Author Interviews, Hospital Readmissions, JAMA, Johns Hopkins / 08.08.2015

Timothy M. Pawlik, MD, MPH, MTS, PhD, FACS, FRACS (Hon.)Professor of Surgery and Oncology John L. Cameron M.D. Professor of Alimentary Tract Diseases Chief, Division of Surgical Oncology Program Director, Surgical Oncology Fellowship Director, Johns Hopkins Medicine Liver Tumor Center Multi-Disciplinary Clinic Johns Hopkins Hospital Baltimore, MD 21287MedicalResearch.com Interview with: Timothy M. Pawlik, MD, MPH, MTS, PhD, FACS, FRACS (Hon.) Professor of Surgery and Oncology John L. Cameron M.D. Professor of Alimentary Tract Diseases Chief, Division of Surgical Oncology Program Director, Surgical Oncology Fellowship Director, Johns Hopkins Medicine Liver Tumor Center Multi-Disciplinary Clinic Johns Hopkins Hospital Baltimore, MD 21287 MedicalResearch: What is the background for this study? What are the main findings? Dr. Pawlik: In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Hospital Readmission Reduction Program (HRRP) whereby hospitals with higher than expected 30-day readmission incur financial penalties. Initially proposed to target readmissions following acute myocardial infarction, pneumonia and congestive heart failure, the program has since expanded to encompass knee and hip replacement surgery with the inclusion of additional surgical procedures anticipated in the near future. Although initial results from the Hospital Readmission Reduction Program have been promising, several concerns have been raised regarding potential limitations in methodological approach; specifically in the ability to adequately risk-adjust and account for variations in patient, provider and disease. As a consequence, many fear that the Hospital Readmission Reduction Program may disproportionately penalize safety-net hospitals as well as hospitals caring for “sicker” and more vulnerable populations. In the current study we sought to investigate factors associated with the variability in 30-day readmission among a cohort of 22,559 patients discharged following a major surgical procedure at the Johns Hopkins Hospital between 2009 and 2013. Overall, 30-day readmission was noted to be 13.2% varying from 2.1% to 24.8% by surgical specialty / procedure and from 2.1% to 32.9% by surgeon. Non-modifiable patient specific factors such as preoperative comorbidity, insurance status and race / ethnicity, were found to be most predictive of 30-day readmission as well as postoperative factors such as complications and length of stay both of which may also be influenced by preoperative comorbidity. Overall, we noted that 2.8% of the variation in 30-day readmission was attributed to provider-specific factors, 14.5% of the variability was due differences in surgical specialty / procedure while over 84% of the variability in 30-day readmission remained unaccounted for due to non-modifiable patient-specific factors.
Author Interviews, Orthopedics, Surgical Research / 08.08.2015

Frank R. Noyes, M.D. President and Medical Director, Noyes Knee Institute and the Cincinnati Sports medicine Research and Education Foundation Cincinnati, OhioMedicalResearch.com Interview with: Frank R. Noyes, M.D. President and Medical Director, Noyes Knee Institute and the Cincinnati Sports medicine Research and Education Foundation Cincinnati, Ohio MedicalResearch: What is the background for this study? Dr. Noyes: Meniscectomy, or removal of the meniscus in the knee, frequently leads to early arthritis – especially in younger active individuals. The meniscus provides a cushion between the femur (thigh bone) and tibia (shin bone) and aids in keeping the knee stable. There are two menisci in the human knee; one on the inner portion (medial) and one on the outer portion (lateral). The problem is that once a meniscus is removed, there are no options for patients who experience knee pain other than a transplant. The operation uses human cadaver menisci from young donors that are implanted intact into the recipient’s knee. This operation has been performed at our Center for 25 years in patients who are typically under the age of 50 and who have some arthritis in their knee and experience pain with activity. There are few long-term clinical studies on meniscus transplantation that provide results in patients who are at least 10 years postoperative. MedicalResearch: What are the main findings? Dr. Noyes: This study reports the long-term results and survival analysis of 40 consecutive meniscus transplants, with a 100% follow-up obtained an average of 11 years postoperatively. The survivor analysis, which included magnetic resonance imaging (MRI) and x-ray criteria in addition to symptoms and clinical examination, revealed transplant survival rates of 68% at 7 years and 48% at 10 years postoperatively. The results of the symptom and activity level analyses in patients without failure of the transplant showed that only 11% experienced pain with daily activities and 72% were able to participate in low-impact athletics many years after surgery.
Author Interviews, Pediatrics / 08.08.2015

