Troubling Increase In HIV Infections In MSM
MedicalResearch.com Interview with: Lorena Espinoza Center for Disease Control MedicalResearch: What is the background for this study? What are the main findings? Response: Men...
MedicalResearch.com Interview with: Lorena Espinoza Center for Disease Control MedicalResearch: What is the background for this study? What are the main findings? Response: Men...
MedicalResearch.com Interview with:
Minna Johansson, PhD student
Department of Public Health and Community Medicine, Institute of Medicine
The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Research Unit and Section for General Practice, Vänersborg, Sweden
Medical Research: What is the background for this study? What are the main findings?
Response: The decision to introduce screening for abdominal aortic aneurysms (AAA) was based on four randomised controlled trials from the 1980s and 1990s that showed a 50% relative risk reduction in aneurysm-related mortality. Over the last 15 years Sweden, the UK and the USA have introduced AAA screening programmes.
However, abdominal aortic aneurysms screening does not only have intended benefits but also unintended harms. The most important harm is overdiganosis; i.e. the overdetection of aneurysms that would not have caused symptoms in that man´s remaining life, nor been the cause of his death. In this study, we estimate that 176 of every 10,000 men invited to screening are overdiagnosed as a consequence of screening. These men are unnecessarily turned into patients and may experience appreciable anxiety throughout their remaining lives. Moreover, 37 of these men unnecessarily have preventive surgery and 1.6 of them die as a consequence.
Furthermore, a recent drop in abdominal aortic aneurysms prevalence by over 70% reduces the potential benefits of AAA screening. Unfortunately, the harms are not likely to be reduced by the same rate, thus leading to a worsened benefit:harm ratio. This means that the benefit:harm ratio is likely to be worse in current screening programmes than in the trials on which they were based.
Additionally, it has been proposed to lower the cut-off for the abdominal aortic aneurysms-diagnosis from 30 to 25 mm. Our estimates show that such a change of definition would increase the rate of overdiganosis substantially and further worsen the benefit:harm ratio of abdominal aortic aneurysms screening.
MedicalResearch.com Interview with:
Marc Brisson
Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease
Associate Professor, Université Laval
Medical Research: What is the background for this study? What are the main findings?
Response: Since 2007, 52 countries have implemented human papillomavirus vaccination (HPV) programmes. Two HPV vaccines are currently available worldwide: the bivalent vaccine, which targets HPV types 16 and 18, causing 70-80% of cervical cancer, and the quadrivalent vaccine, which also targets HPV types 6 and 11, associated with 85-95% of anogenital wart cases. Large international randomised controlled clinical trials have shown both vaccines to be safe, well tolerated and highly efficacious against vaccine-type persistent infections and precancerous cervical lesions. Furthermore, both vaccines have shown some level of cross-protection against 3 HPV types (HPV 31, 33 and 45) not included in the vaccine and associated with a supplementary 10-15% of cervical cancers worldwide. Now that 7 years have elapsed since the implementation of the first HPV vaccination program, we verified whether the promising results from clinical trials are materialising at the population level. We conducted a meta-analysis to examine the population-level impact in countries that have introduced HPV vaccination programs.
In countries with high female vaccination coverage (<50%), our main findings indicate:
MedicalResearch.com Interview with:
Anita Kozyrskyj Ph.D
Professor, Department of Pediatrics
University of Alberta
Medical Research: What is the background for this study? What are the main findings?
Prof. Kozyrskyj: Our study determined what "good" gut bacteria were present in 166 full-term infants enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) Study. Funded by CIHR and AllerGen NCE, this landmark study involves more than 3,500 families and their newborn infants across Canada. Gut bacteria were identified by DNA sequences extracted from infant poop.
Infants with a fewer number of different bacteria in their gut at 3 months of age were more likely to become sensitized to foods such as milk, egg or peanut, by the time they were 1 years old. Infants who developed food sensitization also had altered levels of two specific types of bacteria, Enterobacteriaceae and Bacteroidaceae, compared to infants who didn’t.
MedicalResearch.com Interview with:
Halle C.F. Moore, M.D.
Cleveland Clinic Foundation
Taussig Cancer Institute
Cleveland, OH 44195
Medical Research: What is the background for this study? What are the main findings?
