Dr.Noelle Noyes[/caption]
Noelle R Noyes PhD
Department of Clinical Sciences
Colorado State University, Fort Collins
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background for this study is the increasing concern about antibiotic resistant infections, and what we can do as a society to help minimize the development and spread of antibiotic resistance. Antibiotic resistance is a natural and ancient phenomenon in bacteria, but we can do things to bacterial populations to increase the amount of resistant bacteria and to promote the spread of resistant bacteria. It behooves us to try to identify specific practices that might be contributing to increases in antibiotic resistance, and to understand how we can change them to minimize risk. Towards this end, our study utilized new methods for investigating the ecology of antibiotic resistance throughout the process of beef production, from the time cattle enter feedlots through slaughter to the beef products that we eventually buy in the grocery store. Livestock production is thought to play a role in antibiotic resistance, although we have very little understanding of how important this role may be compared to other sectors like human hospitals, municipal wastewater treatment, daycare facilities, etc… We wanted to use new DNA sequence-based methods to try to get a high-level picture of what was happening with antibiotic resistance genes in feedlots and slaughterhouses. This high-level picture could then help us to understand how important cattle production may be in the overall ecology of antibiotic resistance, including the food chain and wider environment.
Dr.Naveen Pokala[/caption]
Naveen Pokala, MD
Division of Urology
University of Missouri
Columbia, MO 65212
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Pokala: The main purpose of the study was to determine survival outcome following salvage prostatectomy in men that fail radiation therapy. Radiation and surgery are the main modalities utilized to treat localized prostate cancer. When patients fail radiation treatment, traditionally, only hormonal treatment was offered. With refinements in surgical techniques, a select few of these patients that have recurrence after radiation may benefit with salvage surgery. Salvage prostatectomy is a complex procedure because prior radiation makes this procedure tenuous, but this procedure is offered in most major tertiary medical centers.
Dr. Charles Lockwood[/caption]
Charles J. Lockwood, MD
Member of of the March of Dimes Board of Trustees
Dean at Morsani College of Medicine
Senior Vice President, USF Health and Professor of Obstetrics & Gynecology, and Public Health The University of South Florida
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Lockwood: There remain questions about the utility of vaginal progesterone therapy in asymptomatic women with singleton gestations at risk for preterm birth. The OPPTIMUM study investigators conducted a double-blind, randomized, placebo-controlled trial of vaginal progesterone delivered via a pessary releasing 200 mg per day (n=618) vs. placebo (n=610) from around 22 to 34 weeks gestation among women at high risk for prematurity on the basis of a characteristic history and/or the presence of cervicovaginal fetal fibronectin or a cervical length less than 25 mm in length on transvaginal ultrasound. The primary endpoints were fetal death or preterm birth before 34 weeks (obstetrical outcome), or a composite of neonatal mortality or morbidities (neonatal outcome). The authors found that progesterone had no significant impact on either primary endpoint, with an adjusted OR of 0·86, 95% CI: 0·61-1·22 for obstetrical outcomes and an OR of 0·62, 95% CI:0·38-1·03 for neonatal outcomes.
Dr. Ronald Chamberlain[/caption]
Ronald S. Chamberlain, MD, MPA, FACS
Chairman and Surgeon-in-Chief
Department of Surgery
Saint Barnabas Medical Center
Professor of Surgery
New Jersey Medical School
Rutgers University
MedicalResearch.com: What is the background for this study?
Dr. Chamberlain: With the rapidly growing arthritic, aging, and obese population, total hip replacement (THR) has become the most commonly performed orthopedic procedure in the United States (US). The Affordable Care Act signed by President Barack Obama imposed financial penalties for excess readmissions following certain procedures and diagnoses. While the initial program aimed to reduce readmissions for heart failure, pneumonia, and acute myocardial infarction (AMI), the program expanded to include THR in 2015. With current research estimating a 10%, 30-day readmission rate following a total or partial hip replacement, this study sought to identify factors associated with readmission and to create a scale which could reliably stratify preoperative readmission risk.
