MedicalResearch.com Interview with: Sang-Beom Jeon, MD, PhD
From the Department of Neurology
Asan Medical Center
University of Ulsan College of Medicine
Seoul, Republic of Korea.
Medical Research: What are the main findings of the study?Dr. Sang-Beom Jeon: In this MRI study of 825 stroke patients, we demonstrated that high plasma concentrations of homocysteine, also known as hyperhomocysteinemia, were associated with small-vessel disease (lacunar infarcts and leukoaraiosis) and large-vessel atherosclerosis of cerebral arteries.
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MedicalResearch.com Interview with: Dr. Colette Smith: PhDResearch Department of Infection and Population Health
University College London, London, UKMedical Research: What are the main findings of the study?Dr. Smith: We followed a group of approximately 45,000 HIV-positive people from Europe, USA and Australia between 1999 to 2011. We found that the death rate approximately halved over the 12-year study period. For every 1,000 people, around 18 died per year in 1999-2001, reducing to 9 deaths per year in 2009-2011.
We also studied what people died of. We found that the death rate from AIDS and from liver disease decreased by around two-thirds. Deaths from heart disease approximately halved. However, the rate of cancer deaths (excluding cancers that are classified as AIDS events) remained constant over time.
One in three deaths were caused by AIDS in 1999 to 2011, and this decreased to one in five deaths in the last two years of the study. However, even in recent years it was the joint most common cause of death. The proportion of deaths from cancer increased over time. One in ten deaths were from cancer in 1999 to 2001, and this increased to one in five deaths in 2009 to 2011. By the end of the study it was the joint-most common cause of death.
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MedicalResearch.com Interview with: Jared Baeten, MD PhD
Professor, Departments of Global Health and Medicine
Adjunct Professor, Department of Epidemiology
University of Washington
Seattle, WA 98104
Medical Research: What are the main findings of the study?Dr. Baeten: Among heterosexual African couples in which the male was HIV positive and the female was not, receipt of antiretroviral pre-exposure preventive (PrEP) therapy did not result in significant differences in pregnancy incidence, birth outcomes, and infant growth compared to females who received placebo.
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MedicalResearch.com Interview with:Ling Zhao Ph. D.
Associate Professor
College of Acupuncture-Tuina,
Shanghai University of Traditional Chinese Medicine,
China
Medical Research: What are the main findings of the study?Dr. Zhao: In our study, we found that a 6-week course of moxibustion treatment (i.e., a modality of traditional acupuncture using burning moxa to warm and stimulate the acupoint) significantly reduced pain and improved function in patients with knee osteoarthritis compared to a credible placebo control. Our findings suggest that this ancient modality might be a useful adjunctive treatment for knee osteoarthritis. We also found that our sham device is credible for a double-blind randomized clinical trial assessing this traditional treatment modality.
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MedicalResearch.com Interview with: Dennis J. Cotter
President
Medical Technology and Practice Patterns Institute, Inc.
Bethesda, MD 20816
Medical Research: What are the main findings of the study?Answer: This is the first study to document anemia management practice patterns among predialysis CKD patients before and after publication of TREAT. Using a retrospective observational design based on a large US health plan database with over 1.2 million claims for predialysis CKD stage 3 and 4 patients, we report 4 main study findings.
1) For CKD stage 3 patients, the proportion prescribed ESA therapy declined from 17% pre-TREAT to 11% post-TREAT (a 38% decline) and for CKD stage 4 patients, from 34% to 27% (a 22% decline).
2) Prescribing of ESA therapy was declining even before TREAT, but the decline accelerated in the post-TREAT period.
3) ESA prescribing declined after TREAT regardless of anemia status; among patients with hemoglobin <10 g/dL, only 25% of stage 3 and 33% of stage 4 CKD were prescribed ESAs two years after TREAT, a notable 50% decline.
4) After adjusting for all covariates, the probability of prescribing ESAs was 35% less during a two year period after vs. before TREAT publication.
