MedicalResearch.com Interview with:Edward Hill PhD student
Centre for Complexity Science
Member of the Warwick Infectious Disease Epidemiology Research Centre (WIDER)
at the University of Warwick
Medical Research: What is the background for this study?
Response: Depression is a major public health concern worldwide. We know social factors, such as living alone, can influence whether someone becomes depressed. We also know that social support (having people to talk to) is important for recovery from depression.
Our study is slightly different as we looked at the effect of being friends with people on whether you are likely to develop depression or recover from being depressed. To do this, we looked at over 2,000 adolescents in a network of US high school students to see how their mood influenced each other.
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MedicalResearch.com Interview with:
Jorg Dietrich, MBA MMSc MD PhD
Director, Cancer & Neurotoxicity Clinic and Brain Repair Research Program
Massachusetts General Hospital Cancer Center
Assistant Professor of Neurology
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Dietrich: Understanding the adverse effects associated with cancer therapy is an important issue in oncology. Specifically, management of acute and delayed neurotoxicity of chemotherapy and radiation in brain cancer patients has been challenging. There is an unmet clinical need to better characterize the effects of standard cancer therapy on the normal brain and to identify patients at risk of developing neurotoxicity. In this regard, identifying novel biomarkers of neurotoxicity is essential to develop strategies to protect the brain and promote repair of treatment-induced damage.
In this study, we demonstrate that standard chemotherapy and radiation in patients treated for glioblastoma is associated with progressive brain volume loss and damage to gray matter – the area of the brain that contains most neurons.
A cohort of 14 patients underwent sequential magnetic resonance imaging studies prior to, during and following standard chemoradiation to characterize the pattern of structural changes that occur as a consequence of treatment.
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MedicalResearch.com Interview with: Francesca M. Filbey PhD
School of Behavioral and Brain Sciences
Center for Brain Health University of Texas at Dallas
Dallas, TX
Medical Research: What is the background for this study? What are the main findings?Dr. Filbey: Most studies exclude tobacco users from participating, but 70% of marijuana users also use tobacco. We were interested in investigating the combined effects of marijuana and tobacco. Our research targeted the hippocampus because smaller hippocampal size is associated with marijuana use. We chose to study short term memory because the hippocampus is an area of the brain associated with memory and learning. The main finding was surprising. The smaller the hippocampus in the marijuana plus nicotine user, the greater the memory performance. We expected the opposite, which was true of the non-using control group. (more…)
MedicalResearch.com Interview with:
Laura Steenbergen, MSc., PhD Candidate
Cognitive Psychology at Institute of Psychology
Leiden UniversityMedical Research: What is the background for this study? What are the main findings?
Response: A recent initiative supported by several eminent research institutes and scientists calls for a more critical and active role of the scientific community in evaluating the sometimes far-reaching, sweeping claims from the brain training industry with regard to the impact of their products on cognitive performance. tDCS is a noninvasive brain stimulation technique that has developed into a promising tool to boost human cognition. Previous studies using medical tDCS devices have shown that tDCS promotes working memory (WM) updating in healthy individuals and patients. The aim of the current study was to investigate whether the commercial tDCS headset foc.us (v.1), which is easily and freely available to anyone in the world,does in fact improve cognitive performance, as advertised in the media. Results showed that active stimulation with the commercial device, compared to sham stimulation, significantly decreased working memory performance. The device we testedis just one example of a commercial device that can easily be purchased and, without any control or expert knowledge, used by anyone. The results of our study are straightforward in showing that the claims made by companies manufacturing such devices need to be validated. Even if the consequences of long-term or frequent use of the device are yet to be demonstrated, our findings provide strong support the important role of the scientific community in validating and testing far reaching claims made by the brain training industry.
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MedicalResearch.com Interview with:
Dr. Dominic PJ Howard BM BCh MA DPhil (Oxon) MRCS
Vascular and Endovascular Fellow
Flinders Medical Centre
Southern Adelaide Local Health Network
Dr. Howard is I academic vascular surgeon currently based in Oxford, UK. He worked with Professor Peter Rothwell as part of the Oxford Vascular Study.Medical Research: What is the background for this study? What are the main findings?
Dr. Howard: Abdominal aortic aneurysm is a potentially lethal ballooning of the aorta, the body’s largest blood vessel, which supplies blood from the heart to the abdomen and on to the rest of the body. Smoking, high blood pressure, male gender and older age are four key risk factors for abdominal aneurysms. Currently, men 65 and older are screened in the United States and in Europe for the condition based on recommendations from European screening trials and the U.S. Preventive Services Task Force. However, deaths from abdominal aortic aneurysm are moving to older ages.
