Author Interviews, Macular Degeneration, Radiology, Stanford / 10.11.2014

Daniel L. Rubin, MD, MS Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488MedicalResearch.com Interview with: Daniel L. Rubin, MD, MS  Assistant Professor of Radiology and Medicine (Biomedical Informatics) Department of Radiology | Stanford University Stanford, CA 94305-5488 Medical Research: What is the background for this study? What are the main findings? Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive — they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives. (more…)
Author Interviews, Brigham & Women's - Harvard, Karolinski Institute, Nutrition / 10.11.2014

Susanne Rautiainen, PhD From the Department of Institute of Environmental Medicine Karolinska Institutet, Stockholm, Sweden Divisions of Preventive Medicine Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MAMedicalResearch.com Interview with: Susanne Rautiainen, PhD From the Department of Institute of Environmental Medicine Karolinska Institutet, Stockholm, Sweden Divisions of Preventive Medicine  Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Rautiainen: Multivitamins are the most commonly used dietary supplement in the US and other developed countries and it has been shown that many take them with the goal of maintaining or improving their health. Multivitamins typically provide low-doses of essential vitamins and minerals to prevent deficiency. Yet many people who take multivitamins are not deficient. Despite the widespread use, limited number of studies have investigated how multivitamins are associated with major chronic diseases, including cardiovascular disease. We therefore examined how self-reported multivitamin use was associated with both short- and long-term risk of cardiovascular diseases in the Women’s Health Study which is a prospective cohort of 37,193 women aged ≥45 years and free of CVD and cancer at baseline. In this study of middle-aged and elderly women who were apparently healthy at baseline and followed for an average of 16.2 years, we observed that multivitamin use was not associated with neither short- nor long-term risk risk of major CVD events, including MI, stroke, or CVD death. Moreover, there was no significant association observed for women who had taken multivitamins for ≥10 years at baseline. There were some important indications that the association between multivitamin use and long-term risk of major CVD events may be modified by age and fruit and vegetable intake, suggesting that women who were older and had low fruit and vegetable intake may benefit more from multivitamin supplement use. However, these results should be interpreted with caution. Moreover, relying on self-reports of multivitamin use may be subject to misclassification, plus other unmeasured factors may have biased the results despite our best effort to account for everything. (more…)
Aging, Lipids / 10.11.2014

Sofiya Milman, M.D. Assistant Professor of Medicine Divisions of Endocrinology and Geriatrics Albert Einstein College of MedicineMedicalResearch.com Interview with: Sofiya Milman, M.D. Assistant Professor of Medicine Divisions of Endocrinology and Geriatrics Albert Einstein College of Medicine   Medical Research: What is the background for this study? What are the main findings? Dr. Milman: Aging is a major risk factor for many diseases, including cardiovascular disease, dementia, and diabetes. Yet, individuals with exceptional longevity delay the onset of most diseases and often escape from age-related illnesses altogether. Exceptional longevity is an inherited trait. A unique cholesterol profile has been previously associated with longevity and specific genetic variations. This profile included elevated levels of high-density lipoprotein (HDL) cholesterol or “good” cholesterol and large HDL particles. The present study explored whether elevated HDL cholesterol levels and genes that control HDL cholesterol can predict survival in individuals age 95 years or older. The study found that higher levels of HDL cholesterol were related to longer survival in women, but not in men. Higher HDL cholesterol level was also seen in individuals without cognitive problems and diabetes. On the other hand, both men and women with larger HDL particle size and higher levels of APOA1, a protein component of HDL cholesterol, exhibited longer survival. Variants in two genes, the CETP and APOA1, were related to higher HDL cholesterol levels. (more…)
Author Interviews, Electronic Records, Outcomes & Safety, Surgical Research, UCSD / 09.11.2014

MedicalResearch.com Interview with: Jamie Anderson MD MPH Department of Surgery University of California, San Diego Medical Research: What is the background for this study? What are the main findings? Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population. Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel. With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements. We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records. (more…)
Author Interviews, Nutrition / 09.11.2014