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MedicalResearch.com Interview with: Dr Joshua Thaden MD, PhD
Duke University Division of Infectious Diseases
Durham, North Carolina
Medical Research: What are the main findings of the study?Dr. Thaden:The primary findings of the study are that
The rate of detection of particularly antibiotic resistant bacteria -- the carbapenem-resistant Enterobacteriaceae (CRE) -- has increased 5-fold in a set of community hospitals in the southeastern United States, and that
This increase is due to both changes in how we detect CRE and in increased endemicity (i.e., there are just more CRE around).
MedicalResearch.com Interview with:Pradeep Ramulu
Wilmer Eye Institute at John Hopkins
Baltimore, MD
MedicalResearch What are the main findings of the study?Answer: The main finding is that people with vision loss, especially women and people with other diseases such as diabetes, are much less likely to be working.
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MedicalResearch.com: Interview with:Dr. Wenjun Li , PhD
Health Statistics and Geography Lab
Division of Preventive and Behavioral Medicine
University of Massachusetts Medical School, Worcester.
Medical Research: What are the main findings of the study?Dr. Wenjun Li: Compared to those walking for recreational purposes only, older adults walking for utilitarian purposes had higher risk for outdoor falls and fall-related injuries that require medical attention. (more…)
MedicalResearch.com Interview with:Andrea Bellavia
From the Unit of Nutritional Epidemiology and the Unit of Biostatistics
Institute of Environmental Medicine
Karolinska Institutet, Stockholm, Sweden
Medical Research: What are the main findings of the study?Dr. Bellavia:By evaluating together the consumption of processed and fresh red meat, we observed that processed red meat consumption was associated with shorter life, implying a potential negative effect on health. On the other hand, consumption of only fresh red meat was not associated with either shorter or longer survival. Therefore, the main finding of this work is that the negative effects of red meat consumption might only be due to meat processing, which counteract the positive effects of the beneficial nutrients of meat.
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MedicalResearch.com Interview with: Florien Boel MSc
VU University Medical Center
Department of Medical Psychology
Amsterdam, The Netherlands
Medical Research: What are the main findings of the study?Answer: In postmenopausal breast cancer patients, endocrine therapy is widely used, and often for many years on end. Endocrine therapy is thought to have an effect on cognitive functioning, but previous studies have not yet accounted for the possible influence of the diagnosis of cancer and subsequent anxiety, depression or fatigue on cognitive performance. In addition, the cognitive effects of endocrine therapy after long-term use are still mostly unknown.
Therefore, we compared cognitive functioning of postmenopausal breast cancer patients who underwent surgery and/or radiotherapy (N=43) with the cognitive performance of women who also received adjuvant endocrine therapy (tamoxifen) (N=20) and a group of healthy matched individuals (N=44). In accordance with the literature, we found that especially cognitive domains that rely heavily on verbal abilities (verbal memory and fluency) seem to be at risk for deterioration during long-term treatment (~2.5 years) with tamoxifen.
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MedicalResearch.com Interview with: Charles A. Jennissen, MD
Department of Emergency Medicine
University of Iowa Carver College of Medicine
Iowa City, IA 52242
MedicalResearch: Why did you perform this study? Dr. Jennissen: More youth 15 years and younger in the United States are killed in all-terrain vehicle (ATV) crashes than on bicycles. Since 2001, children represent nearly 30% of all ATV-related injuries and 20% of all ATV-related deaths. Although previous studies have shown children to have high exposure to ATVs, these studies have been mostly limited to select rural and agricultural groups. With this study, we wanted to investigate the epidemiology of ATV use and safety-related behaviors among a large cross-sectional sample of adolescents.