Our study is the first prospective population-based study of ruptured abdominal aortic aneurysm events. We have found high incidence and death rates for this condition, particularly in older people. Most ruptured aortic aneurysms currently happen in people aged over 75 and this is likely to shift to those aged over 85 during the next few decades. The few ruptured aortic aneurysms that do occur in younger people (aged 65-75) occur almost exclusively in male smokers. Therefore we have calculated that if the national UK screening policy was modified to screen only male current smokers aged 65 and then all men at age 75 this could result in an almost four-fold increase in the number of deaths prevented and a three-fold increase in the number of life-years saved compared to the current UK strategy, with about a 20% reduction in the number of scans required.
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MedicalResearch.com Interview with:
Professor Mika Kivimäki
Chair of Social Epidemiology
Epidemiology & Public Health
Institute of Epidemiology & Health
Faculty of Population Health Sciences
University College London
Medical Research: What is the background for this study? What are the main findings?
Prof Kivimäki: Long working hours have been implicated in the cause of cardiovascular disease, but the evidence is limited. We conducted a systematic review of published studies on this topic and located additional individual-level data by searching open-access data archives and by including unpublished data from IPD-Work, a consortium of prospective cohort studies. This resulted in a pooled sample of over 600,000 men and women who were followed for cardiovascular disease 7-8 years after the assessment of working hours. During the follow-up, more than 4700 participants had a coronary event and 1700 had a stroke.
Our findings show that individuals who worked 55 hours or more per week had a 1.3-times higher risk of stroke compared to those working standard 35-40 hours. This finding remained unchanged in analyses adjusted for other stroke risk factors, such as age, sex, socioeconomic position and health behaviours.
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MedicalResearch.com Interview with:
Dimitry N. Krementsov PhD
Research Associate
University of Vermont
Burlington, VT 05405
Medical Research: What is the background for this study? What are the main findings?
Dr. Krementsov: Multiple sclerosis (MS) is the most common disabling neurologic disorder affecting young adults. The disease is initiated by the individual’s own immune system attacking the central nervous system (brain and spinal cord).Multiple sclerosis is complex and is controlled by the interplay between sex/gender, genetics, and environmental factors. How this happens is not well understood, but an intriguing clue is that MS incidence over the last 50-100 years has been increasing in women and not men, suggesting that a recent environmental change is affecting MS preferentially in females.
There are several well-documented risk factors for Multiple Scleroisis, including Epstein-Barr virus infection, low sunlight exposure, low vitamin D, and smoking. Recent studies have suggested the existence of a new risk factor – high intake of dietary salt. In our study, we sought to understand how this environmental factor may interact with genetics and sex.
We used an animal model of MS, called experimental autoimmune encephalomyelitis (EAE), in laboratory mice. The advantage of this approach is the ability to precisely control both the genetics and the environment, something that cannot be done in epidemiological studies in humans. Just as in previous studies, we found that when mice were fed a high salt diet, their MS-like disease got worse.
Importantly, we found that this was dependent on genetics and sex; when we varied the genetic background of the mice, we saw three different outcomes:
1) an effect of salt in both males and females,
2) an effect only in females, and
3) no effect in either sex.
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MedicalResearch.com Interview with:
Gillian Schauer, PhD, MPH
Lead author and Contractor
CDC’s Office on Smoking and Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Schauer: Marijuana is the most commonly used federally illicit drug in the United States. State-level policy change legalizing marijuana or one of its constituents for recreational or medical use is increasing. Currently, 23 states and DC have legalized medical use of marijuana. Four states (Alaska, Colorado, Oregon and Washington) and the District of Columbia have legalized recreational and medical use of marijuana.
This paper helps fill two important knowledge gaps. It describes how US adults are using marijuana—for example, whether they smoke it, eat it, or use it in a vaporizer—and it describes whether they report using it for medical reasons or for recreational reasons, or both. Data come from the 2014 Summer Styles national consumer online panel survey (sample size of 4,269 adults), and have been published in the American Journal of Preventive Medicine.
Nationally, marijuana is primarily consumed in combusted (smoked) form. In 2014, among adults who used marijuana in the past 30 days, 92.1% of adults said they smoked it, 16.1% ate or drank it, and 7.6% used a vaporizer or other electronic device.