Prof. Abdel-Latif MohamedDiscipline of Neonatology, Medical School, College of Medicine, Biology & Environment Australian National University Acton, Canberra, ACT, AustraliaMedicalResearch.com Interview with: Prof. Abdel-Latif Mohamed Discipline of Neonatology, Medical School, College of Medicine, Biology & Environment Australian National University Acton, Canberra, ACT, Australia Medical Research: What is the background for this study? What are the main findings? Prof. Mohamed: Despite decades of research and debate amongst neonatologists, consensus regarding optimal management of Patent Ductus Arteriosus (PDA) in the premature infant is yet to be established. The vast majority of premature infants are treated with oral or intravenous medication and surgical ligation is usually reserved to severely ill infants. Our study demonstrated that treatment for Patent Ductus Arteriosus , particularly of a surgical nature, maybe associated with a greater risk of adverse neurodevelopmental outcome at 2-3 years of age. This was particularly so among infants born below 25 weeks gestation. This result may support permissive tolerance of PDAs. However, reasons for this association remain to be elucidated through carefully designed prospective trials.
Author Interviews, Weight Research / 07.08.2015

[caption id="attachment_16375" align="alignleft" width="180"]Candida J. Rebello and Dr. Frank Greenway Pennington Biomedical Research Center Baton Rouge, Louisiana Candida J. Rebello[/caption] MedicalResearch.com Interview with: Candida J. Rebello and Dr. Frank Greenway Pennington Biomedical Research Center Baton Rouge, Louisiana MedicalResearch: What is the background for this study? What are the main findings? Response: Appethyl™ contains concentrated thylakoid membranes extracted from spinach leaves. By interacting with fats and slowing fat digestion thylakoid membranes promote the release of hormones that reduce feelings of hunger and keep consumers full for a prolonged period. In previous studies the spinach extract has been shown to promote reduction of body weight and fat mass (1-3). Studies have also shown that consuming the thylakoid membranes reduces the urge for chocolate and sweet foods in women (2) (4, 5). Research suggests that women tend to crave sweet foods whereas men prefer savory foods. Hence, thylakoids may influence reward mechanisms to promote an inhibition over eating, especially since some of the hormones released in response to delayed fat digestion influence areas of the brain that control reward-induced eating. Further, unlike pharmaceutical drugs such as orlistat, the spinach extract delays but does not prevent fat digestion. Therefore, the excretion of undigested fat which is an unpleasant side effect of these drugs is avoided. Thus, the effect of the extract on reducing the desire to eat is of great interest, especially if its effects are mediated in part through the reward system. Reward mechanisms can be activated outside of conscious control. In the current food environment which is rife with enticing food choices, reward-induced eating assumes importance. The main findings of the study are that consuming 5 g of the spinach extract reduced hunger and increased fullness over a two hour period. Males in the study ate 126 kcal less under the thylakoid condition compared to the placebo.
Author Interviews, Dermatology, JAMA, NIH, Pain Research / 07.08.2015

Edward W. Cowen, MD, MHSc Dermatology Branch, Center for Cancer Research National Cancer Institute Bethesda, MarylandMedicalResearch.com Interview with: Edward W. Cowen, MD, MHSc Dermatology Branch, Center for Cancer Research National Cancer Institute Bethesda, Maryland Medical Research: What is the background for this study? Dr. Cowen: Cutaneous leiomyomas are benign smooth muscle proliferations that are associated with pain that is typically not well-controlled by topical remedies or systemic pain medication. Hereditary leiomyomatosis and renal cell cancer is a rare syndrome in which patients may have dozens or even hundreds of these painful tumors. We sought to determine if botulinum toxin injected directly into leiomyomas may ameliorate discomfort and improve quality of life in patients who experience significant pain from cutaneous leiomyomas. Medical Research: What are the main findings? Dr. Cowen: In a double-blinded placebo-controlled study, we found that injection of botulinum toxin was associated with improved skin-related quality of life (p = 0.007) and decreased skin-specific pain (p = 0.048) on the Dermatology Life Quality Index. A trend for decreased pain (p = 0.06) by visual analog score was reported in the botulinum toxin treated group compared to the placebo group.
Author Interviews, Pulmonary Disease / 07.08.2015

MedicalResearch.com Interview with: Matthew D. Krasowski MD, PhD Department of Pathology University of Iowa, Iowa City, and Jonathan Genzen, MD, PhD Department of Pathology University of Utah, Salt Lake City, UT Medical Research: What is the background for this study? What are the main findings? Response: Serum angiotensin converting enzyme (ACE) activity is commonly measured for the diagnosis and management of sarcoidosis. It was well known several decades ago that serum ACE activity is reduced in patients taking ACE inhibitors (e.g., captopril, enalapril, lisinopril, etc.). However, providers ordering ACE levels may be unaware of this interaction and not realize that ACE inhibitor therapy can dramatically lower serum ACE activity (and thus resulting in a misleadingly low ACE level). The main goal of the study was to determine how often serum ACE levels were performed in patients prescribed ACE inhibitors. Using electronic medical record review at an academic medical center, it was determined that 8.4% of serum ACE levels were ordered on patients currently on ACE inhibitors. The group of patients on ACE inhibitors had significantly lower serum ACE activity than the other patients. Analysis of samples at a national reference laboratory arrived at a similar estimate. This analysis included detection of lisinopril in a subset of serum samples with very low ACE activity. At the academic medical center, the use of targeted warning prompts and alerts greatly reduced the frequency of ordering serum ACE activity in patients on ACE inhibitors.
Author Interviews, Pain Research / 07.08.2015