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MedicalResearch.com Interview with: Emmanuel Lagarde
Director of Research at INSERM, France
Medical Research: What are the main findings of the study?Dr. Lagarde:Concussion accounts for more than 90 percent of all traumatic brain injuries, although little is known about prognosis for the injury. The symptoms cited as potentially being part of post concussion syndrome fall into three areas: cognitive, somatic and emotional. But the interpretation of symptoms after concussion should also take into account that injuries are often sustained during psychologically distressing events which can lead to Posttraumatic Stress Disorder.(more…)
MedicalResearch.com Interview with: Dr inz. Joanna Kaluza
Department of Human Nutrition
Warsaw University of Life Sciences - SGGW
Warsaw POLAND
Medical Research: What are the main findings of the study?Response: The most important finding of my study is the fact that processed red meat consumption, but not unprocessed red meat, increases a risk of Heart Failure incidence and Heart Failure mortality.
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MedicalResearch.com Interview with:Professor Jane Armitage
Professor of Clinical Trials and Epidemiology
Clinical Trial Service Unit, Oxford Cardiovascular Science
Oxford, United Kingdom
Medical Research: What are the main findings of the study?Prof. Armitage: The study showed that adding extended release niacin with laropiprant (to reduce the flushing) to standard treatment including statins in people with heart disease or strokes did not improve their outcome or reduce the risk of recurrent heart attacks or strokes.
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MedicalResearch.com Interview with:
Mads E. Jørgensen, M.B.
University of Copenhagen, Denmark
Medical Research: What are the main findings of the study?Answer: We included all patients undergoing non-cardiac surgery in 2005-2011, which were then categorized by time elapsed between stroke and surgery. Patients with a very recent stroke, i.e. less than 3 months prior to surgery, had a significant 14 times higher relative risk of 30-day MACE following surgery, compared with patients without prior stroke. Patients with a more distant stroke had a 2-5 fold higher risk of MACE following surgery, and still significantly higher than risks in patients without prior stroke.
An additional model including time between stroke and surgery as a continuous measure showed a steep decrease in risks of perioperative MACE during the first 9 months. After 9 months, an increase in time between stroke and surgery did not further reduce the risks. The results for 30-day all-cause mortality showed similar patterns, although estimates were not as dramatic as for 30-day MACE.
When analyzing the MACE components individually, we found that recurrent strokes were the main contributor to the high risk of MACE. A history of stroke any time prior to surgery was associated with a 16 fold increased relative risk of recurrent stroke, compared with patients without prior stroke.
We also performed analyses stratified by surgery risk as low- (OR for stroke anytime, 3.97; 95% CI, 2.79-5.66), intermediate- (OR for stroke anytime, 4.46; 95% CI, 2.87-5.13) and high-risk (OR for stroke anytime, 1.98; 95% CI, 1.20-3.27), which were somewhat challenged in power. However, results indicated that stroke associated relative risk was at least as high in low and intermediate-risk surgery as in high risk surgery.
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MedicalResearch.com Interview with: Ben Mead
Molecular Neuroscience Group
Neurotrauma and Neurodegeneration Section
School of Clinical and Experimental Medicine
University of Birmingham, Birmingham
Medical Research: What are the main findings of the study?Answer: Traumatic and neurodegenerative disease of the retina lead to an irreversible loss of retinal ganglion cells (RGC) which are the neuronal cells located in the inner retina that transmit visual signals to the brain. Thus RGC injury results in visual defects which can ultimately progress into permanent blindness. One promising therapeutic approach is the use of stem cells as a source of replacement for lost retinal cells. However a theory has emerged suggesting that stem cells can act through the secretion of signalling molecules (growth factors). One stem cell that has recently shown great promise for neuronal repair are dental pulp stem cells (DPSC), which are multipotent stem cells easily isolated from adult teeth, including third molars (Mead et al 2013, 2014).
In our research, we transplanted either dental pulp stem cells or the more widely studied bone marrow-derived mesenchymal stem cell (BMSC) into the vitreous chamber of the eye after optic nerve crush (Mead et al 2013). The main finding of this study was that DPSC, to a significantly greater degree than BMSC, promoted the survival of injured RGC and the regeneration of their axons. We also showed that the mechanism of action was not through differentiation and replacement of cells but was actually paracrine mediated, i.e. through DPSC-derived growth factors (Mead et al, 2013, 2014).