Dr. Joseph Unger[/caption]
Joseph Unger, PhD, MS
SWOG Statistical Center
Assistant Member, Public Health Sciences Division, Fred Hutchinson Cancer Research Center
Affiliate Assistant Professor, Health Services Research, University of Washington
Seattle, WA 98109-1024
MedicalResearch.com: What is the background for this study?
Dr. Unger: The rate at which trials are positive has previously been examined, and the relationship between trial results and publication rates in the context of publication bias has also been studied. But the comparative scientific impact of positive vs negative clinical trials using citation data has not been investigated
We used the phase III trial database of SWOG, a major national cooperative clinical trials group, in combination with its trial publication database and citation data from Google Scholar, to compare the scientific impact of positive vs negative phase III cancer clinical treatment trials.
Dr. Eric Sun[/caption]
Eric Sun, MD/PhD
Instructor
Department of Anesthesiology, Perioperative and Pain Medicine
Stanford University
MedicalResearch.com: What is the background for this study?
Dr. Sun: Epidural steroid injections are frequently used to treat chronic low back pain. While previous studies have shown they are effective at improving symptoms, whether they reduce spending is unknown. These concerns are particularly salient because insurers are worried that epidural steroid injections are being overused.
MedicalResearch.com: What are the main findings?
Dr. Sun: Overall, we find that epidural steroid injections were associated with decreases in spending ranging from five to fifteen percent, depending on the specific indication. These differences were largely driven by decreases in outpatient spending (e.g., spending on outpatient physician visits).
Dr. Gary Tearney[/caption]
Guillermo J. Tearney, MD PhD
Mike and Sue Hazard Family MGH Research Scholar
Professor of Pathology, Harvard Medical School
Wellman Center for Photomedicine
Massachusetts General Hospital
MedicalResearch.com: What is the background for this study?
Dr. Tearney: In this study, we investigated a new, advanced catheter-based imaging technology for identifying the coronary plaques that may potentially precipitate heart attack. The new technique combines intracoronary OCT, that provides images of tissue emicrostructure with near-infrared autofluorescence (NIRAF) that informs on the molecular/biological characteristics of plaque.
MedicalResearch.com: What are the main findings?
Dr. Tearney: Our main findings were that:
1) Intracoronary OCT-NIRAF is safe and feasible in patients
2) NIRAF was elevated focally in portions of the coronary artery that contained high risk OCT features, and
3) The findings are suggestive that NIRAF may be a new imaging feature that is indicative of inflammation in human coronary lesions in vivo.
MedicalResearch.com Interview with: [caption id="attachment_22541" align="alignleft" width="200"] Dr. Robert Boyle[/caption] Dr. Robert J Boyle Pediatric Allergist Imperial College London MedicalResearch.com: What is the background for this study? Dr. Boyle: For infants who are fed with formula milk, special hydrolysed formula is widely recommended if they are at risk of allergies, on the basis that this might reduce...
Dr. Roger Zemek[/caption]
Roger Zemek, MD, FRCPC
Associate Professor, Dept of Pediatrics and Emergency Medicine, Clinical Research Chair in Pediatric Concussion, University of Ottawa
Director, Clinical Research Unit, Children’s Hospital of Eastern Ontario
Ottawa, ON
MedicalResearch.com: What is the background for this study?
Dr. Zemek: The number of concussions have dramatically increased over the past decade. Not only are children and adolescents are at highest risk for getting concussions, they also take longer to recover. As part of our background work, our team performed a systematic review (published in JAMA Pediatrics) confirming that validated, easy-to-use prognosticators did not exist for clinicians to identify children with concussion who are at the highest risk for persistent post-concussive symptoms (PPCS) and sequelae.
MedicalResearch.com: What are the main findings?