MedicalResearch.com Interview with: Jane Marjoribanks Obstetrics and Gynaecology University of Auckland, National Women's Hospital, Auckland, New Zealand MedicalResearch: What is the background for this study? Response: This study is a systematic review of all randomised evidence published up to January 2015 on the effectiveness and safety of non-steroidal inflamatory drugs (NSAIDs) used to treat primary dysmenorrhoea (period pain). It includes 80 randomised controlled trials (total 5820 participants), which compare 20 different NSAIDs versus placebo, other NSAIDs or paracetamol. The review was prepared by researchers from the Cochrane Collaboration, which is a global independent network of contributors (37,000 from more than 130 countries) who gather and summarize the best evidence from research to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest.
Author Interviews, Hand Washing, Infections, Lancet / 07.08.2015

MedicalResearch.com Interview with: Paul Little MBBS, BA, MD, DLSHTM, MRCP, FRCGP, FMedSci Professor of Primary Care Research University of Southampton

Medical Research: What is the background for this study? What are the main findings? Prof. Little: Hand washing has been recommended to help prevent respiratory infections (coughs, colds flu, sore throats) - this can be important in normal winters but might be especially important in pandemic flu years. However, there has been little evidence from randomised trials to date to show that handwashing works. [caption id="attachment_16369" align="alignleft" width="350"]A simple internet based intervention to support increasing handwashing behaviour reduced the numbers of infections caught and the number of infections given to family members, A simple internet based intervention to support increasing hand washing behavior reduced the numbers of infections caught and the number of infections given to family members,[/caption]
Author Interviews, CDC, HIV, Sexual Health / 06.08.2015

Adaora Adimora, MD, MPH Chair of the HIV Medicine Association Professor of Medicine School of Medicine University of North Carolina, Chapel Hill.MedicalResearch.com Interview with: Adaora Adimora, MD, MPH Chair,Professor of Medicine School of Medicine University of North Carolina, Chapel Hill. MedicalResearch: What is the current scope of the HIV epidemic? Dr. Adimora: The Centers for Diseases Control and Prevention (CDC) estimates that there are 1.2 million people living with HIV in the U.S. Nearly 13% are undiagnosed and unaware of their status. Men who have sex with men represented 54% of all people living with HIV in 2011. While new infection rates are stable, a majority of new infections (63%) are occurring among men who have sex with men. We have seen alarming increases among young black men who have sex with men who account for 55% of new infections among men who have sex with men. New infections among women have decreased slightly but black and Hispanic/Latina women represent 62% and 17% of new infections respectively among women.[i] While there have been decreases in new HIV infections among people who inject drugs in recent years, the serious outbreak largely among injection drug users in Scott County, Indiana identified this past spring[ii] puts us on high alert to improve access to preventive services and substance use treatment, including access to sterile syringes and equipment. My responses will generally focus on the U.S. epidemic but want to acknowledge that globally an estimated 36.9 million people were living with HIV at the end of 2014 with just 51% of them being diagnosed and more than 34 million deaths were attributed to HIV-related causes.[iii]
Author Interviews, Herpes Viruses, HIV, NEJM / 06.08.2015

Dr. Salim Abdool Karim at CAPRISA Doris Duke Medical Research Institute South AfricaMedicalResearch.com Interview with: Dr. Salim Abdool Karim at CAPRISA Doris Duke Medical Research Institute South Africa Medical Research: What is the background for this study? What are the main findings? Response: Globally, Herpes simplex virus type-2 (HSV-2) is among the most common sexually transmitted infections and is the leading cause of genital ulcers. Available global estimates indicate that approximately 417 million sexually active adults between the ages of 15 and 49 years had an existing prevalent HSV-2 infection in 2012. Current interventions to prevent HSV-2 infection, including condoms, circumcision, and antiviral treatment among heterosexual, HSV-2-discordant couples, have demonstrated protection levels ranging from 6% to 48%. This study showed that peri-coital tenofovir gel reduced HSV-2 acquisition in women by 51%, rising to 71% in high gel-users.
Author Interviews, Hip Fractures, JAMA, Menopause, Osteoporosis, Vitamin D / 05.08.2015

MedicalResearch.com Interview with: Karen E. Hansen, M.D., M.S. Associate Professor of Medicine University of Wisconsin School of Medicine and Public Health Madison, WI 53705-2281 Medical Research: What is the background for this study? Dr. Hansen: The USPTF says to older community dwelling adults, "don't bother taking vitamin D", the Endocrine Society says "take 2,000-4,000 IU daily" and the Institute of Medicine gave an RDA of 600-800 IU daily. The Endocrine Society argues that optimal vitamin D levels are 30 ng/mL and higher, while the Institute of Medicine concludes that 20 ng/mL and higher indicates optimal vitamin D status. The disagreement between experts prompted my study. Medical Research: What are the main findings? Dr. Hansen: Among postmenopausal women whose vitamin D level was ~21 ng/mL at baseline, there was no benefit of high-dose or low-dose vitamin D, compared to placebo, on spine/hip/total body bone mineral density, muscle fitness by 5 sit to stand test or Timed Up and Go, or falls. We did see a small 1% increase in calcium absorption in the high-dose vitamin arm, but this small increase did not translate into clinically meaningful changes in bone density or muscle tests.
Aging, Author Interviews, BMJ, Exercise - Fitness / 05.08.2015

