Author Interviews, Lancet, Melanoma, Radiation Therapy / 23.07.2015

MedicalResearch.com Interview with: Michael A Henderson MBBS BMedSc MD FRACS Professor of Surgery, University of Melbourne Deputy Director Division of Cancer Surgery Head Skin and Melanoma Service Division of Cancer Surgery Peter MacCallum Cancer Centre East Melbourne Victoria  Australia Medical Research: What is the background for this study? What are the main findings? Dr. Henderson:  A number of retrospective reviews of adjuvant radiotherapy after lymphadenectomy for patients at high risk of further lymph node field relapse had all suggested that the risk of lymph node field relapse was reduced but there was controversy about whether there was any impact on survival. In addition many clinicians were concerned about the side effects of radiotherapy and in the absence of a proven survival benefit were reluctant to recommend it. Previously a phase 2 trial of adjuvant radiotherapy conducted by one of our co-authors Prof Bryan Burmiester confirmed that the morbidity of lymph node field radiotherapy was limited and the risks of recurrence was reduced. On that basis the current ANZMTG TROG randomised multicentre trial was initiated. In summary this final report updates information on overall survival, lymph node field relapse etc and provides information for the first time on long term toxicity of treatment, quality of life and lymphedema. Adjuvant lymph node field radiotherapy for patients at high risk of further lymph node field relapse reduces the risk of further lymph node field relapse by 50% but it has no effect on survival. Although radiotherapy toxicity was common (3 in 4 patients), mostly involving skin and subcutaneous tissue it was mild-to-moderate in severity and had little impact upon the patient's quality of life as measured by the FACT-G quality of life tool. Specific regional symptoms were more common in the radiated group. Limb volume measurements confirmed a significant but modest increase for patients receiving inguinal radiation (15%) but not for axillary radiation. In the design of this trial, a decision was made to allow patients in the observation arm who developed an isolated lymph node field relapse to be salvaged by surgery and or radiotherapy. There were only two patients in the radiotherapy arm who developed an isolated lymph node field relapse and both died of metastatic disease. In the observation arm 26 patients developed an isolated lymph node field relapse and the majority (23) achieved lymph node field control with a combination of surgery and or radiotherapy. The five-year survival FROM development of a lymph node field relapse in this group was 34% which is comparable to the overall survival of the entire cohort (42% five-year overall survival). This information whilst a subset analysis suggests that if it would be reasonable in some patients to consider a policy of observation only, reserving further surgery and or radiotherapy for a second relapse. (more…)
Author Interviews, Brain Injury, JAMA, Outcomes & Safety, UCLA / 23.07.2015

Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024MedicalResearch.com Interview with: Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024 Medical Research: What is the background for this study? What are the main findings? Dr. Dawes: In the fall of 2013, we formed the Los Angeles County Trauma Consortium, building upon a prior administrative relationship between LA County’s 14 trauma centers. We added health research researchers from UCLA and USC, and shifted the focus of the group from logistical issues to quality improvement. As a first project, our hospitals wanted to know if there was any variation in how traumatic brain injury patients are cared for across the county. Traumatic brain injury accounts for over 1/3 of all injury-related deaths in the U.S. and is the number one reason for ambulance transport to a trauma center in LA County. When we looked at the data, we found widespread variation in both how these patients were cared for at different hospitals and what happened to them as a result of that care. After adjusting for important differences in patient mix, we found that mortality rates varied by hospital from roughly 25% to 55%. As we tried to explain this variation, we looked into how often hospitals complied with two evidence-based guidelines from the Brain Trauma Foundation, hoping that we could eventually develop an intervention to boost compliance with these recommended care practices. While compliance rates varied even more widely than mortality—from 10 to 65% for intracranial pressure monitoring and 7 to 76% for craniotomy—they did not appear to be associated with risk-adjusted mortality rates. Put simply, we found no connection between how often hospitals complied with the guidelines and how likely their patients were to survive. (more…)
Author Interviews, Cannabis, Pain Research / 23.07.2015

Mark S. Wallace MD Department of Anesthesiology School of Medicine University of California, San Diego, CaliforniaMedicalResearch.com Interview with: Mark S. Wallace MD Department of Anesthesiology School of Medicine University of California, San Diego, California Medical Research: What is the background for this study? What are the main findings? Dr. Wallace: The study was funded by the center for medicinal cannabis research at the University of California San Diego. The center was funded by the state of California. The center was the first to fund a series of double-blind randomized controlled trials with inhaled cannabis for neuropathic pain. My trial is the first in diabetic peripheral neuropathy pain which is one of the most prevalent pain syndromes in our society with limited treatments. We found a dose dependent reduction in pain. However there was also a dose dependent increase in euphoria and sedation which may limit clinical use. Effects on neurocognitive functioning were minimal. (more…)
Author Interviews / 23.07.2015

Allison Ursu, MD Department of Family Medicine University of Michigan Medical School Ann ArborMedicalResearch.com Interview with: Allison Ursu, MD Department of Family Medicine University of Michigan Medical School Ann Arbor Medical Research: What is the background for this study? What are the main findings? Dr. Ursu: This study was the result of a trend I noticed in clinical practice when in 2009 ACOG recommended that screening for cervical cancer =not begin until age 21 and it seemed that chlamydia screening could be easily missed.  When a PAP test is done for cervical cancer screening it is very easy to send another swab for chlamydia screening. Our main findings are two years after the 2009 guideline change the rates of PAP tests decreased significantly which was appropriate but there was an unintended consequence of a significant decrease in chlamydia screening despite no change to the recommendation of chlamydia screening for females age 16-24. (more…)
Author Interviews, Infections, NEJM / 22.07.2015