Dr. Zemek: In this, the largest concussion study in the world to-date, we derived and validated in a large, diverse cohort of children a clinical risk score that is significantly superior to clinicians’ ability to predict future PPCS at the time of ED presentation. Multivariate analysis revealed that age group, female sex, past history of migraine, prior concussion with symptom duration of >1 week, ED presentation with “answering questions slowly”, 4 or more errors on BESS Tandem stance, and the initial symptoms of headache, noise sensitivity and fatigue were all clinically significant and strongly associated with PCS at 1-month.
We assigned points based on the adjusted multivariate odds ratio, and the rule incorporating patient demographic factors, past history, early cognitive deficits, balance (an physical exam finding), and early symptoms. The rule has a maximum of 12 points. We selected two cut-off points in order to yield three clinically relevant (low, intermediate and high risk) categories for the development of PPCS at one month.
Dr. Changhai Ding[/caption]
Changhai Ding, MBBS, MMED, MD
Australian Research Council Future Fellow
Associate Director (International), Menzies Institute for Medical Research
Professor, University of Tasmania, Australia
Honorary Professor, University of Sydney, Australia
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Ding: Vitamin D can reduce bone turnover and cartilage degradation, thus potentially preventing the development and progression of knee osteoarthritis. Observational studies suggest that vitamin D supplementation is associated with benefits for knee osteoarthritis, but current evidence from clinical trials is contradictory.
We conducted a randomised clinical trial in Hobart, Tasmania and Melbourne, Victoria in Australia. We randomly assigned 413 patients with symptomatic knee osteoarthritis and low 25-hydroxyvitamin D to receive monthly treatment with oral vitamin D3 (50,000 IU; n = 209) or an identical placebo (n = 204) for 2 years.
Of 413 enrolled participants (average age, 63 years; 50 percent women), 340 (82 percent) completed the study. Vitamin D supplementation significantly increased blood 25-hydroxyvitamin D levels over 2 years compared with placebo treatment; however, vitamin D supplementation, compared with placebo, did not result in significant differences in change in MRI-measured tibial cartilage volume or a measure of knee pain over 2 years. There were also no significant differences in change of tibiofemoral cartilage defects or change in tibiofemoral bone marrow lesions.
Post-hoc analyses indicated that vitamin D supplementation might improve knee physical function and reduce another measure of knee pain and increases in bone marrow lesion.
Dr. Cathy Handy[/caption]
Cathy Handy, MD MPH
Fellow, Department of Oncology
Johns Hopkins Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Handy: We explored the relationship between coronary artery calcium and age related diseases. Coronary artery calcium refers to calcium deposits in the blood vessels of the heart. It can be seen with a non invasive imaging test and is thought to be a biologic measure of aging. Previous research has shown coronary artery calcium to be highly correlated with cardiovascular disease and mortality. We found that it is also associated with an increased risk of cancer, pneumonia, chronic kidney disease, chronic obstructive pulmonary disease and hip fractures.
Dr. Sophie Seite[/caption]
Sophie Seite, PhD
La-Roche-Posay Dermatological Laboratories
Asnières, France
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Seite: These studies were performed in order to confirm the previous results published by H. Kong et al showing that the skin microbiota of atopic dermatitis patients was less diversified and presented an overabundance of S. aureus in comparison to healthy subjects. Because each of us has a specific skin microbiota (huge inter-individual variation) we performed an intra-individual design protocol in order to compare the microbiome of a lesional skin area to those of a non-lesional adjacent area. This strategy showed that the skin diversity in AD patients was reduced in non-lesional area and even more in lesional area and that not only Staphylococcus aureus is overabundant but also Staphylococcus epidermidis and Staphylococcus haemolyticus. Furthermore, for the first time the effect of a topical treatment on the skin microbiome was evaluated. Prebiotic strategies using thermal spring water or biomass lysate of nonpathogenic bacteria demonstrated their efficiency for a long term management of AD patients through an action on the skin microbiome.
Unni Dokkedal[/caption]
Unni Dokkedal, M.P.H.