Dr David Hupin CHU Saint-Etienne, Hôpital Nord Service de Physiologie Clinique et de l'Exercice, Centre VISAS Cedex 2, FranceMedicalResearch.com Interview with: Dr David Hupin CHU Saint-Etienne, Hôpital Nord Service de Physiologie Clinique et de l'Exercice, Centre VISAS Cedex 2, France Medical Research: What is the background for this study? Dr. Hupin: Today, over 95% of the world’s population has health problems, according to the Global Burden of Disease Study published recently in The Lancet. The proportion of healthy years lost due to disease rapidly increased with age. There is no medical treatment that can influence as many diseases in a positive manner as can physical activity. It is well established that regular physical activity is an efficient strategy for successful aging. The 2008 Physical Activity guidelines for Americans recommend a minimum of 150 min of moderate-intensity (>3 MET) or 75 min of vigorous-intensity (≥6 MET) physical activity per week or an equivalent combination of moderate and vigorous physical activity (MVPA). A Metabolic Equivalent or MET is a unit useful for describing the energy expenditure of a specific physical activity. However, less than 50% of older adults are able to achieve the current recommendations of physical activity. Thus, the prescription of physical activity for older adults needs to be clarified, i.e., what "dose" of physical activity is required. Medical Research: What is the design of your study? Dr. Hupin: Within the dynamic Department of Clinical and Exercise Physiology of University Hospital of St-Etienne, we conducted a systematic review and meta-analysis. Out of at total of 835 relevant studies, nine were suitable for analysis. These involved a total of 122, 417 participants, monitored for an average of around 10 years, during which time 18,122 died.
Author Interviews, JAMA, PTSD / 05.08.2015

Melissa A. Polusny, PhD, LP Staff Psychologist/Clinician Investigator Core Investigator, Center for Chronic Disease Outcomes Research Associate Professor, University of Minnesota Medical School Minneapolis VA Health Care System (B68-2) One Veterans Drive Minneapolis, MN 5541MedicalResearch.com Interview with: Melissa A. Polusny, PhD, LP Staff Psychologist/Clinician Investigator Core Investigator, Center for Chronic Disease Outcomes Research Associate Professor, University of Minnesota Medical School Minneapolis VA Health Care System One Veterans Drive Minneapolis, MN 5541 Medical Research: What is the background for this study? What are the main findings? Dr. Polusny: VA has invested heavily in the dissemination of prolonged exposure therapy and cognitive processing therapy as first-line treatments for PTSD; however, 30% to 50% of Veterans do not show clinically significant improvements and dropout rates are high. Evidence suggests that mindfulness-based stress reduction – an intervention that teaches individuals to attend to the present moment in a non-judgmental, accepting manner – can reduce symptoms of anxiety and depression. This randomized clinical trial compared mindfulness-based stress reduction with present-centered group therapy – sessions focused on current life problems. We randomly assigned 116 Veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy (n=58) or nine sessions of present-centered group therapy (n=58). Outcomes were assessed before, during and after treatment, and at two-month follow-up. Exclusion criteria included: substance dependence (except nicotine), psychotic disorder, suicidal or homicidal ideation, and/or cognitive impairment or medical illness that could interfere with treatment. The primary outcome was a change in self-reported PTSD symptom severity over time. Secondary outcomes included interview-rated PTSD severity scores, self-reported depression symptoms, quality of life, and mindfulness skills. Mindfulness-based stress reduction therapy – compared with present-centered group therapy – resulted in a greater decrease in self-reported PTSD symptom severity. Veterans in the mindfulness-based stress reduction group were more likely to show clinically significant improvement in self-reported PTSD symptom severity (49% vs. 28%) at two-month follow-up, but they were no more likely to have loss of PTSD diagnosis (53% vs. 47%). Veterans participating in mindfulness-based stress reduction therapy reported greater improvement in quality of life and depressive symptoms than those in present-centered group therapy; however improvement in depressive symptoms scores did not reach the level of significance. Improvements in quality of life made during treatment were maintained at 2-month follow-up for Veterans in the mindfulness-based stress reduction group, but reports of quality of life returned to baseline levels for those in present-centered group therapy. The dropout rate observed for mindfulness-based stress reduction therapy (22%) in this study was lower than dropout rates reported in previous studies for PE (28.1% to 44%) and CPT (26.8% to 35%).
Author Interviews, Heart Disease, Medicare, Outcomes & Safety / 05.08.2015