Among adults who used marijuana in the past 30 days, 10.5% say they used it only for medical reasons, 53.4% used it only for recreational reasons, and 36.1% used it for both.
MedicalResearch.com Interview with:
Dr. Yin Cao MPH, ScD
Postdoctoral Fellow, Department of Nutrition
Harvard T. H. Chan School of Public HealthMedical Research: What is the background for this study? What are the main findings?Dr. Cao: Light-to-moderate drinking, defined as up to 1 drink (roughly corresponds to a 355ml bottle of beer, or a small [118-148 ml] glass of wine or 44ml of liquor) for women and up to 2 drinks for men, is prevalent in many western countries. It is believed that light-to-moderate drinking may be healthy for the heart. However, the influence of light-to-moderate drinking on risk of overall cancer is less clear, although it is well known that heavy alcohol intake increases risk of several cancers, including cancers of colorectum, female breast, oral cavity, pharynx, larynx, liver, and esophagus.
Also because drinkers are more likely to be smokers, and smoking is the major risk factor for all of the alcohol-related cancers (mentioned above) except breast cancer, it is thus difficult to tease out the influence of alcohol on cancer in studies among a mixed population of ever and never smokers. In particular, it is important to know how light and moderate drinking would affect cancer risk particularly among never smokers, who now make up the majority of the population in many western countries.
Our main findings are that, light-to-moderate drinking minimally increases risk of overall cancer. For men, the association with alcohol related cancers was primarily observed among smokers, and light to moderate drinking did not appreciably increase risk in never smokers. Among women, even consumption of up to one drink per day was associated with increased risk of alcohol-related cancers (mainly breast cancer) for both never and ever smokers.
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MedicalResearch.com Interview Invitation
Melanie J Davies MB ChB MD FRCP FRCGP
Professor of Diabetes Medicine NIHR Senior Investigator
Leicester Diabetes Unit Leicester Diabetes Centre
Bloom University of Leicester
MedicalResearch: What is the background for this study? What are the main findings? Dr. Davies: This study was designed to test the efficacy and safety of Liraglutide using a dose of 3mg for weight loss among patients with type 2 diabetes. It was a large international study in which we compared once daily subcutaneous Liraglutide at a dose of 3mg to Liraglutide 1.8mg which is the current maximum dose licenced in patients with diabetes and placebo. In all patients we offered a calorie deficit diet and lifestyle advice to increase physical activity. Our main findings were that the dose of 3mg of Liraglutide resulted in greater weight loss than both other arms of the study indeed 54% of patients at 56 weeks achieved more than 5% weight loss and a further 25% were able to achieve more than 10% weight loss. The 3mg of Liraglutide compared to the placebo, there were also significant impacts on HbA1c and other cardiovascular risk factors such as systolic blood pressure and lipids as well as improving patient quality of life particularly physical functioning and patient treatment satisfaction.(more…)
MedicalResearch.com Interview with:Jason H. Wasfy, MD
Assistant Medical Director
Massachusetts General Physicians Organization
Massachusetts General Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Wasfy: Hospital readmission after angioplasty (heart stents) is very common in the United States and is associated with poorer patient outcomes and substantial health care costs. We can predict which patients will get readmitted, but only with moderate accuracy. Analyzing the electronic medical records of large health care systems may provide clues about how to predict readmissions more accurately.
Medical Research: What should clinicians and patients take away from your report?Dr. Wasfy: Patients who are anxious or have visited the emergency department frequently before the procedure may be at higher risk of readmission. For those patients, reassurance and support may help them stay out of the hospital. This has the potential to improve health outcomes after angioplasty and improve value in cardiology care generally. High quality care for patients with coronary artery disease involves not only procedures and medicines, but also creating a support system for patients to cope with their disease.
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MedicalResearch.com Interview with:
Jerome A. Leis, MD MSc FRCPC
Division of Infectious Diseases
Sunnybrook Health Sciences Centre
Physician Lead, Antimicrobial Stewardship Team
Faculty Quality Improvement Advisor, Centre for QuIPS
Assistant Professor, Department of Medicine
University of Toronto
Sunnybrook Health Sciences Centre
Toronto, Ontario
Medical Research: What is the background for this study? What are the main findings?