Punam Ohri-Vachaspati, Ph.D.,R.D Associate Professor, Nutrition Arizona State University School of Nutrition and Health Promotion College of Health Solutions Phoenix, AZ 85004 MedicalResearch.com Interview with Punam Ohri-Vachaspati, Ph.D.,R.D Associate Professor, Nutrition Arizona State University School of Nutrition and Health Promotion College of Health Solutions Phoenix, AZ 85004 Medical Research: What is the background for this study? What are the main findings? Dr. Ohri-Vachaspati: Fast food is heavily marketed to kids -- with the food industry spending over $700 million each year to market their products specifically to children and adolescents.  About half of this money goes towards premiums like toys given away with kids meals. And marketing works --exposure to food marketing is associated with higher fast food consumption among children.  Research has shown us that 2-18 year olds consume 13% of their total calories at fast food restaurants.  Children who eat at fast food restaurants are likely to have poor diets and worse health outcomes. In this study we wanted to examine which communities are more vulnerable to child-directed marketing on the interior and exterior of fast food restaurants. Over a three year  period (2010, 2011, and 2012) we sampled nearly 7000 restaurants from a whole spectrum of communities across the US.  Child-directed marketing measured inside fast food restaurants included indoor play area and display of kids’ meal toys, and on the exterior included advertisements with cartoon characters, advertisements with movie, TV or sports figures, and advertisements for kids’ meal toys among others.We found that more than a fifth of fast food restaurants used child-directed marketing on the inside or on the exterior of their premises. Middle-income communities, majority black communities and rural areas were disproportionately exposed to this type of child-directed marketing. (more…)
Author Interviews, Dartmouth, Lung Cancer, NEJM / 07.11.2014

William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756MedicalResearch.com Interview with: William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014. (more…)
Author Interviews, Biomarkers, Ophthalmology, Stanford / 07.11.2014

Theodore Leng, MD, MS , one of the article’s senior authors Byers Eye Institute at Stanford Stanford University School of Medicine Palo Alto, CA 94303MedicalResearch.com Interview with: Theodore Leng, MD, MS , one of the article’s senior authors Byers Eye Institute at Stanford Stanford University School of Medicine Palo Alto, CA 94303   Dr. Leng: What is the background for this study? What are the main findings? Medical Research: Age-related macular degeneration (AMD) is the leading cause of blindness and central vision loss among adults older than 65 years. 80-85% of patients have the dry, non-exudative, form of the disease, but the wet, exudative, form of advanced AMD is of primary concern as it accounts for a majority of severe vision loss in Age-related macular degeneration. In wet AMD, abnormal blood vessels grow under the retina and can leak blood and fluid. Until now, there has been no effective way to tell which patients with dry AMD are likely to progress to the wet stage. In our recent Investigative Ophthalmology & Visual Science article, we describe a new mathematical model that can predict which patients are likely to progress. The predictive model identifies likely progressors by analyzing 3D spectral domain optical coherence tomography (SD-OCT) retinal imaging data that’s routinely obtained during retinal encounters. We analyzed data from 2,146 SD-OCT scans of 330 eyes in 244 patients seen at The Byers Eye Institute at Stanford over a five-year period. We found that the area and height of drusen, the amount of reflectivity at the macular surface and the degree of change in these features over time, could be weighted to generate a patient’s risk score. Predictions from the model were compared with cases where patients actually progressed to wet Age-related macular degeneration. Our model accurately predicted every occurrence of progression within a year. There was a false positive rate of around 40%, but we thought this was a good tradeoff because we would not miss any potential progressors by using this sensitivity threshold. (more…)
Author Interviews, Cancer Research, Case Western, Dental Research, JAMA / 07.11.2014

MedicalResearch.com Interview with: Brendan J. Perry, BSc, MBBS Princess Alexandra Hospital Brisbane, Queensland, Australia MedicalResearch: What is the background for this study? What are the main findings? Dr. Brendan J. Perry: Oral cavity cancer is usually attributed to the “Five S’s” - smoking, spirits (alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice. This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth. In recent years, dentists have been recommending clients to get removable denture nyc to tackle down on discomfort. We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor. (more…)
Author Interviews, Blood Pressure - Hypertension / 07.11.2014