MedicalResearch.com Interview with: Philip G. Cotterill PhD Centers for Medicare & Medicaid Services Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Dr. Cotterill: Chest pain is one of those elusive complaints where patients can seem initially low-risk based on symptoms or risk factors, and subsequently have an acute myocardial infarction (AMI) or die in a short period of time. Using combinations of history and physical examination findings to discriminate patients with serious causes of chest pain is often not possible. In our study, we demonstrated wide variation in the decision to hospitalize Medicare beneficiaries with chest pain – nearly two fold between the lowest (38%) and highest (81%) quintile of hospitals – and that patients treated in hospitals with higher admission rates for chest pain are less likely to have an acute myocardial infarction within 30-days of the index event and less likely to die. While the findings were statistically significant – differences in outcomes were small: 4 fewer AMIs and 3 fewer deaths per 1,000 patients comparing the highest and lowest admission quintiles. Stated differently, these numbers suggest that if low admitting hospitals were to behave more like high admitting hospitals, 250 patients would need to be admitted to prevent one AMI and 333 cases to prevent one death.
Accidents & Violence, Author Interviews, CDC, JAMA, Primary Care / 05.08.2015

Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, GeorgiaMedicalResearch.com Interview with: Joanne Klevens, MD, PhD Division of Violence Prevention US Centers for Disease Control and Prevention Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Klevens: The United States Preventive Services Task Force recommends women of reproductive age be screened for partner violence but others, such as the World Health Organization and the Cochrane Collaborative conclude there is insufficient evidence for this recommendation. Our randomized clinical trial allocated 2700 women seeking care in outpatient clinics to 1 of 3 study groups: computerized partner violence screening and provision of local resource list, universal provision of partner violence resource list without screening, or a no-screen/no resource list control group.  No differences were found in women’s quality of life, days lost from work or housework, use of health care and partner violence services, or the recurrence of partner violence after 1 year. In this three-year follow-up, no differences were found in the average number of hospitalizations, emergency room visits or ambulatory care visits.
Author Interviews / 04.08.2015

MedicalResearch.com Interview with: Elina Einiö PhD Postdoctoral Researcher Population Research Unit, Department of Social Research University of Helsinki Finland Medical Research: What is the background for this study? Response: Some previous studies have shown that young fatherhood is associated with poorer health and higher later-life mortality. It was unclear whether the association is credible, in the sense that mortality and young fatherhood just appear to be associated because both are determined by family related social and genetic characteristics. Medical Research: What are the main findings? Response: Men who had their first child before age 22 or at ages 22-24 had a higher risk of dying early in middle age than their brothers who had their first child at the average age of 25-26 years. These findings suggest a causal effect of young fatherhood on midlife mortality.
Author Interviews, Inflammation, Lipids, University of Pennsylvania / 04.08.2015

Carsten C. Skarke MD Research Assistant Professor of Medicine McNeil Fellow in Translational Medicine Institute for Translational Medicine and Therapeutics Perelman School of Medicine University of PennsylvaniaMedicalResearch.com Interview with: Carsten C. Skarke MD Research Assistant Professor of Medicine McNeil Fellow in Translational Medicine Institute for Translational Medicine and Therapeutics Perelman School of Medicine University of Pennsylvania Medical Research: What is the background for this study? What are the main findings? Dr. Skarke: A growing body of publications suggests anti-inflammatory actions of fish oils. These health benefits are proposed to emerge from lipids called specialized pro-resolving mediators, (SPMs), which can be formed from omega-3 polyunsaturated fatty acids found in fish. A limitation to date, though, in this field is that there is little evidence of their formation in humans. And the cases where presence of these lipids is reported in humans, less rigorous analytical approaches, such as enzyme immunoassay (EIA), radioimmunoassay (RIA) or mass spectrometry without internal authentic standards, have been used. Thus, the specific aim for our study was to use state-of-the-art mass spectrometry to identify and quantify these specialized pro-resolving mediators. Several aspects of our study design set us apart from what was done in previous studies.
  • First, we biased our ability to detect SPMs formed in healthy volunteers by giving fish oil in high doses which had been previously shown to influence blood pressure and platelet aggregation under placebo-controlled conditions.
  • Second, we also looked at lower doses of fish oil, those more commonly consumed by the general public, for the formation of SPMs during an acute inflammatory response and its resolution.
  • Third, we relied in our measurements of SPMs on authentic internal standards. These deuterated lipids, d4-resolvin E1 for example, facilitate distinct identification of the naturally formed lipid.
  • And fourth, we achieved very low limit of detection levels, below 10 pg/ml for resolvin E1, for example.
The surprising finding of our studies is that we failed to detect a consistent signal of SPM formation in urine or plasma of healthy volunteers who had taken fish oil. Even more surprising was that we found no alteration in the formation of SPMs during the resolution of inflammation. These results let us question the relevance of endogenous specialized pro-resolving mediators to the putative anti-inflammatory effects of fish oils in humans.
Author Interviews, Blood Pressure - Hypertension, Heart Disease / 02.08.2015