MedicalResearch.com Interview with: Alison E. Heald, M.D Harborview Medical Center Seattle, WA 98104 MedicalResearch: What is the background for this study? What are the main findings? Dr. Heald: Marburg virus causes a very serious, potentially fatal infection in humans for which there is currently no licensed or approved treatments or vaccines.  We demonstrated that AVI-7288, an investigational drug specifically directed against Marburg virus, is effective in preventing death in monkeys exposed to Marburg virus in an experimental model, and that AVI-7288 raises no safety concerns in parameters measured in the healthy human volunteers dosed at or above the estimated efficacious dose. Importantly, taken together, these results have allowed us to predict a dose that could be expected to protect humans exposed to Marburg virus. (more…)
Author Interviews, Hip Fractures, Kidney Stones, Menopause, Osteoporosis / 22.07.2015

Monique Bethel, MD Subspecialty Service, Department of Veterans Affairs Medical Center, Department of Medicine, Section of Rheumatology Georgia Regents University Augusta, GAMedicalResearch.com Interview with: Monique Bethel, MD Subspecialty Service, Department of Veterans Affairs Medical Center, Department of Medicine, Section of Rheumatology Georgia Regents University Augusta, GA MedicalResearch: What is the background for this study? Dr. Bethel: Osteoporosis and kidney stones share several risk factors, including elevated calcium in the urine (hypercalciuria), low potassium intake, and possibly, diets high in sodium. Accordingly, several studies have shown a significant relationship between kidney stones and osteoporosis in men. However, it is unclear if this relationship is also true for women. Previous studies examining this association have been small and inconclusive.   With the Women’s Health Initiative, we had data available from approximately 150,000 postmenopausal women in the US. Using this database, we were able to study the relationship between kidney stones and changes in bone mineral density and fractures. MedicalResearch: What are the main findings? Dr. Bethel: We found no association between the presence of kidney stones and changes in bone mineral density over time at the hip, lumbar spine, or the whole body. Also, there was no association between the presence of kidney stones and fractures. We also found that 14% of women who had a history of kidney stones upon entering the studies had another one occur during the course of the study (approximately 8 years). (more…)
Author Interviews / 22.07.2015

Dr-Geoffrey-BarnesMedicalResearch.com Interview with: Geoffrey Barnes, MD, MSc Clinical Lecturer Cardiovascular Medicine and Vascular Medicine University of Michigan Health System Medical Research: What is the background for this study? What are the main findings? Dr. Barnes: While warfarin has been the primary oral anticoagulant used for over 60 years, a new class of anticoagulants known as ‘direct oral anticoagulants’ (including dabigatran, rivaroxaban and apixaban) have been introduced within the last 5 years.  These newer medications were developed to be easier for patients and physicians to use.  While early data suggested quick adoption of these medications, there had not been a nation-wide assessment of their use and how specific diseases influenced the use of specific oral anticoagulants. Using a national sample of office visits, we generated national estimates of oral anticoagulant use for patients between 2009 and 2014.  The primary finding is that total number of office visits where an anticoagulant was used increased from 2.05 million to 2.83 million between 2009 and 2014, largely driven by a rapid increase in the use of the direct oral anticoagulant medications.  Specifically among patient visits for atrial fibrillation, the total number of visits where an oral anticoagulant was used increased from 52% to 67%.  This is important because there has long been concern about “under treatment” of atrial fibrillation and the risk of stroke for patients who do not receive anticoagulation.  This study suggests that the direct oral anticoagulants may be helping to protect more patients with atrial fibrillation from strokes. (more…)
Author Interviews, Lifestyle & Health / 22.07.2015

MedicalResearch.com Interview with: Maria-Gabriela Garcia Ph.D candidate Sensory-Motor Systems Lab, ETH Zurich Zurich, Switzerland and Dr. B.J. Martin University of Michigan, Ann Arbor Medical Research: What is the background for this study? What are the main findings? Response: Many workers are required to stand for prolong periods of time at their workplace. Several investigations have associated prolonged standing with back pain, and musculoskeletal disorders.  The accumulation of muscle fatigue is assumed to lead to such disorders.  However, the long-lasting effects of fatigue in the lower limbs induced by prolonged standing work have received little attention. Our main findings indicate that 5 hours of standing work including regular seated rest breaks lead to a significant long-term fatigue in the lower leg muscles.  The objective measures showed that the effects persisted at least 30 min after a seated recovery period while they were not subjectively perceived.  Thus, subjective evaluations may not be sensitive to the long-term effects of fatigue.  In addition, fatigue was not observed after 2 hours of standing work.       (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Nutrition, Pediatrics / 22.07.2015

Prof. Lu Qi, Assistant Professor, Department of Nutrition Harvard School of Public Health and Channing Division of Network Medicine Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MAMedicalResearch.com Interview with: Lu Qi, MD, PhD, FAHA Associate Professor of Medicine Harvard Medical School Assistant Professor of Nutrition HarvardSchool of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Lu Qi:  Most previous studies focus on the effects of either lifestyle or prenatal malnutrition on diabetes risk; no study has assess these two types of risk factors in combination. (more…)
Author Interviews, Diabetes, Lipids / 22.07.2015