Heather M. Johnson, MD, MS Assistant Professor of Medicine Co-Director, UW Advanced Hypertension Program Department of Medicine, Cardiovascular Medicine Division University of Wisconsin School of Medicine and Public Health Madison, WI 53792MedicalResearch.com Interview with: Heather M. Johnson, MD, MS Assistant Professor of Medicine Co-Director, UW Advanced Hypertension Program Department of Medicine, Cardiovascular Medicine Division University of Wisconsin School of Medicine and Public Health Madison, WI 53792 Medical Research: What is the background for this study? Dr. Johnson: Our study addresses the public health burden that young adults have significantly lower hypertension control rates compared to middle-aged and older adults. The development of incident (new) hypertension is an important “teachable moment” to educate young adults about necessary lifestyle changes to lower blood pressure. (more…)
Author Interviews, Gender Differences, PLoS / 07.11.2014

MedicalResearch.com Interview with: Prof. Roberto Lent Diretor, Instituto de Ciências Biomédicas Centro de Ciências da Saúde, Bloco K, sala 2-35 Universidade Federal do Rio de Janeiro Rio de Janeiro, Brasil Medical Research: What is the background for this study? What are the main findings? Prof. Lent: Our group has been studying the absolute numbers of cells in the human brain, using a novel technique that we have developed. We have done it for the whole male brain, and arrived at a figure of 86 billion neurons and 85 billion glial cells, 15% less than the round number that became a neuromyth (one hundred billion neurons). We did it also for the demented brain, in this case working with females, and showed that it is dementia that is associated with a loss of neurons, because people with alzheimer, but no dementia, displayed normal numbers of neurons. The present paper focuses on sexual dimorphism in the olfactory bulb, and revealed that women have around 40% more neurons and glial cells than men, what correlates with their superior performance in many olfactory abilities. (more…)
Author Interviews, CDC, Infections, Pediatrics, Vaccine Studies, Vanderbilt / 07.11.2014

MedicalResearch.com Interview with: Marie R Griffin MD MPH Director, Vanderbilt MPH Program Department of Health Policy Vanderbilt University Medical Center Nashville TN 37212 Marie R Griffin MD MPH Director, Vanderbilt MPH Program Department of Health Policy Vanderbilt University Medical Center Nashville TN 37212 Medical Research: What is the background for this study? What are the main findings? Dr. Griffin: In Tennessee, the introduction in 2010 of a new pneumococcal vaccine for infants and young children was associated with a 27 percent decline in pneumonia hospital admissions across the state among children under age 2. The recent decline in Tennessee comes on top of an earlier 43 percent decline across the United States associated with the introduction in 2000 of the first pneumococcal vaccine for children under 2 years of age. (more…)
Author Interviews, JAMA, Metabolic Syndrome, Weight Research / 07.11.2014

MedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology (Nuclear Medicine and Cardiothoracic Imaging Divisions), University of Michigan, Ann Arbor, Michigan and Dr. Ravi Shah MD Cardiology Division, Department of Medicine Massachusetts General Hospital, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: Prior studies in Framingham, MESA and other cohorts have demonstrated that obesity is an important risk factor for the metabolic syndrome. However, the observations that many non-obese individuals develop metabolic syndrome and diabetes and, conversely, that not all obese individuals develop these complications has motivated the search for better markers of risk than BMI. More recently, it has been shown that the location of adipose tissue is an important factor. The amount of visceral fat, which is thought to be more harmful from a metabolic perspective, can be accurately quantified with CT imaging. In many prior studies, waist circumference has been used as an approximate measure of visceral adiposity. For this study, we analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA). We found that the amount of visceral fat (as quantified by CT) was an important predictor of metabolic syndrome, even after adjusting for weight, waist circumference, gender, race, smoking, exercise, serum lipids and glucose. Each additional 100 cm2/m of height of visceral fat was associated with a 29% increase in the risk of developing metabolic syndrome. In contrast, subcutaneous fat burden (also quantified by CT) was a much weaker predictor. One of the very novel findings of our study arises from an analysis of subjects who had multiple CTs longitudinally in MESA. Using these data, we found that change in visceral fat burden was associated with a corresponding 5% increase in the risk of metabolic syndrome. In part, this is because very small changes in weight could result in very large changes in visceral fat. (more…)
Author Interviews, Breast Cancer / 06.11.2014