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MedicalResearch.com Interview with:Grace Lu-Yao PhD, MPH
Professor of Medicine
Robert Wood Johnson Medical School
Rutgers, The State University of New Jersey
Rutgers Cancer Institute of New Jersey
New Brunswick, NJ 08903-2681
Medical Research: What are the main findings of the study?Dr. Lu-Yao:Primary ADT (ie., use of androgen deprivation as an alternative to surgery, radiation or conservative management for the initial management of prostate cancer) is not associated with improved overall or disease specific survival.
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MedicalResearch.com Interview with: John D'Orazio, M.D., Ph.D.
Drury Pediatric Research Endowed Chair
Associate Professor, Univ. KY College of Medicine
Pediatric Hematology-Oncology
The Markey Cancer Center
Lexington, KY 40536-0096
Medical Research: What is the background for this study?Dr. D'Orazio: Malignant melanoma is the deadliest of skin cancers, and it’s incidence has increased enormously over the last several decades. In the 1930’s only one in every fifteen hundred Americans would get melanoma in his/her lifetime. Now it’s one in fifty or sixty. Plus, it often affects young adults in the prime of their lives. Altogether, nearly 10,000 Americans die of melanoma every year. However, risk is not equally shared. Fair-skinned people who tend to burn rather than tan from sun exposure have a much higher risk than dark skinned people. On the surface, it would appear that the amount of melanin in the skin would be the only determinant of melanoma risk but the truth is more complex. Our lab has been interested in a particular hormonal pathway in the skin that directly influences melanoma risk. When UV radiation (sunlight) hits the skin, it causes damage to the cells of the skin. Cells respond to this damage to protect themselves against further injury. One way in which they do this is by turning on a hormone called melanocyte stimulating hormone, abbreviated “MSH”. Made by keratinocytes, the most abundant cells in the epidermis, MSH is directly responsible for ramping up melanin production by melanocytes, the cells that make the pigment in the skin that gives us a tan. This pigment called melanin acts as natural sunscreen and blocks UV radiation from penetrating into the skin. This is very important because people who can tan are in a much safer state the next time they get sun exposure. Because they have more melanin in the skin, the UV won’t cause as much damage. The key is to realize that UV causes mutations in melanocytes, and with enough damage to the DNA, melanocytes can turn cancerous and become melanomas. People who have the melanoma-prone, “can’t tan” skin type often have problems in this MSH hormonal pathway. Specifically, they have inherited problems with the receptor on melanocytes that binds to MSH and makes the cells make more pigment. This protein, called the melanocortin 1 receptor (or “MC1R”), is the way that melanocytes sense that the skin has been injured and needs more melanin. If the MC1R won’t signal, then melanocytes just sit there and can’t be induced to make more melanin pigment. Surely this is a major reason why people with MC1R signaling defects are at high risk of melanomas.
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MedicalResearch.com Interview with Rebecca H. Johnson, MD
Assistant Professor, Clinical Genetics
University of Washington
Seattle, Washington
Medical Research: What are the main findings of the study?Dr. Johnson: We observed that, over the past two decades, there has been an increase in the incidence of testicular cancer in Hispanic American adolescents and young adults (AYAs) between 15 and 39 years of age. This increase is seen in both major subtypes of testicular cancer and affects Hispanic AYA patients with all stages of disease at the time of diagnosis. No comparable increase was observed in non-Hispanic white AYA,s or in older American men regardless of Hispanic ethnicity. Between 1992 and 2010, the incidence of testicular cancer in AYA Hispanics has increased 58% in contrast to just 7% in non-Hispanic white AYAs.
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MedicalResearch.com Interview with: Kurt Kroenke, M.D.
Professor of Medicine, Indiana University School of Medicine
Research Scientist, Indiana University Center for Health Services and Outcomes Research
Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc.
Director of Education and Training Programs, Regenstrief Institute, Inc.
Core Investigator, VA HSR&D Center for Health Information and Communication
Medical Research: What are the main findings of the study?