Dr. Leis: We know that urinary tract infections are frequently diagnosed among general medicine patients who lack symptoms of this infection. We wondered whether urinalysis ordering practices in the Emergency Department influence diagnosis and treatment for urinary tract infection among these asymptomatic patients. We found that over half of patients admitted to the general medicine service underwent a urinalysis in the Emergency Department of which over 80% lacked a clinical indication for this test. Urinalysis results among these asymptomatic patients did influence diagnosis as patients with incidental positive results were more likely to undergo urine cultures and treatment with antibiotics for urinary tract infection. The study suggests that unnecessary urinalysis ordering contributes to over-diagnosis and treatment of urinary tract infection among patients admitted to general medicine service.
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MedicalResearch.com Interview with:
Carlota Batres
PhD Candidate at the Perception Lab
School of Psychology and Neuroscience
University of St Andrews
Medical Research: What is the background for this study? What are the main findings?Response: Dominance in men is associated with a variety of social outcomes, ranging from high rank attainment of cadets in the military to high levels of sexual activity in teenage boys. Dominant men are also favored as leaders during times of intergroup conflict and are more successful leaders in the business world. Therefore, we wanted to investigate what exactly it is that makes a face look dominant.
Our main finding was that maximum dominance was achieved by increasing perceived height and masculinity while maintaining a man's age at around 35 years.
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MedicalResearch.com Interview with:
Louanne Bakk, Ph.D
Assistant Professor
Director, Institute on Innovative Aging Policy and Practice
School of Social Work
The University at Buffalo
Buffalo, NY 14260
Medical Research: What is the background for this study? What are the main findings?Dr. Bakk: Medicare Part D reduces out-of-pocket health care costs and increases access to medications. While overall the benefit has facilitated the purchase of medications, cost sharing exists and be particularly difficult for more vulnerable populations. Racial and gender disparities in cost-related nonadherence (CRN) exist under Medicare Part D plans. However, it was unknown whether the impact of the coverage gap on older Blacks and females. This study examined whether the Medicare Part D coverage gap directly and indirectly affects the relationship between race, gender, and CRN.
Racial differences in cost-related nonadherence were largely driven by reaching the coverage gap. In other words, the gap appears to be more difficult for older Blacks than Whites. Additionally, both reaching and not reaching the coverage gap, poorer health and having a lower income were associated with cost-related nonadherence .
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MedicalResearch.com Interview with:
Jennifer B. Kane PhD
Assistant professor of Sociology
University of California, Irvine
Medical Research: What is the background for this study? Dr. Kane: We know that low-birth-weight babies are more susceptible to later physical and cognitive difficulties and that these difficulties can sharpen the social divide in the U.S. But knowing more about what causes low birth weight can help alleviate this intergenerational perpetuation of social inequality through poor infant health. This study was designed to expand our knowledge of these causes.
Medical Research: What are the main findings?Dr. Kane: This study found that risk factors for low birth weight extend far beyond pregnancy—dating all the way back to women’s early life environment as well as to conditions dating back three generations. For example, a woman’s own weight at birth, as well as her education level and marital status pre-pregnancy can have repercussions for two generations, putting her children and grandchildren at higher risk of low birth weight.
This study also discovered new pathways of risk that contribute to poor infant health. For example, intergenerational transmissions of maternal education, potentially reflecting parent-child socialization or role modeling, appear to have a long-term influence on birth outcomes of future generations.
In addition, this study showed that intra-generational and inter-generational processes work in conjunction with one another to place some infants at higher risk of low birth weight.
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MedicalResearch.com Interview with:
Jaclyn Bradley Palmer, MM, MT-BC
University Hospitals Of Cleveland
Cleveland, OH
Medical Research: What is the background for this study? What are the main findings?
Response: Patients awaiting breast cancer surgery may be understandably anxious. While pharmacologic intervention may reduce anxiety, higher doses of preoperative drugs can depress circulation and respiration, making alternative measures a particular interest. Music therapy is the clinical use of music interventions to accomplish individualized goals within a therapeutic relationship by a board-certified music therapist. While music in surgery has been researched under the label of "music therapy", many of the studied investigations illicit recorded music provided by non-music therapy staff, making it truly "music medicine" practices instead. In this investigation, the effect of both live and recorded music therapy on anxiety, anesthesia requirements, recovery time and patient satisfaction were studied perioperatively. Breast cancer surgery patients were engaged in a brief music therapy session which consisted of one live or recorded preferred song choice, followed by discussion and processing of emotions. Compared to usual care, both live and recorded music therapy groups experienced significantly greater reductions in anxiety (p<.001) with point reductions of 27.5 (42.5%) and 26.7 (41.2%), respectively. During surgery, both music groups listened to music-therapist selected recorded, instrumental harp music, chosen for it's evidence-based therapeutic value of smooth lines, consistent volumes and stable melodies. In measuring the amount of interoperative drug (propofol) needed to reach moderate sedation, the intraoperative music was not found to have an effect in this trial. Patient satisfaction was universally high in all three study groups. Those who received live music preoperatively were discharged an average of 12.5 minutes sooner than those who received recorded music preoperatively, although neither music group was dischanged significantly sooner than the control group. Subjective reactions to the music interventions relayed that music therapy in surgery was an enjoyable addition.