Antoine E. Karnoub, Ph.D. Assistant Professor of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Center for Life Science 0634 Boston, MA 02215MedicalResearch.com Interview with: Antoine E. Karnoub, Ph.D. Assistant Professor of Pathology Beth Israel Deaconess Medical Center Harvard Medical School Center for Life Science 0634 Boston, MA 02215 Medical Research: What are the main findings of the study? Dr. Karnoub: The main findings of the study are: (1) that the metastatic propensities of cancer cells can be remarkably modulated by otherwise ‘normal’ mesenchymal stem/stromal cells found in their vicinity; (2) that generation of highly malignant tumor-initiating cells can be significantly triggered by microenvironmental cues; (3) that repression of the gene FOXP2 by a miR-199a-led microRNA network enables the propagation of cancer stem cell and metastatic traits in otherwise weakly metastatic cancer cells; and (4) that such a signaling axis appears to forecast poor patient outcome. (more…)
Accidents & Violence, Author Interviews, General Medicine / 06.11.2014

Christopher J. Ferguson PhD. Associate Professor and Chair of Psychology Department of Psychology Stetson University DeLand, FL MedicalResearch.com Interview with: Christopher J. Ferguson PhD. Associate Professor and Chair of Psychology Department of Psychology Stetson University DeLand, FL Medical Research: What is the background for this study? What are the main findings? Dr. Ferguson: People have debated whether media violence contributes to societal violence for centuries.  A lot of individual laboratory experiments have tried to answer this question, but results have always tended to be inconsistent.  Not too much data had yet looked at concordance between media violence and societal violence.  In the current study I examined levels of movie violence across the 20th century, and video game violence in the latter part of the 20th, into the 21st century.  Results generally indicted that it was not possible to demonstrate that media violence consumption correlated with increased crime in society. (more…)
Author Interviews, Orthopedics, Pediatrics, Rheumatology / 06.11.2014

Professor Flavia Cicuttin School of Public Health and Preventive Medicine Monash University and Alfred Hospital Melbourne, AustraliaMedicalResearch.com Interview with: Professor Flavia Cicuttin School of Public Health and Preventive Medicine Monash University and Alfred Hospital Melbourne, Australia Medical Research: What is the background for this study? What are the main findings? Prof. Cicuttin: Previous research found that low birth weight and preterm birth have been linked to hypertension, cardiovascular disease, insulin resistance and reduced bone mass in adulthood.  Given these adverse outcomes related to birth weight and preterm birth we set out to investigate if low birth weight and preterm birth also played a role in increase risk of joint replacement surgery as adults. We found that  low birth weight and preterm birth were associated with a 2-fold increased risk of hip but not knee replacement surgery. (more…)
Author Interviews, Genetic Research, Nature, NYU / 06.11.2014

Leslie Mitchell, PhD New York University Langone Medical Center Boeke Lab, Institute for Systems Genetics NY NY, 10016MedicalResearch.com Interview with: Leslie Mitchell, PhD New York University Langone Medical Center Boeke Lab, Institute for Systems Genetics NY NY, 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: One of our major interests is building synthetic chromosomes. Typically we construct synthetic chromosomes using a bottom-up approach, first designing the sequence in silico and then synthesizing and piecing together the DNA to build the designer molecule. While eukaryotic chromosomes are usually linear in structure, oftentimes we build our designer synthetic chromosomes as circular molecules to take advantage of cloning technologies available in E. coli, an organism that tolerates only circular chromosomes. We developed the telomerator as a means by which to convert circular synthetic chromosomes into linear molecules, which more closely resemble the native chromosomes found in eukaryotic cells. We discovered that the telomerator is an extremely effective tool for generating linear derivatives of circular synthetic chromosomes. There are two main reasons for this.
  • First, the action of the telomerator can be assessed using a simple phenotypic assay so it is easy to differentiate cells that encode linear synthetic chromosomes from those with the circular format.
  • Second, the telomerator encodes ‘telomere seed sequences’ that are exposed and recognized by the cell upon linearization, thus the ends of a newly linearized chromosome are protected, which ensures its stability over generations. We put the telomerator to the test by integrating it in 54 different positions on a circular synthetic yeast chromosome called synIXR (Dymond et al. 2011). In 51 of the 54 positions we could successfully linearize the synIXR chromosome and recover viable cells, however many of the different linear derivatives conferred growth defects. We determined the mechanism underlying both the growth defects and lethality associated with linearization to be telomere position effect. In other words, when essential genes were re-positioned near telomeres their reduction in expression due to subtelomeric silencing was detrimental to the cell.
(more…)
Aging, Author Interviews, Cost of Health Care / 06.11.2014