Petter Bjornstad, MDFellow in Pediatric Diabetes & Endocrinology Children's Hospital Colorado & Barbara Davis Center for Childhood Diabetes Aurora, CO 80045MedicalResearch.com Interview with: Petter Bjornstad, MD Fellow in Pediatric Diabetes & Endocrinology Children's Hospital Colorado & Barbara Davis Center for Childhood Diabetes Aurora, CO 80045 MedicalResearch: What is the background for this study? Dr. Bjornstad: Apolipoprotein B (apoB) and non-high density lipoprotein-cholesterol (nonHDL-C) have been proposed to be superior indicators of cardiovascular (CV) risk than total cholesterol and/or low density lipoprotein-cholesterol (LDL-C). Some authors argue that while nonHDL-C and apoB correlate, they are not necessarily interchangeable, and may in fact provide unique information about cardiovascular risk. However, there are insufficient data on the concordance between apoB and nonHDL-C in adults with type 1 diabetes mellitus (DM) across a wide range of risk factors for cardiovascular disease. MedicalResearch: What are the main findings? Dr. Bjornstad: Adults with type 1 diabetes and elevated apoB (≥90mg/dL) and nonHDL-C (≥130mg/dL) had greater odds of coronary artery calcification progression compared to adults with type 1 diabetes and normal apoB and nonHDL-C (OR: 1.90, 95% CI 1.15-3.15), and compared to adults with type 1 diabetes with elevated apoB alone (OR: 2.86, 95% CI 1.43-5.74) adjusting for age, sex, duration, HbA1c and statins. We also obtained similar results with elevated apoB and nonHDL-C defined as ≥ the cohort means. Accordingly, we concluded that elevated apoB and nonHDL-C carry a greater risk of atherosclerosis than elevated apoB in the absence of elevated nonHDL-C in adults with type 1 diabetes.  (more…)
Author Interviews, Heart Disease, Race/Ethnic Diversity / 22.07.2015

Dr. Sumeet Chugh MD Pauline and Harold Price Professor of Cardiac Electrophysiology Associate director of the Cedars-Sinai Heart InstituteMedicalResearch.com Interview with: Dr. Sumeet Chugh MD Pauline and Harold Price Professor of Cardiac Electrophysiology Associate director of the Cedars-Sinai Heart Institute Medical Research: What is the background for this study? What are the main findings? Response: Research studies performed in the past 2 decades suggest that there is a higher burden of sudden cardiac arrest in black americans compared to whites. However there are no studies that explore the reasons for this phenomenon. Our study confirmed that these observations hold true in the current era. There are two additional novel findings. Firstly, we uncovered the disturbing fact that blacks are significantly younger than whites at the time of their cardiac arrest. The majority of blacks are under the age of 65 and the majority of whites were over 65. Furthermore, blacks who suffered sudden cardiac arrest were more likely to have diabetes, high blood pressure and chronic kidney disease. (more…)
Author Interviews, Heart Disease, JACC / 22.07.2015

Dr. Jagat Narula MD, PhD Associate Dean For Global Affairs Professor Medicine, Cardiology and Radiology Mt. Sinai Hospital, NYMedicalResearch.com Interview with: Dr. Jagat Narula MD, PhD Associate Dean For Global Affairs Professor Medicine, Cardiology and Radiology Mt. Sinai Hospital, NY Medical Research: What is the background for this study? What are the main findings? Dr. Narula: The cardiovascular diseases remain number one cause of mortality in men and women and in high as well as middle and low income countries. It is important that we identify those who are likely to die of preventable causes. Identification of the vulnerable plaques that are likely to result in acute events has been an interesting focus of investigators, and numerous intravascular imaging and noninvasive imaging strategies have been employed. CT angiography has offered fairly attractive accuracy. We were the first to establish the features of high-risk plaques (Motoyama, Narula JACC 2007) and their short-term prognostic implications (Motoyama, Narula JACC 2009). In this new paper in a large population we present intermediate- to long-term follow-up that critically analyzes the role of plaque characterization and puts it in perspective. Should we keep chasing plaques or should we treat the patient? Does the answer lie in high risk plaque busting or prevention be the mainstay? From the previous studies from us and others we have known that computed tomography angiography (CTA)-based plaque characteristics identify high-risk plaque (HRP) that predict short-term risk of acute coronary syndrome (ACS). We in this study wanted to evaluate whether plaque characteristics by CTA would predict intermediate- to long-term likelihood of acute events. The presence of high-risk plaque characteristics were evaluated in more than 3000 patients undergoing CTA and plaque progression (PP) in additional 450 patients who had two CTA one year apart. We recorded fatal and nonfatal acute events and outcomes during follow-up: mean about 4 years and maximum up to 10 years. Acute Coronary Syndrome occurred in about 40 of ~300 (16%) with high risk plaque and 40 (less than 1.5%) of the remaining patients with non high risk plaques. In patients with serial CTA, plaque progression also was an independent predictor of ACS, with HRP (27%) and without HRP (10%) compared with patients without plaque progression (0.3%). (more…)
Author Interviews, Duke, Education, Heart Disease, JAMA / 22.07.2015