MedicalResearch.com Interview with: Prof. Sante D. Pierdomenico Associate Professor of Internal Medicine University "Gabriele d'Annunzio" Chieti-Pescara - Italy Medical Research: What is the background for this study? What are the main findings? Dr. Pierdomenico: Though a peak incidence of cardiovascular events in the morning has been observed, the independent prognostic value of morning surge (MS) of blood pressure (BP) is not yet clear. We investigated the association between morning surge of systolic blood pressure and risk of coronary events in elderly treated hypertensive patients. Subjects were divided according to tertiles of MS of systolic blood pressure of the population as a whole, by dipping status (nondippers are at increased risk than dippers) and by group-specific tertiles of morning surge of systolic blood pressure in dippers and nondippers because these groups have different MS of blood pressure. In elderly treated hypertensive patients, high MS of systolic BP predicts coronary events in dippers but not in nondippers. Nondippers, however, show higher risk of coronary events independently of morning surge in systolic blood pressure. Medical Research: What should clinicians and patients take away from your report? Dr. Pierdomenico: Blood pressure should be better controlled after awakening in dippers with high morning surge and during the night in nondippers in order to better prevent cardiovascular events.
Author Interviews, Cancer Research, Genetic Research / 02.08.2015

Christos Nikolaidis Ph.D. Laboratory of Pharmacology Medical School, Democritus University of Thrace Dragana, Alexandroupolis GreeceMedicalResearch.com Interview with: Christos Nikolaidis Ph.D. Laboratory of Pharmacology Medical School, Democritus University of Thrace Dragana, Alexandroupolis Greece Medical Research: What is the background for this study? Response: Epigenetic changes are part of the natural history of cervical neoplasia. Tracking these changes at the molecular level is necessary for understanding disease progression, response to treatment and prognosis. Epigenetic biomarkers can potentially assess the stage of cervical intraepithelial neoplasia (CIN). This information can be used for screening purposes, to improve the overall quality of cervical cancer diagnostics. Medical Research: What are the main findings? Response: Paired boxed 1 (PAX1) gene methylation status has been widely used as a biomarker for cervical cancer screening.  We have conducted a meta-analysis of the diagnostic test accuracy of PAX1 methylation, on moderate cervical dysplasia or worse (CIN2+) versus normal epithelium, and severe cervical dysplasia or worse (CIN3+) versus normal epithelium, for a total population of 1385 women. The results of this assay were generally satisfactory for CIN2+ vs normal, and extremely satisfactory for CIN3+ vs normal (Sensitivity=0.77, Specificity=0.92, AUC=0.931). This raises the possibility of utilizing this biomarker to improve current diagnostic protocols.
Author Interviews, Genetic Research / 01.08.2015

Dr. Rosalind Arden Centre for Philosophy of Natural & Social Science London School of Economics LondonMedicalResearch.com Interview with: Dr. Rosalind Arden Centre for Philosophy of Natural & Social Science London School of Economics London MedicalResearch: What is the background for this study? What are the main findings? Dr. Arden: We've known for a while that people who score higher on IQ-type tests tend to live longer. A study published in the British Medical Journal (Whalley & Deary, 2001) examined intelligence in childhood and later survival. People born in Scotland in 1921 took an IQ-type test at age 11 in 1932. Those with higher test scores were more likely to survive to age 76. What we haven't known is 'why?' One possibility is that advantages from being raised in a wealthier family may enhance intelligence and health - leading to brighter people living longer. Another possibility is that many genes that influence brains also influence bodies. If well-built brains co-occur with well-built bodies, that could also explain the link. These are only two of several possible explanations. We aimed to test whether genes caused the link between intelligence and life-expectancy. We found 1) the link between intelligence and life expectancy is positive but small. 2) The cause of the link is almost all genetic. We found this by examining differences within twin pairs. Twins offer a quasi-natural experiment because they share many features of the environment that are often thought (mistakenly) to cause differences between people. And marvelously, for science there are two kinds of twins, with known genetic relatedness (100 % or 50%). This give us a means to test questions about the cause of differences in a population, as well as the causes of correlations among traits within a population.
Author Interviews, Cancer Research, End of Life Care, Lancet, Leukemia / 01.08.2015

Prof David C Currow Discipline of Palliative and Supportive Services Flinders University Adelaide, SA, AustraliaMedicalResearch.com Interview with: Prof David C Currow Discipline of Palliative and Supportive Services Flinders University Adelaide, SA, Australia Medical Research: What is the background for this study? Prof. Currow: This study grew out of a desire to better understand the symptom burden experienced by people with hematological malignancies at the end of life. This has been very poorly documented and although there are lots of strong opinions, there are very few data at a population level. Medical Research: What are the main findings? Prof. Currow: The main finding is that community-dwelling people with hematological malignancies at the end of life have a burden of symptoms that looked almost identical to people with solid tumours. Given much lower rates of access to the hospice and palliative care, this suggests that these people and their family caregivers are missing out on opportunities for better symptom control and better support.
Author Interviews, HIV, PLoS, UC Davis / 31.07.2015