MedicalResearch.com Interview with: Dr. Amalavoyal Chari PhD Department of Economics, University of Sussex Brighton UK Medical Research: What is the background for this study? What are the main findings? Dr. Chari: It is well-known that in the United States, informal (unpaid) caregiving by family members and friends is the primary source of long-term care for the elderly population: Recent estimates indicate that nearly 1 in 5 adults in the United States provides care to an elderly relative or friend over the age of 50. Informal care is not really “free”: Rather, it diverts caregivers’ effort from other productive activities, and the value of these displaced activities is the opportunity cost of informal elder-care. Estimates of this cost have been limited by the lack of nationally representative data with detailed information to allow an assessment of the value that caregivers attach to time and time spent providing care. Our study utilizes new and unique data from the American Time Use Survey (ATUS) to remedy this deficit, and to provide careful, up-to-date estimates of the opportunity costs of informal eldercare in the United States. We find that informal care is mainly provided by working-age adults, who consequently bear most of the economic burden in terms of opportunity costs. We find that the price tag for informal caregiving of elderly people by friends and relatives in the United States comes to $522 billion a year. Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually. (more…)
Author Interviews, NEJM, Rheumatology / 06.11.2014

Professor Paul Emery Arthritis Research UK Professor of Rheumatology Director - Leeds Musculoskeletal Biomedical Research Unit, LTHT Director – Leeds Institute of Rheumatic and Musculoskeletal Medicine University of LeedsMedicalResearch.com Interview Professor Paul Emery Arthritis Research UK Professor of Rheumatology Director - Leeds Musculoskeletal Biomedical Research Unit, LTHT Director – Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Medical Research: What is the background for this study? What are the main findings? Professor Emery: Joint damage and functional disability are common in people who suffer from rheumatoid arthritis (RA), even in those with early disease. We know that early aggressive treatment with biologics, such as the anti-TNF agent etanercept, results in rapid remission in many patients with moderate-to-severe rheumatoid arthritis, which can help reduce the risk of joint destruction and disability long term. However, we don’t yet know whether remission achieved with biologic therapy can be maintained after doses are reduced or therapy is withdrawn. The PRIZE trial, a “state-of-the-art” biologic treatment trial conducted in adults with early untreated rheumatoid arthritis, was designed to fill this knowledge gap. The trial included three phases:
  • 1) induction therapy with full-dose combination etanercept-methotrexate therapy;
  • 2) maintenance therapy with a reduced-dose etanercept-methotrexate regimen, methotrexate alone, or no treatment; and
  • 3) complete treatment withdrawal. After clinical remission was induced, remission was shown to be effectively maintained with the reduced-dose combination regimen but not with the biologic-free regimens.Significantly more patients who had received the reduced-dose regimen were in remission after therapy was withdrawn than patients who received no therapy after remission induction. Interestingly, however, after remission was induced with the full-dose combination regimen, no substantial progression of joint damage on x-ray was seen in patients receiving the reduced-dose regimen, methotrexate only, or no treatment.
(more…)
Alcohol, Author Interviews, Hearing Loss / 06.11.2014

Sharon G. Curhan, MD, ScM Channing Division of Network Medicine Department of Internal Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115MedicalResearch.com Interview with: Sharon G. Curhan, MD, ScM Channing Division of Network Medicine Department of Internal Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 Medical Research: What is the background for this study? Dr. Curhan: Hearing loss is a highly prevalent and disabling chronic condition that can impair communication, quality of life, and health. Although it is often perceived as an inevitable companion of aging, recent evidence suggests modifiable factors can potentially aid in prevention or slow progression of hearing loss. Alcohol consumption may influence several mechanisms that have been proposed to underlie age-related hearing decline. Although chronic excess alcohol intake has been associated with irreversible hearing loss and acute alcohol intake may temporarily impair auditory function, some evidence suggests that long-term moderate alcohol intake may protect against hearing loss. (more…)
Author Interviews, Heart Disease, Kidney Disease / 06.11.2014