Dr. Moore: Ovarian failure is a common long-term side effect of chemotherapy. Previous studies investigating whether suppressing ovarian function during chemotherapy treatment will preserve ovarian function following chemotherapy have had mixed results. Our study found that suppressing the ovaries with the GnRH analog goserelin during chemotherapy treatment for early stage ER-negative breast cancer resulted in a reduced risk of ovarian failure two years after initiation of treatment.
Also, more women who received the goserelin with chemotherapy became pregnant than women who received chemotherapy without goserelin.
In addition, there was an apparent improvement in survival among the goserelin group, confirming the safety of this approach in this patient population.
MedicalResearch.com Interview with:
Courtney Benjamin Wolk, Ph.D.
Postdoctoral Researcher
Center for Mental Health Policy and Services Research
Perelman School of Medicine Department of Psychiatry
University of Pennsylvania Philadelphia, PA 19104
Medical Research: What is the background for this study? What are the main findings?
Response: Previous research investigating the relationship between anxiety and suicidality has been mixed. An ongoing question in the field has been whether anxiety disorders independently increase risk for suicidal ideation and behavior or if the high co-occurrence of anxiety and mood symptoms or other shared demographic factors are driving relationships that have been observed between anxiety and suicidality.
We examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts 7 to 19 years after treatment with cognitive-behavioral therapy, more commonly referred to as CBT. Our results indicated that participants who responded favorably to cognitive-behavioral therapy during childhood had lower rates of lifetime, past month, and past two-week suicidal ideation endorsement than treatment non-responders. This was the case across both self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, though plans and attempts were infrequently endorsed in our sample, limiting the ability to detect findings.
MedicalResearch.com Interview with:
Fernando Pardo-Manuel De Villena, PhD
Professor and Associate Chair for Research
Department of Genetics
School of Medicine
University of North Carolina at Chapel Hill
Medical Research: What is the background for this study? What are the main findings?
Response: We set out to identify mutations that affect diseases through changes in gene expression. Our first major finding is that some mouse populations such as the Collabaorative Cross are exceptionally good models to achieve this goal.
We also wanted to sort out an ongoing controversy about the number, location and type of genes that are differentially expressed when you inherit them from your mom or your dad (so called imprinted genes). We conclude that to some extent both sides were right; there are only a limited number of imprinted genes in the classical sense but there are also hundreds or thousands of genes that are preferentially expressed from the father.
MedicalResearch.com Interview with:
Dr. Richard H. Myers Ph.D.
Department of Neurology and Genome Science Institute
Boston University School of Medicine, Boston, MA
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Myers: Andy Hoss, who is a graduate student in my group is the primary investigator for this project.
We are investigating changes that occur in the brain of individuals who had Huntington's disease. We were focused on studying regulatory mechanisms that control the levels of messenger RNAs (mRNAs) in the brain, since that is an area that has been implicated in this disease.
MicroRNAs (miRNAs) are known to target mRNAs for degradation or to be sequestered for storage and later use.
A few limited studies of microRNAs had been done, but we sought to measure the levels of all of the miRNAs present in the brains of persons with Huntington's disease and in controls using next-generation sequencing.
MedicalResearch.com Interview with: Yaron Arbel, M.D. Department of Cardiology Tel Aviv Medical Center Medical Research: What is the background for this study? What are...
MedicalResearch.com Interview with:
Dr. Michael Farzan PhD
Vice Chairman
Department of Immunology and Microbial Science
Florida Campus
The Scripps Research Institute
Medical Research: What is the background for this study?
Dr. Farzan: The key points are that HIV-1 needs two receptors – CD4 and CCR5 – to infect cells. CD4’s primary job is to initially bind the viral entry protein, which upon CD4 binding, uncloaks its CCR5 binding site. A number of years ago we observed that CCR5 had an unusual modification that was really important to HIV-1. We later showed that antibodies – protein your body makes to protect from pathogens – mimics CCR5 by incorporating this modification. We develop a peptide from one of these antibodies that mimics CCR5.
Medical Research: What are the main findings?
Dr. Farzan: By combined a soluble form of CD4 with this CCR5-mimicking peptide, we created a protein that neutralizes all HIV-1 isolates tested, including the hardest-to-stop viruses, as well as distantly related viruses found in monkeys. It does so better than the best HIV-1 antibodies. We expressed this protein using a commonly used gene-therapy vector, and showed that after a one-time inoculation we could protect from doses much higher than most humans are likely to see, and we did so 34 weeks after the inoculation.