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MedicalResearch.com Interview with: Oleh Taratula, PhD Assistant Professor
Oregon State University/Oregon Health & Science University College of Pharmacy
MedicalResearch: What is the background for this study?
Dr. Taratula: The background for the study consists of previous work we had published in the lab using photodynamic therapy (PDT) as the stand alone treatment modality. We were successful in synthesizing and incorporating the photodynamic nanoplatform in the treatment for ovarian cancer, but our current graduate student, Canan Schumann said he could make the therapy more efficient using his current research on gene therapy. The gene therapy he is currently working on is the delivery of siRNA targeted to the multifaceted oncogenic protein DJ-1 which has been implicated in antioxidative stress defense as well as the overall survival of ovarian cancer. Cancer is highly intelligent able to adapt quickly to new insults that it comes across, even ROS formed inside the cell. Cancer cells can even upregulate a whole host of antioxidant stress response proteins to combat the formation of or scavenge already created ROS. The idea was can we combine our currently used PDT, which uses the generation of reactive oxygen species (ROS) as its cytotoxic mechanism of action, coupled with gene therapy targeted to DJ-1, in hope to drastically increase ROS inside the cell leading to a more pronounced cell death.
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MedicalResearch.com Interview with:
Jessica Leung, MPH and Rafael Harpaz, MD, MPH
Division of Viral Diseases,
National Center for Immunization and Respiratory Diseases (NCIRD)
Centers for Disease Control and Prevention (CDC)
MedicalResearch: What is the background for this study?Authors’ Response: Prior to the introduction of varicella (chickenpox) vaccination in the U.S., there were millions of cases, tens of thousands of hospitalizations, and hundreds of deaths due to varicella. One-dose of varicella vaccination was recommended in 1995, and two-doses in 2006. Since 1995, there have been substantial declines in varicella disease. In a previously published paper by authors Zhou et al (JAMA. 2005 Aug 17;294(7):797-802), they found an 88% decrease in varicella-related hospitalizations and a 59% decrease in outpatient visits during 1994-2002, a period after the one-dose program began in the U.S. but before the two-dose program started.
We wanted to update the prior analyses with an additional 10 years of data to describe the impact of the varicella vaccination program during a period of high 1-dose coverage and increasing levels of 2-dose coverage. We looked at claims data during the 1994-2012 period using the Truven Health MarketScan® databases.
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MedicalResearch.com Interview with:
Susan A. Slaugenhaupt PhD
Professor of Neurology,
Harvard Medical School
Associate Geneticist, Department of Neurology,
Molecular Neurogenetics Unit
Center for Human Genetic Research
Massachusetts General Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Slaugenhaupt: Mitral valve prolapse (MVP) is one of the most common human diseases affecting 1 out of every 40 people worldwide. The mitral valve is found between two chambers of the heart, and mitral valve prolapse results when the valve does not close properly. By studying families in which multiple members have mitral valve prolapse, we have identified a biological explanation for the disease. Mutations in the DCHS1 gene cause mitral valve prolapse in three families, and suggest that early defects in heart valve formation during development contribute to the progressive deterioration of the valve.
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MedicalResearch.com Interview with:
Professor Jackie Andrade PhD
School of Psychology
Cognition Institute
Plymouth University
Plymouth Australia
Medical Research: What is the background for this study? What are the main findings?
Dr. Andrade: We want to understand the mental processes that are going on during episodes of craving for drugs or food. We know that cravings are largely mental events because people rarely experience them when in the middle of a mentally-engaging task - giving a presentation or finishing an exciting novel, for example. By understanding the mental processes underpinning cravings, we can improve treatments for addiction and eating problems, and also find ways of strengthening desires for healthy activities. Visual mental imagery is a key component of craving, with people picturing themselves indulging their desires. Laboratory research has shown that blocking this craving imagery can reduce the strength of cravings for food and cigarettes. Tetris is a good task for doing this because it involves a lot of visual processing to keep track of the different coloured shapes and mentally rotate them to fit the spaces. For our latest study, we wanted to find out if Tetris helped block cravings in ‘real life’ rather than in the laboratory, and whether it worked for a range of common cravings.