MedicalResearch.com Interview with: Ning Tan, MD, PHD Senior Consultant Cardiologist. Department of Cardiology Guangdong Cardiovascular Institute Guangdong General Hospital Guangdong Academy of Medical Sciences Guangzhou, Guangdong, China Medical Research: What are the main findings of the study? Dr. Tan: In this study, we evaluated whether Low density lipoprotein cholesterol (LDL-C) is an independent risk factor of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 3236 consecutive patients undergoing PCI in our hospital and demonstrated that LDL-C is significantly and independently associated with CI-AKI in patients undergoing PCI. (more…)
Alcohol, Author Interviews, Genetic Research / 05.11.2014

Victor M. Karpyak, M.D., Ph.D. Medical Director, Intensive Addiction Treatment Program Director, Mayo Clinic Addiction Services Consultant, Department of Psychiatry and Psychology Assistant Professor of Psychiatry Mayo Clinic College of Medicine MedicalResearch.com Interview with: Victor M. Karpyak, M.D., Ph.D.  Medical Director, Intensive Addiction Treatment Program Director, Mayo Clinic Addiction Services Consultant, Department of Psychiatry and Psychology Assistant Professor of Psychiatry  Mayo Clinic College of Medicine Medical Research: What is the background for this study? Dr. Karpyak: The staggering costs of alcohol use disorders call for the development and implementation of evidence-based treatment strategies. Several medications (acamprosate, naltrexone, and disulfiram) were approved for treatment of alcohol use disorders; yet, only a fraction of patients respond to each medication. Clearly, response predictors are needed to improve treatment efficacy and personalize recommendations for treatment selection. It is expected that pharmacogenomic research will aid the discovery of such predictors. (more…)
Author Interviews, Erasmus, Gastrointestinal Disease, Pediatrics / 05.11.2014

MedicalResearch.com Interview with: Anne Tharner, PhD and Jessica C. Kiefte-de Jong, PhD Department of Epidemiology Erasmus Medical Center, Rotterdam The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Constipation is one of the most common health problems in children, and occurs in most cases without organic reason. In our study, we examined if fussy eating behavior might be related to constipation in children. “Fussy eaters” are children who reject specific foods – often (green and bitter) vegetables – and often compensate this with the intake of less healthy but highly palatable foods (such as fast food or sweets). This kind of diet might be one of the reasons for constipation in children, but at the same time, children might develop difficult eating patterns due to digestive problems such as constipation. Therefore, we examined whether fussy eating and functional constipation mutually affect each other, which might point to the development of a vicious cycle. We examined this in a large study including almost 5000 children aged 2-6 years who participated in a longitudinal study in Rotterdam, the Netherlands. Families were regularly followed up starting in pregnancy. Our main finding was that fussy eating co-exists with functional constipation and also predicts subsequent development of functional constipation. In addition, we also found evidence for the reverse, as functional constipation predicted subsequent fussy eating behavior. Together with previous studies, our findings suggest that indeed a vicious cycle may develop throughout childhood in which children’s constipation problems and problematic eating behavior mutually affect each other. On the one hand, fussy eating might affect the development of functional constipation via poor dietary quality which is a characteristic for the diet of fussy eaters. On the other hand, our findings show that functional constipation in also predicts future fussy eating. This pathway is less well studied, but it is conceivable that children with constipation and the accompanying abdominal pain and painful defecation may develop problematic eating behavior. (more…)
Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, NIH / 05.11.2014

MedicalResearch.com Interview with: Anita Kohli, MS, MD Clinician Investigator, Clinical Monitoring Research Program (CMRP) Leidos Biomedical Research, Inc. formerly SAIC-Frederick, Inc. National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? What are the main findings? Dr. Kohli: We previously treated 60 patients with sofosbuvir and ribavirin for 24 weeks. Patients who relapsed after treatment were offered re-treatment with another regimen of directly acting antivirals alone. 13 patients who relapsed were treated with sofosbuvir and ledipasvir for 12 weeks. All patients achieved SVR12. This is the first report of re-treating patients who failed a regimen including sofosbuvir with another regimen incorporating this same antiviral. (more…)
AHA Journals, Author Interviews, Heart Disease / 05.11.2014