Carolina Malta Hansen, M.D Duke Clinical Research InstituteMedicalResearch.com Interview with: Carolina Malta Hansen, M.D Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Hansen: Approximately 300,000 persons in the United States suffer an out-of-hospital cardiac arrest every year and under 10% survive. Cardiopulmonary resuscitation (CPR) and defibrillation within the first few minutes of cardiac arrest can increase the chance of survival from under 10% to over 50%. In 2010, the HeartRescue program in North Carolina initiated statewide multifaceted interventions to improve care and outcomes for cardiac arrest patients in North Carolina. The project included public training programs in defibrillators and compression-only CPR at schools, hospitals and major events such as the N.C. State Fair, plus additional instruction for EMS and other emergency workers on optimal care for patients in cardiac arrest. We found that following these four years of initiatives to improve care and outcomes for cardiac arrest patients, the proportion of patients who received bystander CPR and first responder defibrillation increased by more than 25% to approximately 50%, the combination of bystander CPR and first responder defibrillation increased from 14% to 23%. Survival with favorable neurologic outcome increased from 7% to 10% and this increase was only observed among patients who received bystander CPR. Finally, we found that compared to patients who received CPR and defibrillation by emergency medical services (EMS), patients who received bystander and/or first responder CPR, defibrillation, or both, were more likely to survive. The combination of bystander CPR and bystander defibrillation was associated with the best survival rates but remained low during the study period with no increase over time. (more…)
Author Interviews, Heart Disease, JACC, Outcomes & Safety, Surgical Research / 22.07.2015

Dr Scot Garg FRCP PhD (Hons) FESC Cardiology Department, Royal Blackburn Hospital United KingdomMedicalResearch.com Interview with: Dr Scot Garg FRCP PhD (Hons) FESC Cardiology Department, Royal Blackburn Hospital United Kingdom Medical Research: What is the background for this study? Dr. Garg: In contrast to other countries, in particular the United States, the UK has seen a vast expansion in the number of PCI centres operating without on-site surgical support. Part of the reason for this is that outcome data from these centres are from modest populations at short-term follow-up; consequently the ACC/AHA have failed to give delivery of PCI in centres without surgical back-up a strong endorsement. The study was ultimately driven therefore to show whether any differences existed in mortality between patients having PCI in centres with- and without surgical support at long-term follow-up in large unselected population cohort. Medical Research: What are the main findings? Dr. Garg: The study included the largest population of patients treated in centres without off-site surgical support (n=119,036) and main findings were that following multi-variate adjustment there were no differences in mortality for patients treated at centres with- or without surgical support at 30-days, 1-year or 5-year follow-up irrespective of whether patients were treated for stable angina, NSTEMI or STEMI. Furthermore, similar results were seen in a sensitivity analysis of a propensity matched cohort of 74,001 patients. (more…)
Author Interviews, Breast Cancer, Journal Clinical Oncology, Race/Ethnic Diversity / 21.07.2015

Helmneh Sineshaw, MD, MPH Senior Epidemiologist, Health Services Researcher American Cancer Society, Inc Atlanta, GA 30303MedicalResearch.com Interview with: Helmneh Sineshaw, MD, MPH Senior Epidemiologist, Health Services Researcher American Cancer Society, Inc Atlanta, GA 30303 MedicalResearch: What is the background for this study? Dr. Sineshaw: Male breast cancer is a rare disease, and its incidence rate is increasing. Younger black men have a higher breast cancer incidence than their white counterparts. Although black/white disparities in treatment receipt and survival among women with breast cancer have been widely documented in the literature, there have been few similar studies in men with breast cancer. Previous studies were based on smaller sample size, older databases, or using data from elderly patients. (more…)
Alzheimer's - Dementia, Author Interviews, NYU / 21.07.2015

Fernando Goni, PhD MS Adjunct associate professor Department of Neurology, Center for Cognitive Neurology NYU School of Medicine NYU Langone Medical CenterMedicalResearch.com Interview with: Fernando Goni, PhD MS Adjunct associate professor Department of Neurology, Center for Cognitive Neurology NYU School of Medicine NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Goni: It has been established that most neurodegenerative diseases including Alzheimer's, Lewy Body and other dementias, Parkinson's and prion diseases develop and progress along similar paths. In each disease, a particular protein undergoes a change in its shape from a soluble, physiologically functional protein to a protein that has lost the ability to perform its required tasks in the brain, starting off a chain reaction of binding to each other with little control. These aggregates become toxic to brain cells. We raised antibodies in mice against the common beta-sheet structures present in toxic oligomers of many neurodegenerative diseases including amyloid and tau in Alzheimer's; oligomeric forms of prions and oligomerized alpha-synuclein in Parkinson's. From that response, we produced monoclonal antibodies of the same characteristics. At least three of the monoclonals recognize pathological structures in histological samples of human brains from Alzheimer's disease, Parkinson's disease and GSS (human prionosis). They also recognized in vitro the oligomeric forms particular for each disease. In old animals of a mouse model of Alzheimer's, that already had pathology, the monoclonal antibodies could rescue behavior and reduced significantly the oligomers of Tau and Abeta. (more…)
Author Interviews, Breast Cancer, Radiology / 21.07.2015