Dr. Satya Dandekar PhD Professor and Chair Department of Medical Microbiology and Immunology UC DavisMedicalResearch.com Interview with: Dr. Satya Dandekar PhD Professor and Chair Department of Medical Microbiology and Immunology UC Davis Medical Research: What is the background for this study? What are the main findings? Dr. Dandekar: Current anti-retroviral therapy is effective in suppressing HIV replication and enhancing immune functions in HIV infected individuals. However, it fails to eradicate the latent HIV reservoirs. Therapy interruption leads to a rapid viral rebound in these patients.  Eradication of latent HIV reservoirs is essential to achieve HIV cure. A “shock and kill” strategy for HIV cure has been proposed that involves reactivation of latent viral reservoirs using latency reversal agents (LRA) and eradication by the immune response. This highlights the need to identify potent LRAs to optimally activate latent HIV reservoirs so that immune surveillance and clearance mechanisms can be effectively engaged in the process of viral eradication. We have found that ingenol-3-angelate (PEP005), an anti-cancer drug can effectively reactivate latent HIV. It is a protein kinase C agonist that activates NF-kB and stimulates HIV expression. In combination with another compound, JQ1, a previously known p-TEFb agonist, the efficacy of PEP005 for HIV reactivation is markedly increased. In addition, ingenol-3-angelate decreases the expression of HIV co-receptors on immune cells, which potentially will help preventing further spread of the virus. The use of ingenol-3-angelate in combination with other latency reversal agents provides an excellent opportunity to optimally activate latent HIV reservoirs and target them for eradication.
Addiction, Author Interviews, Inflammation / 31.07.2015

Prof. Igor Yakymenko Laboratory of Biophysics, Institute of Experimental Pathology, Oncology and Radiobiology NAS of UkraineMedicalResearch.com Interview with: Prof. Igor Yakymenko Laboratory of Biophysics, Institute of Experimental Pathology, Oncology and Radiobiology NAS of Ukraine Medical Research: What is the background for this study? What are the main findings? Prof. Yakymenko: We know a lot about both health effects and metabolic effects of radiofrequency radiation (RFR) today, including mutagenic and carcinogenic effects. For example, epidemiological studies over the world indicate that 5 years of cell phone use 20 min per day increase risk of acoustic neuroma 3 times. Or, for example, 4 years of cell phone use 1 hour or more per day increase risk of some kinds of brain tumors, including glioma, 3-5 times. But it was not understandable the primary mechanisms of such effects. In our study we had analyzed about 100 recent studies on metabolic effects of radiofrequency radiation, including our own experimental data, and demonstrated that oxidative/free radical effects are mandatory feature of RFR exposure of living cells. Moreover, the chronic radiofrequency radiation exposure can produce chronic oxidative stress in living cells as a first step for possible development of bulk of hazardous health effects.
Author Interviews, Biomarkers, Brain Injury / 31.07.2015

Dr. Heinrich Thaler Trauma Hospital Meidling Vienna AustriaMedicalResearch.com Interview with: Dr. Heinrich Thaler Trauma Hospital Meidling Vienna Austria Medical Research: What is the background for this study? Dr. Thaler:  An increased prevalence of minor head injuries in elderly patients combined with the frequent use of platelet aggregation inhibitors resulted in increased hospital admissions and cranial computed tomography. We undertook the study with the aim to reduce the workload of medical staff and costs as well as the radiation burden in the management of patients with mild head injuries. Medical Research: What are the main findings? Dr. Thaler:  S 100B is a reliable negative predictor in elderly patients and/or in patients on platelet aggregation inhibitors to rule out an intracranial hemorrhage after minor head injury (S100B is an astroglial derived protein detectable in serum in the case of cerebral tissue damage). The negative predictive value of S100B is 99,6%. We conclude that S100B levels below 0.105 µg/L can accurately predict a normal cranial computed tomography after minor head injury in older patients and those on antiplatelet medication. Additionally we found no increased risk for intracranial hemorrhage in older patients or in patients receiving antiplatelet therapy.
Alzheimer's - Dementia, Author Interviews, Diabetes, JAMA, Nutrition / 31.07.2015

Auriel A. Willette, M.S., Ph.D. Food Science and Human Nutrition Neuroscience Interdepartmental Graduate Program Gerontology Interdepartmental Graduate Program Iowa State University, AmesMedicalResearch.com Interview with: Auriel A. Willette, M.S., Ph.D. Food Science and Human Nutrition Neuroscience Interdepartmental Graduate Program Gerontology Interdepartmental Graduate Program Iowa State University, Ames Medical Research: What is the background for this study? What are the main findings? Response: Obesity is a major health concern around the world. Obesity causes insulin resistance, defined in this case as the inability of insulin to bind to its receptor and mediate glucose metabolism. Other researchers and I have recently found that higher insulin resistance is associated with less glucose metabolism in the brains of patients with Alzheimer's disease. This relationship is found primarily in medial temporal lobe, an area necessary for generating new memories of facts and events. This is important because Alzheimer's disease is characterized by progressive decreases in glucose metabolism over time, and partly drives worse memory performance. Insulin resistance in midlife also increases the risk of developing Alzheimer's disease. We wanted to determine if insulin resistance is linked to similar effects in cognitively normal, late middle-aged participants decades before Alzheimer's disease typically occurs. If so, insulin resistance might be an important biological marker to track from middle-age onwards. Thus, we examined the association between insulin resistance, regional glucose metabolism using FDG-PET, and memory function in 150 middle-aged participants, many of whom had a mother or father with Alzheimer's disease. We found that higher insulin resistance was strongly associated with less glucose metabolism throughout many brain regions, predominantly in areas that are affected by Alzheimer's disease. The strongest statistical effects were found in left medial temporal lobe, which again is important for generating new memories. This relationship, in turn, predicted worse memory performance, both immediately after learning a list of words and a 20-minute delay thereafter. The take-home message is that insulin resistance has an Alzheimer's-like association with glucose metabolism in middle-aged, cognitively normal people at risk for Alzheimer's, an association which is related to worse memory.
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Salt-Sodium / 31.07.2015