MedicalResearch.com Interview with:
Linda Chin, MD
Department Chair, Department of Genomic Medicine, Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Houston, TX
Medical Research: What is the background for this study? What are the main findings?
Dr. Chin: BRAF inhibitors have worked very well against melanoma in the clinic, but when the tumors relapse on treatment, it is not always clear what causes it. Without this information, it can be difficult for doctors to identify specific second-line therapies likely to overcome the drug resistance. In this study, we used both mouse and patient melanoma samples to identify patterns of selected protein levels that can categorize modes of drug resistance when other assays such as DNA sequencing are uninformative. We hope that this information can provide missing clues for clinicians.
Prof. Dr. med. Paul Erne
AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute
University of Zurich
Department of Cardiology
Clinic St. Anna, Lucerne and University Hospital Zurich
Zurich, Switzerland
MedicalResearch: What is the background for this study? What are the main findings?
Prof. Erne: Very little is known on this important subgroup of patients with Acute Coronary Syndrome (ACS) at admission who for various reasons receive restricted or palliative treatment only. Reasons for withholding comprehensive and/or invasive therapy may be the very limited life expectancy, advanced age or severe comorbidities. These patients are not represented in prospective trials and often not included in outcome statistics and registries.
This study provides evidence that the population which received palliative therapy is older and sicker when compared to patients who underwent conservative or reperfusion treatment. However, this study shows that these decisions are very individually addressed. Acute Coronary Syndrome patients treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. Changes of treatment decisions over time and the proportion of patients surviving 1 year suggest in part non homogenous and potentially questionable decision criteria. While refraining from more active therapy may be the most humane and appropriate approach in many patients, in others it represents under treatment.
MedicalResearch.com Interview with Irene Shui ScD MPH Staff Scientist Fred Hutchinson Cancer Research Center Seattle, WA 98109 MedicalResearch: What is the background for this study?...
MedicalResearch.com Interview with:
Professor Andrew W. Munro FRSC FSB
Professor of Molecular Enzymology
Manchester Institute of Biotechnology
Faculty of Life Sciences University of Manchester
Manchester UK
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Munro: Statins are blockbuster drugs that inhibit the key enzyme in cholesterol synthesis: 3-beta-hydroxymethylglutaryl CoA reductase (HMG-CoA reductase), which catalyzes the rate-limiting step in the biosynthesis of cholesterol. As a consequence, statin drugs reduce levels of low-density lipoprotein (LDL-) cholesterol, are effective against hypercholesterolemia and reduce the risk of atherosclerosis and heart attack. One of the major statin drugs is pravastatin, which is derived from a fungal natural product called compactin. The process of conversion of compactin into pravastatin involves the use of an oxygen-inserting enzyme called a cytochrome P450 (or P450), which catalyzes the hydroxylation of compactin to form pravastatin. In order to produce a more cost-efficient and streamlined route to pravastatin production, our teams from the University of Manchester (UK) and DSM (Delft, The Netherlands) developed a single-step process for pravastatin production. This process involved harnessing the productive efficiency of an industrial strain of the beta-lactam (penicillin-type) antibiotic producing fungus Penicillium chrysogenum. The beta-lactam antibiotic genes were deleted from this organism, and replaced by those encoding for compactin biosynthesis (transferred from a different Penicillium species). This led to high level production of compactin, but also to substantial formation of a partially degraded (deacylated) form. To get around this problem and in order to further improve compactin production, the enzyme responsible for the deacylation (an esterase) was identified and the gene encoding this activity was deleted from the production strain. The final stages of development of the novel, one-step pravastatin production process involved the identification of a suitable P450 enzyme that could catalyze the required hydroxylation of compactin. A bacterial P450 was identified that catalyzed hydroxylation at the correct position on the compactin molecule. However, the stereoselectivity of the reaction was in favour of the incorrect isomer – forming predominantly epi-pravastatin over the desired pravastatin. This was addressed by mutagenesis of the P450 – ultimately leading to a variant (named P450Prava) that hydroxylated compactin with the required stereoselectivity to make pravastatin in large amounts. Determination of the structure of P450Prava in both the substrate-free and compactin-bound forms revealed the conformational changes that underpinned the conversion of the P450 enzyme to a pravastatin synthase. The expression of P450Prava in a compactin-producing strain of P. chrysogenum enabled pravastatin production at over 6 g/L in a fed-batch fermentation process, facilitating an efficient, single-step route to high yield generation of pravastatin.