Alison L. Chetlen, D.O. Associate Professor, Department of Radiology Penn State Milton S. Hershey Medical Center Hershey, PA 17033MedicalResearch.com Interview with: Alison L. Chetlen, D.O. Associate Professor, Department of Radiology Penn State Milton S. Hershey Medical Center Hershey, PA 17033 Medical Research: What is the background for this study? Dr. Chetlen:  Breast cancer risk assessment provides a means of identifying women who are at risk for development of this disease.   Identifying individuals at high risk for breast cancer allows for genetic testing, supplemental breast cancer screening, possibly prophylactic surgery or chemoprevention in hopes of decreasing mortality from breast cancer.  Despite the advantages of cancer genetic risk assessment and testing, most individuals in the general population who would benefit from such services currently do not receive them.  Medical Research: What are the main findings? Dr. Chetlen:  After implementation of a specific high-risk recommendation within our standardized mammography report along with a letter written in “lay” language informing patients of their high-risk status, the number of referrals to our high-risk clinic increased only modestly.   Despite these specific recommendations to both physicians and patients, over 85% of high risk patients did not consult a high-risk provider regarding their elevated lifetime risk of breast cancer. (more…)
Author Interviews, Neurological Disorders / 21.07.2015

Dr Michael Lee PhD MPhty MChiro BSc Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney Clinical Neurophysiologist, The Brain & Mind Research Institute, The University of Sydney Research Affiliate, Neuroscience Research Australia Neurology Research Fellow, Institute of Neurological Sciences, Prince of Wales HospitalMedicalResearch.com Interview with: Dr Michael Lee PhD MPhty MChiro BSc Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney Clinical Neurophysiologist, The Brain & Mind Research Institute, The University of Sydney Research Affiliate, Neuroscience Research Australia Neurology Research Fellow, Institute of Neurological Sciences, Prince of Wales Hospital Medical Research: What is the background for this study? Dr. Lee: Our research team at the University of Sydney has previously shown that the functioning of peripheral nerves deteriorate following spinal cord injury (SCI). Using novel, non-invasive electrophysiological techniques (nerve excitability testing), we showed in this study that peripheral nerves below the level of spinal cord injury underwent dramatic functional reorganization. Peripheral nerve dysfunction will not only contribute to a number of undesirable medical complications including peripheral neuropathy and pain, it exacerbates muscle atrophy and can potentially limit the effectiveness of rehabilitative therapies that drive central plasticity. In this study, we were interested to see whether this secondary peripheral nerve dysfunction could be reversed with a short-term targeted peripheral nerve stimulation therapy. Medical Research: What are the main findings? Dr. Lee: We studied peripheral nerve function in both the upper (median nerve at the wrist) and lower limbs (peroneal nerve near the fibular head) in 22 patients with acute spinal cord injury (all within 6 months of injury). We then randomly assigned one upper limb and one lower limb nerve to a daily regimen of 30-min peripheral nerve stimulation for 6 week. All study participants continued with standard rehabilitation. The results from our nerve excitability studies showed that 6-weeks of daily stimulation reversed a number of nerve excitability abnormalities secondary to spinal cord injury, and in some cases normalized it to a level comparable to healthy age-matched subjects. The peripheral nerves in the opposite limbs remained dysfunctional over the 6-week period. The results of our study showed convincingly that the addition of peripheral nerve stimulation in the early stages of spinal cord injury is beneficial by ameliorating the downstream effects of spinal cord injury. Spinal cord injuries can be an unfortunate effect of being a car accident, causing serious issues for those who suffer from it whether financial or physical. Those who find themselves in this type of situation may look into contacting someone like these car accident injury lawyers near Sacramento who might be able to help them to get compensation for their accident, which could help with phisyotherapy and medical bills. (more…)
Aging, Author Interviews / 20.07.2015

Jessica Finlay M.A. Department of Geography, Environment and Society University of Minnesota MNMedicalResearch.com Interview with: Jessica Finlay M.A. Department of Geography, Environment and Society University of Minnesota MN Medical Research: What is the background for this study? What are the main findings? Response: Natural environments are known to promote physical, mental, and spiritual healing. People can attain health benefits by spending time outside, often in remote places to "get away from it all." Now research conducted by a University of Minnesota graduate student with a team in Vancouver, B.C., shows that green and "blue" spaces (environments with running or still water) are especially beneficial for healthy aging in seniors. The research team interviewed older adults aged 65 - 86 years who lived in Vancouver, B.C., Canada. All study participants were low-income, represented 8 different self-identified racial and ethnic groups, and experienced a range of chronic conditions and health status. Published in the journal Health and Place, the study - "Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older adults" - demonstrates that by incorporating smaller features, such as a koi pond or a bench with a view of flowers, public health and urban development strategies can optimize nature as a health resource for older adults. Throughout the research, green and blue spaces promoted feelings of renewal, restoration, and spiritual connectedness. They also provided places for multi-generational social interactions and engagement, including planned activities with friends and families, and impromptu gatherings with neighbors.  (more…)
Author Interviews, Connective Tissue Disease, Genetic Research, Rheumatology / 20.07.2015