Salt-SodiumMedicalResearch.com Interview with: Tomonori Sugiura, MD, PhD Department of Cardio‐Renal Medicine and Hypertension Nagoya City University Graduate School of Medical Sciences Nagoya  Japan Medical Research: What is the background for this study? What are the main findings? Dr. Sugiura: Although there is a close relationship between dietary sodium and hypertension, the concept that individuals with relatively high dietary sodium are at increased risk of developing hypertension compared to those with relatively low dietary sodium, has not been intensively studied in a cohort. Therefore, the present observational study was designed to investigate whether individual levels of dietary sodium critically affect future increases in blood pressure in the general population. The main findings of this study were that a relatively high level of dietary sodium intake and also a gradual increase in dietary sodium, estimated by urinary sodium excretion, are associated with a future increase in blood pressure and the incidence of hypertension in the general population.
Author Interviews, Heart Disease, JACC, Johns Hopkins / 31.07.2015

Alan Cheng, MD, FACC, FAHA, FHRS Associate Professor of Medicine Associate Professor of Pediatrics Director, Arrhythmia Device Service Johns Hopkins University School of Medicine Baltimore, MD 21287MedicalResearch.com Interview with: Alan Cheng, MD, FACC, FAHA, FHRS Associate Professor of Medicine and Pediatrics Director, Arrhythmia Device Service Johns Hopkins University School of Medicine Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Dr. Cheng: Sudden cardiac death (SCD) has been the most common way in which people in the United States die. While it's hard to accurately identify who is a higher risk for SCD, we have learned from a number of studies over the past 30-40 years that people with significant reductions in their heart function (measured as the ejection fraction (EF)) is one group of individuals at high risk for Sudden cardiac death. In fact, the current American College of Cardiology and American Heart Association guidelines state that people with an EF below 35% are at high enough risk for Sudden cardiac death that these patients should undergo implantation of an implantable cardioverter defibrillator (or ICD for short), a device capable of monitoring the heart 24/7 and shocking the heart out of any arrhythmias that could lead to Sudden cardiac death. The data they cite for this recommendation are so compelling that they currently recommend implanting ICDs in patients not only among those who already experienced an Sudden cardiac death event, but also those who have not. Implanting an ICD to prevent Sudden cardiac death before they have had Sudden cardiac death is known as primary prevention and this accounts for about 70-80% of all ICD implants in the United States. While the EF is the best metric out there to determine if a patient should get an ICD, it has its limitations. Because of these limitations, we have been interested for a long time in better understanding how the EF and other metrics affect a patient's risk for Sudden cardiac death. In this study, we followed 538 patients who were recipients of a primary prevention ICD who underwent repeat assessment of their EF during followup in order to determine if changes in their EF over time altered their risk for ICD shocks for ventricular arrhythmias or death. Over a median of almost 5 years of followup, we found that 40% of the cohort had improvements in their EF. And when the EF does improve, the risk goes down for ICD shocks for ventricular arrhythmias as well as for death.
Author Interviews, Cancer Research, Sexual Health / 30.07.2015

Gwendolyn P. Quinn, Ph.D. Moffitt Cancer Center University of South FloridaMedicalResearch.com Interview with: Gwendolyn P. Quinn, Ph.D. Moffitt Cancer Center University of South Florida MedicalResearch: What is the background for this study? What are the main findings? Dr. Quinn: Our research group has been conducting studies of the LGBTQ community and their healthcare experiences combined with providers knowledge and attitudes about LGBTQ and cancer care. This led us to examine the literature on cancer and LGBTQ. The main findings point to the lack of rigorous data about cancer in the LGBTQ community. Our review revealed that 7 cancers (anal, breast, cervical, colorectal, colon and rectal, endometrial, lung and prostate cancers) may occur more frequently in the community due to elevated prevalence of risk factors and behaviors such as obesity and substance use; however, there are limited data on outcomes, morbidity and mortality. The lack of data makes it difficult for providers to fully inform patients about early detection, prevention, and treatment options and outcomes. Further, the lack of psychosocial data makes it difficult to provide supportive care recommendations and other forms of support.