MedicalResearch.com Interview with:
Dr. Yang Lu Ph.D
Los Angeles Biomedical Research Institute
Dr. Lu’s research interests include utilization, cost and treatment regimen adherence of chronic conditions, such as obesity and diabetes; behavioral economic
interventions, and cost effectiveness studies
MedicalResearch: What is the background for this study?
Response: Non-adherence is a serious issue in type 1 diabetes management. It leads to
poor glycemic control and peaks in adolescence and young adulthood. Peer
support is critical for young patients yet few studies examined whether
pairing youth with slightly older and more experienced peers with diabetes
improves their diabetes self-management and glycemic control.
This study had two aims:
(1) assess whether adolescents (as prospective mentees) and young
adults (as prospective mentors) with diabetes would be interested in peer
mentoring as a way to improve adherence, and
(2) identify contents and delivery modes for a peer mentoring topic from the perspective of patients and their parents. Fifty-four adolescents and 46 young adults with type 1
diabetes were surveyed.
MedicalResearch.com Interview with:
Julie M. Zito, PhD
Professor of Pharmacy and Psychiatry
Department of Pharmaceutical Health Services Research
University of Maryland School of Pharmacy
Baltimore, MD 21201
MedicalResearch: What is the background for this study?
Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with Atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’.
MedicalResearch: What are the main findings?
Dr. Zito: The continued expansion in Atypical antipsychotics use for behavioral conditions, particularly in poor and foster care youth prompted several government reports asking states to implement oversight programs. In our survey of state Medicaid agencies, we identified programs implementing a new and promising approach to increase the likelihood that these medications are used appropriately. These ‘peer review’ programs have been launched in 15 of the 31 prior authorization state Medicaid programs. There is a distinct advantage in having a qualified peer review, on a case-by-case basis, of the rationale for use of an atypical antipsychotic in a condition or age group that is ‘off-label’ according to the FDA product information label.
MedicalResearch.com Interview with:
Anestis Dougkas, MSc, PhD
Food for Health Science Centre
Lund University Lund, Sweden
MedicalResearch: What is the background for this study?
Dr. Dougkas: There has been an increased interest in the macronutrient profile of diets and meals as a factor that influences appetite. Dietary protein is considered as the most satiating macronutrient, yet there is little evidence on whether the effects observed are attributed to the protein or to the concomitant manipulation of carbohydrates and fat. The aim was to examine the effect of consumption of beverages varying in macronutrient content on appetite ratings, energy intake and appetite-regulating hormones.
MedicalResearch: What are the main findings?
Dr. Dougkas: Increased protein content suppressed more average appetite than carbohydrate and fat with a more pronounced effect of protein intake on subjective ratings of prospective consumption. Protein was also the most influential macronutrient for postprandial glucagon like peptide-1 (GLP-1, an appetite- suppressing hormone) response. This appetite-suppressing effect of protein was independent of the changes in fat and carbohydrates.
MedicalResearch.com Interview with: Dr. David T. Hsu Ph.D Department of Psychiatry, Stony Brook University, Stony Brook, NY Department of Psychiatry The Molecular & Behavioral...
MedicalResearch.com Interview with:
Mallika L. Mendu, MD, MBA
Division of Renal Medicine
Brigham and Women’s Hospital, Harvard Medical School
Boston, MA
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Mendu: Chronic kidney disease affects a significant number of adults in the United States, approximately 13%, and is associated with significant morbidity, mortality and cost. We conducted a review of 1487 patients referred for initial evaluation of chronic kidney disease to two academic medical centers in Boston over a 3-year period, and examined how often laboratory and imaging tests were ordered and how often these tests affected diagnosis and/or management. The main finding was that a number of tests (renal ultrasound, paraprotein testing, serologic testing) were commonly ordered despite low diagnostic and management yield. Urine quantification and hemoglobin A1c testing had the highest diagnostic and management yield.
MedicalResearch.com Interview with: Dr. Alex Johnstone PhD Rowett Institute of Nutrition and Health Aberdeen Medical Research: What is the background for this study? Response: Previous...
MedicalResearch.com Interview with: Antti Saari, M.D. Department of Pediatrics University of Eastern Finland and Kuopio University Hospital Kuopio Finland MedicalResearch: What is the background for...