Dr. Kroenke: The telecare intervention including monitoring of pain using automated phone calls or the Internet with contacts by a nurse care manager who met weekly with a physician pain specialist to discuss treatment of new patients or patients already being followed who were not improving.
Almost twice as many patients in the telecare group had improvement in their pain compared to the usual care control group (52% vs. 27%).
Moreover, nearly twice as many patients in the usual care group got worse over 12 months (36% vs. 19%). Thus, patients with chronic pain may not only fail to improve with current treatment, they in fact can get worse over time.
Although one-third of these chronic pain patients were on opioids at start of study, there were very few patients in which opioids needed to be started or dose increased.
The intervention group was about equally divided between those who chose to do automated symptom monitoring (ASM) by IVR (51%) or internet (49%). The majority of patients rated the monitoring as easy to do, and the telecare intervention helpful.
MedicalResearch.com Interview with: Dr Hallvard Holdaas
Consultant in Nephrology
Department of Transplant Medicine
Oslo University Hospital
Rikshospitalet, Oslo Norway.
Medical Research: What are the main findings of the study?Dr. Holdaas:Most studies examining long-term risk for living kidney donors have included comparators from the background population with hypertension, diabetes mellitus, reduced renal function, cancer and other concomitant diseases; or for the few studies with more “healthy” comparators the follow-up time have been restricted. In our study we compared living donors to a healthy non-donor population which would have qualified as donors themselves, with median follow-up of 15.1 years for the donors. The relative risk for the living donors compared to a healthy control was 11.38 for endstage renal disease (ESRD), 1.4 for cardiovascular death and 1.3 for all-cause mortality (Mjoen et al., 2014).
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MedicalResearch.com Interview with:Paul Kimmel, M.D.
Division of Kidney, Urologic and Hematologic Diseases
National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health
Professor Division of Renal Diseases and Hypertension
The George Washington UniversityMedical Research: What are the main findings of the review?Dr. Kimmel: AKI (Acute Kidney Injury) and CKD (Chronic Kidney Disease), two syndromes approached separately in medical school curricula as well as in the clinical arena are inextricably intertwined. They should be taught as a combined entity, culminating in progressive loss of renal function necessitating renal replacement therapy (dialysis or transplantation).
The two syndromes increase risk for cardiovascular disease and diminished quality of life as well. Preventive and therapeutic strategies should be directed at the combined entity.
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MedicalResearch.com Interview with: Iftikhar J. Kullo, MD
Division of Cardiovascular Diseases
Mayo Clinic Rochester, MN
Medical Research: What are the main findings of the study?Dr. Kullo: The main findings of the study are:
1) Family history of stroke or heart attack is associated with presence of significant narrowing (greater than 70%) of the carotid arteries. These are the arteries that supply blood to the brain and narrowing or blockage of these arteries is associated with increased risk of stroke;
2) Having a sibling history of stroke or heart attack was more strongly associated with narrowing of the carotid artery than having a parent with such history;
3) The greater number of relatives with history of stroke or heart attack, the greater the odds of having narrowing in one of the carotid arteries.
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MedicalResearch.com Interview with: Dr. Kirsty Boyd
Programme theme head (Clinical Communication)
Honorary Clinical Senior Lecturer
Primary Palliative Care Research Group
Division of Community Health Sciences: General Practice
University of Edinburgh
Medical Research: What do we know already about people with ‘multimorbidity’?
Dr. Boyd: We know that an increasing number of patients have multiple life-limiting illnesses or progressively deteriorating health due to several long term conditions or general frailty. Caring for them well poses major challenges and they are often hospitalised in the last year of life. They do not fit well into illness and healthcare models that focus on single conditions. Understanding the experiences of patients and their family caregivers is vital to inform improvements in best supportive care and palliative care. We wanted to build on care models for integrated care of people with long term conditions and consider the needs of those at risk of dying with multiple conditions in more detail. (more…)
MedicalResearch.com Interview with: Jeffrey Allen Kline
Vice Chair of Research
Department of Emergency Medicine
Indiana University Health
Medical Research: What are the main findings of this study?Dr. Kline: We believe that clinicians use information from their patients’ faces to make decisions about diagnostic testing.