MedicalResearch.com Interview with: Dr. Changfu Kuo MD PhD Division of Rheumatology, Orthopaedics, and Dermatology School of Medicine, University of Nottingham, Nottingham, England Division of Rheumatology, Allergy, and Immunology Chang Gung Memorial Hospital, Taoyuan, Taiwan Medical Research: What is the background for this study? What are the main findings? Dr. Kuo: Systemic lupus erythematosus (SLE) is a prototype of autoimmune disease with features like autoantibody production and multiple target organ damage. SLE can affect any part of the body and the course of the disease is highly diverse and unpredictable. SLE can occur at any age and affect both females and males with a sex ratio of 9 to 1. Familial predisposition has been recognised as a risk factor previously and heritability of SLE has been estimated to be 66%. However, previous reports are often based on less robust sampling strategies and case ascertainment which generally depend on hospital records, self-reported diagnosis and disease registries, therefore limiting generalisability. The previous estimates of heritability are overestimated, due to a lack of consideration of shared environmental contribution. This study utilised a unique health insurance database that provides information on the whole population of Taiwan and permits determination of spouse and first-degree relatives. Over 23 million people were included in this study. Furthermore, through inclusion of SLE status of the spouse in our analyses the study is also able to examine how much of familial clustering results from genetic versus shared environmental factors. Overall the familial relative risk is 16.92. The genetic contribution to SLE susceptibility is estimated to be 44%. In addition to SLE, other autoimmune diseases are also more prevalent in individuals with a family history of SLE. (more…)
Author Interviews, Cannabis, Orthopedics / 20.07.2015

Yankel Gabet, DMD, PhD Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University Tel Aviv IsraelMedicalResearch.com Interview with: Yankel Gabet, DMD, PhD Department of Anatomy and Anthropology Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel Medical Research: What is the background for this study? What are the main findings? Dr. Gabet: Cannabis affects the body via specific components that are able to binding to receptors in the brain and other tissues. The components include the well-known ?9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the major constituents of cannabis. The cannabinoid receptors in our body are activated by several molecules (‘endocannabinoids’) synthesized by different sorts of cells under specific conditions. These receptors can be activated by synthetic compounds (cannabinoid ligands) as well as by natural cannabis. The effect of endocannabinoids in bone metabolism has been studied before but this study is the first report on the actions of natural THC and CDB in bone fracture healing. This is particularly important in light of the high incidence of both cannabis use and bone fractures; it is likely that many patients suffering from bone fractures consume cannabis that may have beneficial or adverse effects on the healing process. Another important point is that the non-psychogenic CDB is enough to promote bone healing, so there is no need to be exposed to the euphoric effects of cannabis/THC to get the beneficial functions of CBD on bone. (You can buy cbd oil online to help with other conditions as well such as fibromyalgia and diabetes.) If you are interested in learning more about CBD/THC and its products there are places online where you can find information, for example, from an online cbd store, a CBD Blog and other resources. (more…)
Aging, Author Interviews, Sexual Health / 20.07.2015

Dr. Alan J. Gow PhD, CPsychol, CSci, AFBPsS, FHEA Associate Professor in Psychology School of Life Sciences Heriot-Watt University EdinburghMedicalResearch.com Interview with: Dr. Alan J. Gow PhD, CPsychol, CSci, AFBPsS, FHEA Associate Professor in Psychology School of Life Sciences Heriot-Watt University Edinburgh Taylor-Jane Flynn, who conducted the research is a recent graduate in psychology from Heriot-Watt, and is about to commence postgraduate training in Counseling Psychology at Glasgow Caledonian University Medical Research: What is the background for this study? What are the main findings? Dr. Gow: We were interested in exploring how sexual behaviours might be associated with quality of life in older adults. Ms. Taylor-Jane Flynn, who led on the research, noted "There is an abundance of research identifying factors that predict better health and well-being in later life, but sex is one that is under researched." We asked our participants to report the frequency with which they engaged in six sexual behaviours from touching or holding hands to sexual intercourse, and then to also rate how important the behaviours were to them. Our results suggested that how often older adults engaged in sexual behaviours was positively associated with the quality of their social relationships. Interestingly, the importance of these sexual behaviours was found to be positively associated with their psychological quality of life. Our recently published research on how sexual behaviours are associated with quality of life in older adults grew from Taylor-Jane’s work with older adults. She reflected "I found my inspiration for this study while working as a Health Care Assistant caring for older adults. In recent years, many of those who opened up to me on a personal level expressed their need and want to have intimacy and companionship in their lives. However, sex has generally been seen as a taboo subject, especially among older adults. Despite this, older adults shared in our conversations that they miss and want to engage in sexual behaviours, whether that be a kiss to intercourse, and for many these behaviours remained an important element in their life." We were therefore keen to use these anecdotal accounts as a foundation for studying sexual behaviours as one of the many and varied determinants of wellbeing. (more…)
Author Interviews, Probiotics, UC Davis / 20.07.2015

Maria L Marco, PhD Associate Professor Department of Food Science & Technology Davis, CA 95616MedicalResearch.com Interview with: Maria L Marco, PhD Associate Professor Department of Food Science & Technology Davis, CA  95616 Medical Research: What is the background for this study? What are the main findings? Dr. Marco: Probiotics encompass certain strains of bacteria and yeast that when administered alive and in sufficient amounts can confer specific health benefits. Probiotics are increasingly added to foods, beverages, and intestinal supplements for delivery to the digestive tract. (Fermented) dairy products are currently the most popular food carriers for probiotic strains in clinical studies and commercial products. Although microorganisms generally respond quickly and adapt to their surrounding environments (e.g. in foods), the importance of the carrier format on probiotic function in vivo has yet to be systematically and mechanistically investigated. To address this need, we performed a couple studies in rodents to (i) examine whether probiotic Lactobacillus casei produces different proteins during low temperature (refrigeration) incubation in milk and (ii) measure whether incubation in milk is required for L. casei protection against inflammation. We found by shot-gun proteomics that L. casei does adapt for growth and survival in milk by producing a variety of (extra)cellular proteins, even at low-temperatures used to store dairy products prior to consumption. Such exposure of L. casei to milk was also essential for reducing the severity of disease in a mouse model of Ulcerative Colitis (UC), an inflammatory bowel disease characterized by continuous inflammation in the large intestine. Consuming milk alone also provided some protection against weight loss and intestinal inflammation in the Ulcerative Colitis mouse model but was not as effective as L. casei and milk in combination. Lastly, the importance of dairy for L. casei in preventing Ulcerative Colitis was confirmed by our findings that L. casei mutants lacking the capacity to synthesize proteins which are selectively produced during low-temperature incubation in milk were also impaired in preventing inflammatory responses in the intestine. (more…)
Author Interviews, BMJ, Nutrition, Weight Research / 20.07.2015