We asked 31 participants to carry iPods with them for a week. They received text messages 7 times a day prompting them to use the iPod to report whether they were craving something and, if so, what it was and how strong the craving was. A random 15 participants assigned to the Tetris condition were also asked to play Tetris for 3 minutes and answer the craving questions again. For this group, we compared the before-Tetris and after-Tetris craving scores on each occasion and found that cravings were 20% weaker after playing Tetris. People played Tetris 40 times on average, but the craving-reducing effect did not wear off as they got used to the game. The control group who reported cravings without playing Tetris allowed us to see how cravings varied naturally across the week. Tetris reduced craving strength across the range of cravings reported, which included cravings for drugs (alcohol, nicotine, caffeine), food, and ‘other activities’ including sleep, videogaming, sex and social interaction.
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MedicalResearch.com Interview with:
Edward D. Barker, PhD
Developmental Psychopathology Group
Department of Psychology, King’s College London
Institute of Psychiatry London
Medical Research: What is the background for this study?Dr. Barker: The study looks at how the brain may be affected by experiences that happen early in life and adolescence. It has been known for a long time now that people who experience intense adversity are at increased risk of developing depression and other psychiatric problems. Previous research has also shown that both adversity and depression can affect the development of the brain and lead to altered brain structure. In this study, we wanted to examine how early adversity and depression relate to altered brain structure when you examined each within a specific temporal order (i.e., adversity, then depression/anxiety, then brain structure). This study design allowed us to examine not only the effects of adversity and depression, but also if some of the variation in brain structure associated with depression may also be explained by early adversity.
Other researchers have previously suggested that some of the variation in brain structure observed in depressed patients may relate to early adversity, but no previous study has examined this prospectively like we did, using the Avon Longitudinal Study of Parents and Children.
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MedicalResearch.com Interview with:Prof. Jonathan M. Hodgson
School of Medicine and Pharmacology
Royal Perth Hospital
University of Western Australia
Perth, Australia
MedicalResearch What is the background for this study? What are the main findings?Prof. Hodgson: Flavonoids are a class of phytochemicals present at high levels in tea. Observational studies have found that higher tea and flavonoid intakes are associated with higher bone mineral density. However, the relationships of tea and flavonoid intakes with fracture risk are not clear. We therefore examined the relationship of black tea drinking and flavonoid intake with fracture risk in a population of women aged over 75 years followed for 10 years. We found that a higher intake of black tea and particular classes of flavonoids, some of which are derived primarily from tea, were associated with lower risk of fracture-related hospitalizations in these elderly women.
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MedicalResearch.com Interview with:
Bernardo L. Rapoport M. D.
The Medical Oncology Centre of Rosebank
Johannesburg, South Africa
Medical Research: What is the background for this study? What are the main findings?Dr. Rapoport: Chemotherapy-induced nausea and vomiting (CINV) is one of the most feared side effects of chemotherapy, and can lead to dose reductions or discontinuations of life-extending anti-cancer therapy. In the past, the serotonin (5-HT3) receptor antagonists, such as granisetron, palonosetron , and ondansetron, have shown effectiveness in preventing acute CINV (0-24 hours after chemotherapy administration), but many chemotherapies, such as cisplatin, carboplatin, and anthracycline/cyclophosphamide combinations, can cause delayed chemotherapy-induced nausea and vomiting that occurs from >24 hours to 5 days or more after chemotherapy. Neurokinin-1 receptor antagonists (NK-1 RAs) work though the substance P signaling pathway and are effective at preventing the delayed phase of chemotherapy-induced nausea and vomiting. Aprepitant was the first NK-1 RA to come to market in 2003, followed by a fixed dose of netupitant plus palonosetron late last year.
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MedicalResearch.com Interview with:
Kathrine Sullivan Ph.D. Candidate
University of Southern California
School of Social Work
Medical Research: What is the background for this study? What are the main findings?