MedicalResearch.com Interview with: Dr. Bilal Iqbal MD Royal Brompton and Harefield NHS Foundation Trust Harefield Hospital Middlesex United Kingdom. Medical Research: What is the background for this study? What are the main findings? Dr. Iqbal: The optimal strategy for revascularization of bystander coronary disease at the time of PPCI is unknown. Certainly, this has been the focus of recent debate and randomized controlled trials. We evaluated a strategy of culprit vessel versus multivessel intervention at the time PPCI in the real world setting. We conducted an observational analysis of 3984 consecutive patients with STEMI undergoing Primary percutaneous coronary intervention (PPCI) who had multivessel disease. We excluded patients with cardiogenic shock and patients with bystander LMS disease, which may potentially dictate staged surgical intervention. When analysing all-cause mortality at 1 year, we found that a strategy of culprit vessel intervention only at the time of PPCI was associated with increased survival at 1 year. (more…)
Author Interviews, Heart Disease, JAMA / 05.11.2014

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART ProgramMedicalResearch.com Interview with: Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Maddox: Nonobstructive coronary artery disease (CAD) is atherosclerotic plaque that would not be expected to obstruct blood flow or result in anginal symptoms (such as chest pain). Although such lesions are relatively common, occurring in 10 percent to 25 percent of patients undergoing coronary angiography, their presence has been characterized as “insignificant” or “no significant CAD" in the medical literature.  However, this perception of nonobstructive coronary artery disease may be incorrect, because prior studies have noted that the majority of plaque ruptures and resultant myocardial infarctions (MIs; heart attacks) arise from nonobstructive plaques. Despite the prevalence of nonobstructive CAD identified by coronary angiography, little is known about its risk of adverse outcomes, according to background information in the article. During the study period, 37,674 patients underwent elective coronary angiography for indications related to CAD; of those, 22.3 percent had nonobstructive CAD and 55.4 percent had obstructive CAD.  Within 1 year, 845 patients died and 385 were rehospitalized for myocardial infarction. The researchers found that the 1-year myocardial infarction risk progressively increased by the extent of coronary artery disease, rather than abruptly increasing between nonobstructive and obstructive CAD.  Patients with nonobstructive CAD had an associated risk of MI that was 2-to 4.5-fold greater than among those with no apparent coronary artery disease. Similar observations were seen with 1-year mortality and the combined outcome of 1-year myocardial infarction and death. (more…)
Author Interviews, Emergency Care, PLoS / 05.11.2014

Anna Alassaad Pharmacist, PhD Student, Department of Medical Sciences, Uppsala University Uppsala, Sweden, Uppsala University Hospital, Uppsala, SwedenMedicalResearch.com Interview with: Anna Alassaad Pharmacist, PhD Student, Department of Medical Sciences, Uppsala University Uppsala, Sweden, Uppsala University Hospital, Uppsala, Sweden Medical Research: What is the background for this study? What are the main findings? Response: The main findings from our study are that patients with a low number of prescribed drugs benefited more from a comprehensive clinical pharmacist intervention than patients with a higher number of drugs. There was no difference in effect between the patients with higher and lower levels of inappropriate prescribing, as measured by two validated tools for inappropriate prescribing. Clinical pharmacist interventions have in several studies shown positive effects on inappropriate prescribing and clinical outcomes. Since the concomitant use of a large number of drugs is associated with an increased risk of adverse drug events, it is often assumed that patients receiving a larger number of drugs would benefit most from interventions aiming to improve the quality of drug use. However, differences in the effects of clinical pharmacist intervention between different subgroups of patients have rarely been analyzed. We have, in a randomized controlled trial, previously demonstrated that a clinical pharmacist intervention at an acute internal medicine hospital ward reduces emergency department visits by 47%, revisits to hospital by 16%, and drug-related readmissions by 80% for patients aged 80 years or older. We aimed to investigate whether there was any difference in treatment effect of the clinical pharmacist interventions on number of subsequent revisits to the emergency department between the patients with less than five drugs and those with five or more drugs on admission to hospital. We also explored whether the effect of the intervention was consistent for patients with a high or low level of inappropriate prescribing. (more…)
Author Interviews, JAMA, Pediatrics, Weight Research / 05.11.2014