Unit of Epidemiology, Biostatistics, and Biodemography
University of Southern Denmark
MedicalResearch: What is the background for this study?
Response: Early (seven days) postoperative cognitive impairment is common in adult surgical patients of all ages, but elderly patients are at higher risk for this complication. Previous studies have shown that these impairments are detectable up to three months after surgery in patients older than 60 years. Furthermore, the condition may persist for longer than six months in some patients with potential long-term implications of the surgery leading to impaired quality of life and increased mortality risk. We wanted to investigate the contribution of surgery, anesthesia, preexisting conditions and other factors on the postoperative cognitive functioning of elderly patients.
MedicalResearch: What are the main findings?
Response: For a sample of 4,299 middle-aged twins younger than 70 years and 4,204 elderly twins over 70 years, all of whom were residents of Denmark, medical records were reviewed from 1977 and until the accomplishment of cognitive tests in the period from 1995 to 2001. Results from five cognitive tests were compared in twins exposed to surgery, classified as major, minor, hip and knee replacement, or other, with those of a reference group without surgery. A statistically significant lower composite cognitive score was found in twins with at least one major surgery compared with the reference group (mean difference, −0.27; 95% CI, −0.48 to −0.06), which is a negligible effect size. None of the other groups differed from the reference group except the knee and hip replacement group that tended to have higher cognitive scores (mean difference, 0.35; 95% CI, −0.18 to 0.87).To consider genetic and shared environmental confounding and to take preoperative cognition into account, intrapair analyses were performed in same-sexed pairs in whom one had a history of major surgery and the other no surgery. No difference was found in the intra-pair analysis. The results suggest that preoperative cognitive functioning and underlying diseases were more important for cognitive functioning in mid- and late life than surgery and anesthesia.
Anna Gundlund[/caption]
Anna Gundlund, MB
Gentofte Hospital, Kildegårdsvej
Hellerup, Denmark
MedicalResearch.com: What is the background for this study?
Response: Atrial fibrillation seems to accumulate in families and several studies have indicated that a family history of atrial fibrillation may be an important risk factor for developing atrial fibrillation. In addition, three genomic regions associated with atrial fibrillation have been identified in Genome Wide Association Studies. In this study we compared atrial fibrillation patients with or without a family history of atrial fibrillation.
MedicalResearch.com: What are the main findings?
Response: We found that patients with a family history are diagnosed with atrial fibrillation at a younger age and with more disabling symptoms than those without a family history of atrial fibrillation. When looking at the longitudinal course of the disease, we found no differences in risk of progression of atrial fibrillation (e.g. from paroxysmal to persistent), risk of thromboembolic complications, all-cause hospitalization, or all-cause death when comparing those with a family history of atrial fibrillation with those without a family history.
Benedicte Kirkøen[/caption]
MedicalResearch.com Interview with:
Benedicte Kirkøen, PhD candidate
Bowel Cancer Screening in Norway – a pilot study
Cancer Registry of Norway (Kreftregisteret)
MedicalResearch.com: What is the background for this study?
Response: Randomised controlled trials have demonstrated that screening for colorectal cancer (CRC) can reduce CRC related mortality, but the total benefit and harm of national cancer screening programmes are under debate. Saving relatively few lives requires a large number of people to be screened. Most people who attend screening will never develop cancer, but may be exposed to potential psychological stress by participation. Cancer is one of the largest threats to peoples’ health, and participating in screening for cancer might therefore cause anxiety.
In Norway, colorectal cancer incidence has nearly tripled since the 1950s, and currently a large randomised pilot study of a national screening programme (Bowel Cancer Screening in Norway) is investigating the effect of screening on reduction in CRC incidence and mortality. As part of an evaluation of the benefits and harms of the pilot, we investigated the psychological effect of screening participation in a large group of participants. Of particular interest to us were participants who received a positive screening result and were referred to colonoscopy.
Dr. Michele Orditura[/caption]
Michele Orditura MD, PhD
Associate Professor in Medical Oncology
Faculty of Medicine, Second University of Naples
Naples Italy
MedicalResearch.com: What is the background for this study?
