarean delivery.
Children born to mothers who gained excessively during pregnancy are at much higher risk of developing obesity themselves. We performed a randomized trial where half of the women received an intensive intervention of diet and exercise counseling in an effort to limit their weight gain. Compared to the control group, those in the intervention gained on average 4 pounds less and were more likely to gain within recommended guidelines. Despite this improvement, however, we did not see any improvement in any of the pregnancy complications.
24 Jan Hypertension in Pregnancy Linked To Early Mortality
MedicalResearch.com Interview with: Dr. Lauren Theilen, MD Obstetrics/Gynecology specialist Salt Lake City, Utah. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Women with a history of hypertensive disease of pregnancy are known to have increased risk of mortality from cardiovascular and other causes. Our study shows that hypertensive disease of pregnancy is strongly associated with deaths due to diabetes, heart disease, and stroke. The association is strongest for early mortality – deaths occurring before age 50 – and life expectancy decreases with increasing number of affected pregnancies.24 Jan Non-Surgical Stretta Therapy For Recalcitrant GERD
MedicalResearch.com Interview with: [caption id="attachment_31334" align="alignleft" width="126"]
Dr. Mark Noar[/caption]
Dr. Mark Noar
Director of The Heartburn and Reflux Study Center
Towson, MD
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background for this study was developed out of a need to know whether the Stretta procedure was effective in both the short and long-term in all forms of reflux. This included standard refluxing patients who had never had surgery but also in the subpopulation of patients who had recurring reflux after having had reflux corrective surgery. The question to be answered was whether the Stretta procedure would be less effective, more effective, or just as effective in the patient who had had prior surgery compared to patients who did not have surgery.
The main findings were that independent of whether a patient had had surgery for the correction of reflux or just had standard reflux without prior surgery, the Stretta procedure was equally effective in all patient subgroups both in the short-term and the long-term.
24 Jan Glucose Supplementation Reduced Length of Induced Labor
MedicalResearch.com Interview with: Dr Josianne Paré MD, FRCSC Département d'obstétrique-gynécologie Faculté de médecine et des sciences de la santé de l'université de Sherbrooke 3001 12e avenue Nord, Sherbrooke (Québec), J1H 5N4 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prolonged labor is a significant cause of maternal and fetal morbidity and very few interventions are known to shorten labor course. Skeletal muscle physiology suggests that glucose supplementation might improve muscle performance in case of prolonged exercise and this situation is analogous to the gravid uterus during delivery. Therefore, it seemed imperative to evaluate the impact of adding carbohydrate supplements on the course of labor. Accordingly, we conducted a single centre prospective double-blind randomized-controlled trial comparing the use of parental IV of dextrose 5% with normal saline to normal saline in induced-nulliparous women. A total of 193 patients (96 in the dextrose with normal saline [NS+D] group and 97 in the normal saline group [NS] were analysed in the study. The median total duration of labor was 76 minutes shorter in the NS+D group (499 versus 423 minutes, p = 0.024) than in the NS group. There was no difference in the rate of caesarean section, instrumented delivery, APGAR score or arterial cord pH.24 Jan Sunscreen Use Beats Shade For Preventing Sunburn
MedicalResearch.com Interview with: [caption id="attachment_31459" align="alignleft" width="169"]
Dr. Hao Ou-Yang[/caption]
Hao Ou-Yang, PhD
Johnson & Johnson Consumer Inc
Skillman, New Jersey
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This is the first-ever published study to evaluate UV protection value of shade in a real-world setting.
Eighty-one subjects with Fitzpatrick skin type I to III were divided into two groups: one using only a commercially available beach umbrella (round-shaped, 80” diameter, 75” high) and the other using only Neutrogena® Ultra Sheer® SPF 100+ sunscreen. Sunscreen subjects were monitored applying the product to all exposed areas following the label directions 15 minutes before beach exposure and were instructed to re-apply at least every 2 hours or as needed. Subjects were instructed to stay at the beach for 3.5 hours but could leave or stay under a shade for up to 30 minutes for cooling or rest. Shade subjects were instructed to stay under the umbrella without wearing clothes that could block the evaluated areas during the study duration. They were allowed to leave the umbrella after covering up for up to 30 minutes.