MedicalResearch.com Interview with: Angela Alberga, PhD Eyes High Postdoctoral Fellow Werklund School of Education University of Calgary Ronald J. Sigal, MD, MPH, FRCPC Professor of Medicine, Kinesiology, Cardiac Sciences and Community Health Sciences Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary Health Senior Scholar, Alberta Innovates-Health Solutions Member, O'Brien Institute of Public Health, Libin Cardiovascular Institute and Julia McFarlane Diabetes Research Centre Medical Research: What are the main findings of the study? Response: The Healthy Eating, Aerobic and Resistance Training in Youth study examined the effects of exercise on body composition and cardiometabolic risk markers in adolescents with obesity. A total of 304 overweight or obese adolescents were randomized to four groups. The first group performed resistance training involving weight machines and some free weights; the second performed only aerobic exercise on treadmills, elliptical machines and stationary bikes; the third underwent combined aerobic and resistance training; and the last group did no exercise training. All four groups received nutritional counseling. In analyses involving all participants regardless of adherence, each exercise program reduced percent body fat, waist circumference and body mass index to a similar extent, while the diet-only control group had no changes in these variables. In participants who exercised at least 2.8 times per week, we found that combined aerobic and resistance training produced greater decreases in percentage body fat, waist circumference, and body mass index than aerobic training alone. Waist circumference decreased close to seven centimeters in adherent participants randomized to combined aerobic plus resistance exercise, versus about four centimeters in those randomized to do just one type of exercise, with no change in those randomized to diet alone. (more…)
Author Interviews, MRSA / 05.11.2014

Melissa Ward PhD CIIE Research Fellow Centre for Immunity, Infection and Evolution University of EdinburghMedicalResearch.com Interview with: Melissa Ward PhD CIIE Research Fellow Centre for Immunity, Infection and Evolution University of Edinburgh   Medical Research: What is the background for this study? What are the main findings? Dr. Ward: We studied a strain of the bacterium Staphylococcus aureus known as CC398, which can colonise and cause MRSA infection in humans and livestock. People and animals generally harbour genetically distinct variants of CC398, but we found human isolates, including a small number from Scottish hospitals, which were more similar to the livestock strains. Such isolates were resistant to a larger number of antibiotics than the CC398 strain which typically circulates in humans. By looking at the genetic sequences of strains from across the globe, we also inferred that CC398 has entered Scotland on multiple occasions. (more…)
Asthma, Author Interviews / 04.11.2014

Robert H. Schiestl, Ph.D. Professor of Pathology, Environmental Health and Radiation Oncology UCLA Schools of Medicine and Public Health Los Angeles, CA 90095MedicalResearch.com Interview with: Robert H. Schiestl, Ph.D. Professor of Pathology, Environmental Health and Radiation Oncology UCLA Schools of Medicine and Public Health Los Angeles, CA 90095 Medical Research: What is the background for this study? What are the main findings? Dr. Schiesti: We studies whether asthma has any effect on peripheral blood and we found that it significantly increased DNA double strand breaks, single strand breaks, oxidative DNA damage, inflammation and oxidative protein damage. (more…)
Author Interviews, CMAJ, Diabetes, Electronic Records / 04.11.2014

Dr. Tim A. Holt PhD MRCP FRCGP NIHR Academic Clinical Lecturer University of Oxford Department of Primary Care Health Sciences Radcliffe Observatory Quarter Woodstock Road OxfordMedicalResearch.com Interview with: Dr. Tim A. Holt PhD MRCP FRCGP NIHR Academic Clinical Lecturer University of Oxford Department of Primary Care Health Sciences Radcliffe Observatory Quarter Woodstock Road Oxford Medical Research: What is the background for this study? Dr. Holt: Undiagnosed diabetes is a serious and very costly problem. Early diagnosis is important to reduce risk of long term complications. A structured approach to management at the practice level involves electronic diabetes registers, enabling audit of care, automated recall, and screen reminders. Such registers depend on the presence of an electronic code for diabetes in the record.  (more…)