Fumiaki Imamura Ph.D. MRC Epidemiology Unit University of CambridgeMedicalResearch.com Interview with: Dr. Fumiaki Imamura Ph.D. MRC Epidemiology Unit University of Cambridge Medical Research: What is the background for this study? What are the main findings? Dr. Imamura: Soft drink consumption is associated with risk of diabetes, but whether or not the association persists after controlling for obesity status is not known. Diet drinks and fruit juice may be good alternatives to soft drinks. However, while obese individuals may consume diet drinks or fruit juice instead of sugar-sweetened soft drinks, evidence was weak to determine whether or not consuming these beverages is associated with risk of diabetes. (more…)
Author Interviews, OBGYNE, Weight Research / 20.07.2015

Maya Tabet, MS Graduate Research Assistant Saint Louis University College for Public Health and Social Justice Department of Epidemiology St. Louis, MO 63104MedicalResearch.com Interview with: Maya Tabet, MS Graduate Research Assistant Saint Louis University College for Public Health and Social Justice Department of Epidemiology St. Louis, MO 63104 MedicalResearch: What is the background for this study? Response: The majority of women in the U.S. have an unhealthy weight before they start pregnancy, most of them being overweight or obese. It is well-known that having an unhealthy weight before pregnancy increases the likelihood of having adverse outcomes for the mother and baby. However, this study is the first to examine the likelihood of adverse outcomes in a second pregnancy among women who had an unhealthy weight before a first pregnancy that had no complications. MedicalResearch: What are the main findings? Response: Our study involved 121,049 women in Missouri who delivered their first 2 singleton pregnancies between 1989 and 2005. Findings revealed that women who were underweight before a first uncomplicated pregnancy had a 20% increased likelihood of having a shorter gestation and a 40% increased likelihood of having a small baby for gestational age in the second pregnancy, as compared to women who had a healthy weight before their first pregnancy. Also, women who were obese before a first uncomplicated pregnancy had a 55% increased likelihood of having a large baby for gestational age, a 156% increased likelihood of having preeclampsia, and an 85% increased likelihood of having a cesarean delivery. Babies born to these women also had a 37% increased likelihood of dying in the first 28 days of their life. (more…)
Author Interviews, Breast Cancer / 20.07.2015

Niels de Jonge, Ph.D Head of the Innovative Electron Microscopy group German Cancer Research Center (DKFZ) in Heidelberg University of FreiburgMedicalResearch.com Interview with: Niels de Jonge, Ph.D Head of the Innovative Electron Microscopy group German Cancer Research Center (DKFZ) in Heidelberg University of Freiburg Medical Research: What is the background for this study? What are the main findings? Response: HER2 membrane proteins play a special role in certain types of breast cancer: amplified levels of HER2 drive unrestricted cell growth. HER2-tailored antibody-based therapeutics aim to prevent cancer cell growth. However, two-thirds of HER2 positive breast cancer patients develop resistance against HER2-targeting drugs. The reason for this is not yet understood. We now found out, that HER2 dimers appeared to be absent from a small sub-population of resting SKBR3 breast cancer cells. This small subpopulation may have self-renewing properties that are resistant to HER2-antibody therapy and thus able to seed new tumor growth. (more…)
Author Interviews, Race/Ethnic Diversity / 20.07.2015

MedicalResearch.com Interview with: Francesco Acciai, Aggie J Noah and Glenn Firebaugh Department of Sociology Pennsylvania State University University Park, PA MedicalResearch: What is the background for this study? Response: Life expectancy in the United States varies greatly by race. Asian–Americans enjoy the greatest longevity, with a nearly 8 year mortality advantage on whites. This advantage can derive from two separate processes. One, from a more favorable allocation of causes of death (incidence effect); i.e. from the fact that Asians tend to die of causes that strike on average at older ages while avoiding causes of death that afflict the young. Two, they can die of the same causes of death, but at an older age (age effect). By using the age-incidence decomposition method we are able to distinguish and quantify these contributions to the 7.8 year gap in life expectancy between Asians and whites. MedicalResearch: What are the main findings? Response: Nearly 90% (or 6.9 years) of this gap is attributable to the fact that Asians tend to outlive whites regardless of the cause of death (age effect). The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). The incidence effect accounts for the remaining 0.9 years of the Asian-white gap in life expectancy. Moreover, sex-specific analyses show that men contribute somewhat more to the gap than women do (55% vs 45%), primarily because Asian–white differences in mortality are greater among men than among women with respect to suicide, traffic accidents and accidental poisoning. (more…)
Author Interviews, Genetic Research, Heart Disease, McGill / 20.07.2015

Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec CanadaMedicalResearch.com Interview with: Christopher Labos MD CM, MSc FRCPC Division of Epidemiology, Biostatistics and Occupational Health McGill University Montreal, Quebec Canada Medical Research: What is the background for this study? What are the main findings? Response: There have been great advances in the field of genetics in recent years. Especially in cardiology, a number of genetic variants have been identified that are associated with cardiovascular disease. But it is not clear how useful these variants are in terms of predicting future evens in patients that have already suffered a myocardial infarction. What we found in our study is that a genetic risk score composed of the 30 most common genetic variants associated with cardiovascular diseases was not useful in predicting recurrent events in the first year after a patient suffered a myocardial infarction. (more…)
Author Interviews, Beth Israel Deaconess, Diabetes, Heart Disease, University of Michigan / 18.07.2015

MedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD, FACC, FASNC University of MichiganVenkatesh L. Murthy, MD, PhD, FACC, FASNC University of Michigan Dr. Ravi Shah MD Beth Israel Deaconess Medical Centerand Dr. Ravi Shah MD Beth Israel Deaconess Medical Center   MedicalResearch: What is the background for this study? Response: Recent changes recommend statin therapy for cardiovascular risk reduction in an increasingly large number of Americans. Conversely, a number of studies have identified an increased risk of diabetes with statin treatment. Thus, there is increasing need for tools to target statin therapy to those with a favorable risk-benefit profile. MedicalResearch: What are the main findings? Response: In our study, we analyzed data from 3,153 individuals from the Multi-Ethnic Study of Atherosclerosis who underwent CT scanning at baseline for assessment of calcium score. The CT scans were analyzed to assess liver attenuation as a measure of the amount of liver fat. We demonstrated that high liver fat doubled the risk of diabetes over a median of 9 years of follow-up. Importantly, statin therapy also doubled the risk of diabetes. The two together had an additive effect, even after adjusting for BMI, age, gender, family history of diabetes, waist circumference, lipids, hsCRP and exercise habits. As in prior studies, the risk of cardiovascular disease (CVD) events increased with increasing calcium score, as has previously been shown in MESA and in other studies. We then divided the cohort into six groups based on calcium score (0, 1-100 and >100) and liver fat (low/high). Using published data from meta-analyses of statin trials, we computed the number needed to treat to prevent one hard CVD event for statin therapy. Using data from our study, we computed the number needed to harm to cause one additional case of diabetes from statin therapy. The numbers needed to treat with ranged from 29-40 for calcium score of >100 to 218-252 for calcium score of 0. Conversely, the numbers needed to harm were approximately 63-68 for those with low liver fat versus 22-24 for those with high liver fat. Thus the combination of calcium score and liver fat assessment, from a single standard calcium score scan, allows for physicians to provide better assessment of risk and benefit of statins in discussion with their patients. (more…)
Author Interviews, Dermatology / 17.07.2015

Adam Friedman, MD, FAADAssociate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health ScienceMedicalResearch.com Interview with: Adam Friedman, MD, FAAD Associate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health Sciences Medical Research: What is the background for this study? What are the main findings? Dr. Friedman: Given pruritus is not only a hallmark symptom of atopic dermatitis, and in fact is even part of the diagnostic criteria, we sought to evaluate whether factors known to cause itch or inhibit said pruritogens in other disease states are over or under expressed in skin from patients diagnosed with atopic dermatitis. Over the past 10 years considerable attention has been paid to the complexity of the immune dysregulation and plethora of inflammatory and neurogenic factors involved in the activity and progression of this disease. Our study showed significant differences between atopic dermatitis skin and normal skin.  Specifically, we found significantly elevated levels of several well-known components of both the inflammatory and pruritus cascade including interleukin-2, BLT1 (the receptor for leukotriene B4, recently implicated in atopic dermatitis), 5-lipoxygenase and Matrix Metalloproteinase-7.  Interestingly, for the first time to our knowledge, α-2 macroglobulin, a ubiquitous protein found in the skin that binds a host of proteases, growth factors (TGF-b, PDGF, b-NGF) and inflammatory cytokines (TNF-α, IL-1b, IL-2, IL-6, IL-8), was found to be significant unregulated in atopic skin. Because it has a known an important role in the modulation of inflammation, as its binding acts to inhibit the majority of these mediators, this overexpression may in fact be a compensatory mechanism for ongoing disease. Importantly, when activated through chloramination by, for example, bleach, it can very effeectively scavenge these pro-inflammatory mediators. Thus leading to the second goal of this study. One of the driving forces for selecting the various "itch or anti-itch factors" is that all can be augmented by hypochlorous acid, which is what bleach disassociates into when mixed with water. Bleach baths have been used for years as an adjuvant to treatment in atopic dermatitis.  When mixed with water, sodium hypochlorite (NaOCL) produces hypochlorous acid (HOCl), a compound stable between pH 3 and 6. HOCl is known to have antimicrobial properties, and therefore it was believed that bleach baths lowered bacterial burden on the skin and prevented and treated localized skin infections and colonization by organisms such as Staphylococcus aureus. Recent studies have found that HOCl intact has potent anti-inflammatory properties, and therefore we sought to expand this data by evaluating whether factors augmented by HOCl are overexposed in atopic dermatitis skin, giving some insight into how bleach bathes or HOCl products may aid in disease and symptom management. (more…)