There were significant differences between the two groups in clinically evaluated sunburn protection for all seven body sites measured. The Ultra Sheer SPF 100+ sunscreen provided excellent sunburn protection for all the body sites, as demonstrated by no significant changes in sunburn grading before and after UV exposure in any sites except for face. Of the subjects in the shade group, there were a total of 142 sunburn areas across all parts of the body in 78% of the umbrella group (vs. 17 areas among 10 people in the sunscreen group – 25%). Sunburn incidence within the sunscreen group may be due to uneven application (missed spots), failure to re-apply after sweating, and under-application. Most subjects in the sunscreen group applied roughl yhalf of the amount of sunscreen recommended to achieve the SPF value on the label.
High SPF products provide a margin of safety for consumers who under-apply, as shown here and in other studies.
24 Jan New Guidelines for Prevention, Detection and Management of Surgical Site Infections
MedicalResearch.com Interview with: [caption id="attachment_31455" align="alignleft" width="200"]
Dr. Kristen Ban[/caption]
Kristen A. Ban, MD
Loyola University
American College Surgery Clinical Scholar
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The American College of Surgeons previously released surgical site infections (SSI) guidelines, and we wanted to update them with the most recent literature to give surgeons a concise, comprehensive document of recommended practices to reduce SSI. We were very fortunate to partner with our colleagues and content experts at the Surgical Infection Society for this update. There are a few areas where we had additional literature to support new or different guidelines.
Blood glucose control is now recommended for all patients regardless of diabetic status. SSI reduction bundles have become very popular, and we emphasize that compliance must be high with all parts of these bundles to obtain the maximum benefit.
Finally, we recommend cessation of prophylactic antibiotics at incision closure with some exceptions (mainly in regard to implanted material/hardware).
24 Jan New Oncoprotein Offers Potential Therapeutic Target
MedicalResearch.com Interview with: [caption id="attachment_31452" align="alignleft" width="150"]
Dr. Hua Lu[/caption]
Dr. Hua Lu MS PhD
Department of Biochemistry & Molecular Biology
Reynolds and Ryan Families Chair in Translation Cancer
Tulane Cancer Center
Tulane University School of Medicine
New Orleans, Louisiana 70112
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It has been well appreciated and acknowledged that p53 is the most important tumor suppressor in human body. However, approximately 50% of human cancers still sustain the wild type form of its gene, and also oddly, some cancers, such as breast cancer, which contain wild type p53, are often less sensitive to chemotherapy than those harbor mutated p53. Although a number of oncoproteins, including MDM2 and MDMX (MDM4), have been shown to be highly expressed and to inactivate p53 in those wild type p53-containing cancers, more molecules need to be discovered to keep p53 in control in order to let cancer cells to proliferate and growth.
Our study as described in our recent publication in Nature Communications unveils a new p53 target gene that encodes pleckstrin homology domain-containing protein (PHLDB3) as another p53 inhibitor in a negative feedback fashion. Interestingly and mechanistically, PHLDB3 can work with MDM2 by boosting its E3 ubiquitin ligase activity, consequently leading to degradation of p53. Biologically, PHLDB3 can promote cancer cell proliferation and growth in culture and in xenograft tumor models by in part inactivating p53 activity. More interestingly, PHLDB3 is highly amplified and expressed in a number of human cancers, such as pancreatic, prostate, colon and breast cancers. High expression of PHLDB3 is well correlated with the wild type status of p53 in certain portion of breast cancer. These findings uncover PHLDB3 as another oncoprotein that can promote cancer growth by partially inactivate p53, and thus might serve as a potential target for future development of anti-cancer therapy. Our study also suggests that PHLDB3 has a p53-independent function important for cancer growth.
23 Jan Non-Dialysis Chronic Kidney Disease Expenses On Par With Cancer and Stroke
MedicalResearch.com Interview with: [caption id="attachment_31437" align="alignleft" width="134"]
Dr. Talar Markossian[/caption]
Talar W. Markossian PhD MPH
Assistant Professor of Health Policy
Loyola University Chicago
2160 S. First Ave, CTRE 554
Maywood, IL 60153
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses.
We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke.
23 Jan ACA Medicare Changes Increased Diagnosis of Early-Stage Colorectal Cancer Among Seniors.
MedicalResearch.com Interview with: [caption id="attachment_31434" align="alignleft" width="200"]
Dr. Nengliang Yao[/caption]
Nengliang “Aaron” Yao PhD
Assistant professor
Department of Public Health Sciences
University of Virginia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting.
We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.