Response: Military families and military-connected youth exhibit significant strengths; however, a sizeable proportion of these families appear to be struggling in the face of war-related stressors. Understanding the consequences of war is critical as a public health concern and because additional resources may be needed to support military families. This study used a large, normative, and geographically comprehensive dataset to determine whether military-connected youth are at risk of adverse outcomes, including substance use, victimization, and weapon-carrying, during wartime. Results indicated that military-connected 7th, 9th and 11th grade students had greater odds of substance use, victimization, and weapon-carrying compared to non-military connected peers. Specifically, more military-connected students reported using alcohol (45 percent vs. 39 percent), being hit, kicked, slapped or pushed (36 percent vs. 27 percent) or bringing a gun to school (10 percent vs. 5 percent) than other students. Children with parents or a caregiver in the armed forces were also much more likely to have used prescription medications (36 percent vs. 27 percent), brought a knife to school (15 percent vs. 9 percent), been in a fight (27 percent vs. 17 percent) or feared being beaten up (24 percent vs. 18 percent).
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MedicalResearch.com Interview with:
Arpitha Chiruvolu MD FAAP
Neonatologist
Baylor University Medical Center
Department of Neonatology
Dallas, TX 75246MedicalResearch: What is the background and main findings of the study?Dr.Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes.
We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort.
Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort. A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities.
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MedicalResearch.com Interview with:
Dr. Karen Hardy
ICREA, Catalan Institution for Research and Advanced Studies
Departament de Prehistòria
Facultat de Filosofia i Lletres
Universitat Autònoma de Barcelona
Barcelona, Spain
MedicalResearch: What is the background for this study? What are the main findings?Dr. Hardy: There continues to be little clear agreement on what quantitatively constitutes a healthy diet. The global increase in the incidence of obesity and diet-related metabolic diseases have intensified interest in ancestral or “Palaeolithic” diets as it is clear that to a first order of approximation our physiology should be optimized to the diet that we have experienced during our evolutionary past. However, reconstructing ancestral diets is very challenging, and exactly what was eaten during the Palaeolithic remains largely unknown.
Until now, there has been a heavy focus on the role of animal fats and protein in the development of the human brain and there is little doubt that increases in meat consumption from around 3.4 million years ago, was a major driver. However, the role of carbohydrates, particularly in the form of starch-rich plant foods, has largely been overlooked. But the human brain today uses up to 25 % of the body’s energy budget and up to 60 % of blood glucose as a general rule, while pregnancy and lactation in particular, place additional demands on the body’s glucose budget. In this study we integrated multiple lines of evidence from human genetics, archaeology, anthropology, physiology, and nutrition, to hypothesise that cooked carbohydrates played an important part in the evolution of the body, and particularly the brain, over the last 800,000 years.
Our results suggest that while meat was important, brain growth is less likely to have happened without the energy obtained from carbohydrates. While cooking has also been proposed as contributing to early brain development, it has a particularly profound effect on the digestibility of starch. Furthermore, humans are unusual among primates in that they have many copies of the salivary amylase gene (average of around six salivary amylase genes, other primates have only two) leading to more efficient starch digestion. This suggests that cooking starch-rich plants and having more amylase coevolved. We don’t know exactly when the number of amylase gene copies multiplied, but genetic data suggest it was in the last million years; a timeframe that brackets archaeological evidence for cooking and when our brain size increase accelerated (around 800,000 years ago). Salivary amylases are largely ineffective on raw crystalline starch, but cooking substantially increases both their energy-yielding potential and glycemia.
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MedicalResearch.com Interview with:
Tatjana Crnogorac-Jurcevic MD PhD
Reader Centre for Molecular Oncology
Barts Cancer Institute, Queen Mary
University of London
London UKMedical Research: What is the background for this study? What are the main findings?Dr. Crnogorac-Jurcevic: Pancreatic adenocarcinoma (PDAC) is one of the most difficult cancers to detect. More than 80% of patients usually present at a late stage, with either locally advanced or with already metastatic disease. This is one of the major reasons for a bleak prognosis of this malignancy, which is typically 3-6 months and with <5% five-year survival. However, if patients are diagnosed with stage II disease, the survival rate is 20%, and at stage I, in patients with very small tumours, the five-year survival can increase up to 60%.
In order to find biomarkers for early detection of this disease, we have performed in depth GeLC/MS/MS (SDS-PAGE-liquid chromatography-tandem mass spectrometry) analysis of 18 proteomes of urine samples collected from healthy controls, chronic pancreatitis, and patients with Pancreatic adenocarcinoma and obtained around 1500 non-redundant proteins. From these, three proteins, LYVE-1, REG1A, and TFF1, were selected for further analysis based on their known biological functions and statistical difference in comparisons of the experimental groups. These biomarkers were subsequently validated using ELISA assays in a multicenter cohort of urine samples: 87 from healthy people, 92 from patients with chronic pancreatitis, and 192 from PDAC patients.