Prof. Orditura: In the last few years increasing evidence suggests that cancer-related inflammatory response plays a crucial role in the development and progression of several malignancies. Neutrophil to lymphocyte ratio (NLR), calculated as the neutrophil count divided by the lymphocyte count , may represent an easily measurable and inexpensive marker of systemic inflammation.
Several studies have reported NLR as an unfavourable prognostic indicator for patients with gastrointestinal, lung, renal and gynaecological cancers. In the breast cancer setting, the results of published trials evaluating the relationship between NLR and outcome are controversial, and a recent meta-analysis including eight trials published between 2012 and 2014 has shown that elevated NLR is strongly associated with poor survival. In addition, the available data mainly concern women of Asian race and only three papers have included patients of Europe race.
The main aim of this study was to clarify the correlation between pre surgery NLR and distant metastasis-free survival in a series of 300 Italian patients with early breast cancer. The propensity score-matched analysis was chosen for statistical evaluation to avoid risk of confounding bias.
Dr. Jane McDevitt[/caption]
Dr. Jane McDevitt
Temple University in Philadelphia
MedicalResearch.com: What is the background for this study?
Dr. McDevitt: During a head impact there is a mechanical load that causes acceleration and deceleration forces on the brain within the cranium. The acceleration and deceleration causes stress to the neurons and initiates a neurometabolic cascade, where excitatory neurotransmitters such as glutamate are released and depolarize the cell. This triggers protein channels to open and allow ions into and out of the cell. Increases in calcium persist longer and have greater magnitude of imbalance than any other ionic disturbance. One channel responsible for allowing calcium into the cell is r-type voltage-gated calcium channel. One of the main proteins within this voltage-gated calcium channel is the CACNA1E protein produced by the CACNA1E gene. This protein forms the external pore and contains a pair of glutamate residues that are required for calcium selectivity. It is also responsible for modulating neuronal firing patterns. A variation within this gene (i.e,CACNA1E ) that regulates expression levels of CACNA1E could be associated with how an athlete recovers following a concussion injury.
Upwards of 20% of the concussed population fall into the prolonged recovery category, which puts these athletes at risk for returning to play quicker than they should. Variation in recovery depends on extrinsic factors like magnitude of impact, and sport, or intrinsic factors like age or sex. One intrinsic factor that has not been definitively parsed out is genetic variation. Recovery is likely to be influenced by genetics because genes determine the structure and function of proteins involved in the cell’s resistance and response to mechanical stress. Due to CACNA1E’s relationship to calcium influx regulation, a single nucleotide polymorphism (SNP) could modify the expression level of the protein responsible for regulating calcium. Altered protein levels could lead to athlete’s responding to concussive injuries differently. The main objective of this study was to examine the association between CACNA1E SNPs with concussion recovery in athletes.
Dr. Cynthia Daniels[/caption]
Cynthia R. Daniels PhD
Professor, Political Science Department.
Rutgers University
New Brunswick, N.J. 08901
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Daniels: The study found that over 30% of information regarding embryological and fetal development is medically misleading in the informed consent materials states require women see before receiving an abortion. Nearly half of the information provided about the 1st trimester of pregnancy, when most women have abortions, was medically inaccurate, meaning either 'false' or 'misleading.'
Dr. Chance York[/caption]
Dr. Chance York PhD
School of Journalism and Mass Communication
Kent State University
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. York: A number of studies have examined the effects of heavy television viewing during childhood on childhood levels of Body Mass Index (BMI), but my study added a new element to this literature: it explores the long-term effects of TV viewing on adult-era BMI.
The major takeaway is that heavy television viewing during childhood results in an individual propensity to watch TV much later in life, and this propensity to watch television results in increased BMI. In other words, kids who watch a lot of television tend to remain heavy TV users as adults, and the fact that they're heavy TV viewers as adults has a separate, unique effect on their adult BMI.