This is particularly relevant in emergency medicine, where the clinicians make decisions rapidly with limited information. We videotaped patients’ faces who had chest pain and dyspnea and used the most well-known facial scoring system to assess their facial expression variability in response to seeing visual stimuli. We found that patients who ultimately had emergent problems tended to hold their faces in a neutral position and be less likely to show the expression of surprise. The investigators were not surprised at this, but we did find that patients with emergent problems also tended to have less negative affect as well as less positive affect. In other words, patients who were sickest even tended to frown less than patients with no medical problem.
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MedicalResearch.com Interview with: Alejandro Arrieta, PhD
Assistant Professor
Department of Health Policy and Management
Florida International University
Medical Research: What are the main findings of the study?Dr. Arrieta: We found that it makes business sense for insurance companies to reimburse patients for the cost of blood pressure monitors that they can use at home. In just the first year, we estimate that insurance companies can produce returns that range from $0.85 to $3.75 per dollar invested in blood pressure monitors provided to their members.
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MedicalResearch Interview with: Dr. Lu Wang MD PhD
Associate Epidemiologist, Brigham and Women's Hospital
Assistant Professor of Medicine, Harvard Medical School
Brigham and Women's Hospital
Department of Medicine Preventive Medicine
Boston, MA 02115
Medical Research: What are the main findings of the study?Dr. Wang: We found that vitamin E supplement 400 IU every other day and vitamin C supplement 500 mg daily had no effect on total cancers, the incidence of prostate cancer and other site-specific cancers during periods of intervention, post-trial observation, or overall.
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MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI
Director of Research, Cardiac Catheterization Laboratory
Director, Cardiovascular Outcomes Group
Associate Professor of Medicine,
New York University School of Medcine
Principal Investigator ISCHEMIA-CKD trial
Medical Research: What are the main findings of the study?Dr. Bangalore: Our objective was to evaluate whether non-fasting LDL has similar prognostic significance as that of the conventionally measured fasting LDL values. We found that in an analysis of over 16,000 patients from the National Health and Nutrition Examination Survey that the non-fasting LDL values had similar prognostic significance as that of fasting LDL values for the prediction of long term (up to 14 years) death or cardiovascular death, thus questioning the traditional practice of insisting that patients fast prior to blood draw for a lipid panel. This was also true for other components of the lipid panel including the triglycerides and total cholesterol.
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MedicalResearch.com with:Sandip M. Prasad MD
Assistant Professor
Medical University of South Carolina, Charleston, SC and
Scott E. Eggener, MD
Associate Professor of Surgery
Co-Director, Prostate Cancer Program
Director of Translational and Outcomes Research, Section of Urology
University of Chicago Medical Center, Chicago, IL;
Medical Research: What are the main findings of the study?Answer: Depressed men with a diagnosis of intermediate- or high-risk prostate cancer have worse overall outcomes than those without baseline depression and are less likely to undergo definitive therapy. The difference in overall survival between men with and without a depression diagnosis was independent of prostate cancer treatment type.
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MedicalResearch.com Interview with: Dr Gundula Behrens
Department of Epidemiology and Preventive Medicine
University of Regensburg
Franz-Josef-Strauss-Allee 11
93053 Regensburg, Germany
Medical Research: What are the main findings of the study? Dr Behrens: We studied the relations of obesity and physical activity to the incidence of chronic obstructive pulmonary disease (COPD) among more than 100,000 middle-aged to elderly men and women living in the U.S. People with a large waist circumference (43.5 inches (110 cm) or over in women and 46.5 inches (118 cm) or over in men) had a 72% increased risk of COPD as compared to people with a normal waist circumference. In contrast, individuals who were physically active five times or more per week had a 29% decreased risk of COPD as compared to their physically inactive counter-parts.
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