Multiple logistic regression was then applied: when comparing Pancreatic adenocarcinoma with healthy urine specimens, the resulting areas under the receiver-operating characteristic curves (AUC) of the three biomarkers combined into a panel were 0.89 (95% confidence interval: 0.84–0.94) in the training dataset (70% of the data) and 0.92 (95% confidence interval: 0.86–0.98) in the validation dataset (30% of the data). When the results from the analysis of PDAC stage I–II (n=71) urine samples were compared with the healthy urine specimens, the panel achieved AUCs of 0.90 (95% confidence interval: 0.84–0.96) and 0.93 (95% confidence interval: 0.84–1.00) in the training and validation datasets, respectively. In comparison to matching plasma CA19.9 values, the only Pancreatic adenocarcinoma biomarker in widespread clinical use (albeit mostly for monitoring of the disease), the panel achieved a higher AUC of 0.97 (95% confidence interval: 0.94–0.99) than CA19.9 (AUC 1/4 0.88; 95% confidence interval: 0.81–0.95, P=0.005). When combined with CA19.9, increased AUC of 0.99 (95% confidence interval: 0.97–1.00, P=0.04) was achieved, but this was not seen in a panel combined with plasma CA19.9 in stage I–IIA PDAC (n =17) vs. healthy sample comparison.
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MedicalResearch.com Interview with:
Dr. Jeff Karp Ph.D
Associate Professor of Medicine
Brigham and Women's Hospital
Harvard Medical School
Cambridge, MA 02139 and
Giovanni TraversoM.B., B.Ch., Ph.D
The David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology, Cambridge, MA
Medical Research: What is the background for this study? What are the main findings
Dr. Karp: Almost all patients with ulcerative colitis will require enema-based therapy at some point in their treatment. Enema therapy has 3 major issues.
It is difficult to retain
There is high systemic absorption of the drug (that can lead to toxic side effects), and
Compliance is low as patients must take enemas every day.
Our approach can potentially address all three. The engineered gel that we designed has dual targeting capability. It rapidly attaches to ulcers within seconds to minutes (we have 5-10x less systemic absorption as the gel only attaches to ulcers) and selectively releases drug in the presence of ulcers, and we showed that we could reduce the dosing frequency.
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MedicalResearch.com Interview with:
Reed A.C. Siemieniuk, MD
Department of Clinical Epidemiology & Biostatistics
Ontario Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration.
Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence).
For an interactive summary of findings table that shows the study's findings, please see: http://isof2.epistemonikos.org/#/finding/550bc6acf30d0c43083e63a0.
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MedicalResearch.com Interview with:
Kevin Heslin, Ph.D., Staff Service Fellow, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality
Medical Research: What is the background for this study?
Dr. Heslin: Previous trends in inpatient mortality suggest that rates have been decreasing for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, and pneumonia (Hines et al., 2010; Stepanova et al., 2013). Continued study of these trends can help researchers and policymakers assess the impact of health care quality efforts. Further, examining trends across patient and hospital subgroups may inform strategies for addressing disparities in health care quality by identifying groups that are leading and lagging in improvement.
Medical Research: What is the background for this study
Dr. Heslin: From 2002 to 2012, inpatient mortality decreased among patients admitted to U.S. hospitals for pneumonia (45 percent decrease, from 65.0 to 35.8 deaths per 1,000 admissions), AMI (41 percent decrease, from 94.0 to 55.9 deaths per 1,000 admissions), CHF (29 percent decrease, from 44.4 to 31.4 deaths per 1,000 admissions), and stroke (27 percent decrease, from 112.6 to 82.6 deaths per 1,000 admissions). The inpatient mortality rate for all four conditions decreased among both younger and older patients, and among men and women.
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MedicalResearch.com Interview with:
Edward Hill PhD student
Centre for Complexity Science
Member of the Warwick Infectious Disease Epidemiology Research Centre (WIDER)
at the University of Warwick
Medical Research: What is the background for this study?
Response: Depression is a major public health concern worldwide. We know social factors, such as living alone, can influence whether someone becomes depressed. We also know that social support (having people to talk to) is important for recovery from depression.
Our study is slightly different as we looked at the effect of being friends with people on whether you are likely to develop depression or recover from being depressed. To do this, we looked at over 2,000 adolescents in a network of US high school students to see how their mood influenced each other.
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