Medicalresearch.com Interview with:
Mark Rabbat, MD
Assistant Professor of Medicine and Radiology
Division of Cardiology at Loyola University Medical Center
MedicalResearch.com: What are the main findings of this study?
Dr. Rabbat : Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice and is responsible for significant morbidity and mortality. Epidemiologic data suggest that obesity as measured by one’s BMI is a risk factor for Atrial fibrillation. But there is more to the story. What may be even more important than overall BMI is how much fat you have around the heart. There are many individuals who, as measured by their BMI, are not considered obese, but they have high volumes of fat around their heart, which may have been a major cause for their atrial fibrillation. Therefore, simple measures such as BMI may fail to completely inform us of a patient’s true CV risk.
In a previous study we found that epicardial adipose tissue (EAT), or the fat around the heart, has been associated with the presence and severity of AF independent of known risk factors and body mass index (BMI). The inflammatory mediators released from the fat are metabolically active, and may promote fibrosis in adjacent heart muscle. Fibrosis of the left atrium appears to be a hallmark feature of atrial fibrillation and higher amounts of fibrosis are linked to recurrence of atrial fibrillation. New innovations in cardiac magnetic resonance imaging (CMR) allow LA fibrosis and EAT to be precisely quantified. Our current study is the first of its kind to demonstrate the association of EAT volume and extent of LA fibrosis in human AF independent of LA size, BMI, and other AF risk factors.
MedicalResearch.com Interview with:
Bentley Bobrow, MD,
Medical Director
Bureau of Emergency Medicine Services and Trauma System
Arizona Department of Health Services, Phoenix
Professor, University of Arizona
Medical Research: What is the background for this study? What are the main findings?
Dr. Bobrow: Out-of-Hospital Cardiac Arrest is a leading cause of death worldwide. There are nearly half a million EMS-assessed Out-of-Hospital Cardiac Arrest s in the United States annually. Bystander CPR (B-CPR) before arrival of EMS can double or even triple survival from OHCA. Yet it occurs in only 1/3 of cases. Telephone CPR - the provision of B-CPR with a 9-1-1 telecommunicator's instructions - is independently associated with increased rates of Bystander CPR and patient survival and requires almost no capital investment. For this reason, we believe Telephone CPR may be THE most effective and efficient way to move the needle on OHCA survival. In order to achieve this potential, however, EMS systems must adopt the latest guideline recommendations for T-CPR and continuously measure system performance. Very few systems do this. The aim of our project was to do just this at multiple 9-1-1 centers in Arizona. We implemented the guidelines and measured the impact on process metrics and patient outcomes. Our findings confirmed what we expected: a significant increase in the proportion of cases where T-CPR was performed, a significant reduction in time from call-receipt to first bystander chest compression, and, most importantly, significant increases in patient survival and survival with positive neurologic outcome.
MedicalResearch.com Interview with Dr. Peter Mazzone MD, FCCP Regarding CHEST lung cancer experts recent policy statement to CMS Committee on Coverage for Lung Cancer Screening Medical Research: What is the background for this study? What are the main findings? Dr. Mazzone: The National Lung Screening Trial showed that lung cancer screening of a well-defined group, at...
MedicalResearch.com Interview with:
Dr. Grace Hsiao-Wei Lo
Baylor College of Medicine
Assistant Professor, Section of Immunology, Allergy and Rheumatology, Department of Medicine, Baylor College of Medicine
Faculty, Immunology, Allergy, and Rheumatology Section,
Michael E. DeBakey VA Medical Center
Medical Research:What is the background for this study? What are the main findings?
Dr. Hsiao-Wei Lo: Controversy exists regarding whether running is harmful versus beneficial to the knee. There is concern that chronic repetitive loading of the knee could physically damage structures within the knee. Alternatively, runners have a lower body mass index, which we know is protective of knee osteoarthritis. Limitations of prior studies evaluating the relationship between running and osteoarthritis include that they have been small studies and they have focused on those participating in a high level or an elite level of running which may not be very generalizable. Addressing the question of whether running is associated with osteoarthritis is of particular relevance given that recent CDC guidelines recommend that all adults participate in regular physical activity, as there is definitive evidence that increased physical activity is associated with reduced cardiovascular events and mortality.
To address this question, we used data from a multicenter observational study, the Osteoarthritis Initiative (OAI). Of 2,683 participants, 56 percent were female, the mean age was 64.5 and the mean BMI was 28.6. Twenty-nine percent of the participants reported that they ran at some time in their lives.
Patients had knee X-rays, were given symptom assessments, and were asked to complete the Lifetime Physical Activity Questionnaire (LPAQ), identifying the top three most frequently performed physical activities (≥ 10 times in life) they performed at different age ranges throughout their life. Age ranges included 12-18, 19-34, 35-49, and 50 years or older.
Knee X-rays were taken and then scored for evidence of radiographic OA using the Kellgren-Lawrence (KL) grade scale. Participants with KL grades of two or higher were considered as having radiographic OA (ROA). The researchers also measured if participants had frequent knee pain. Researchers considered a participant to have symptomatic OA (SOA) if they had at least one knee with both ROA and frequent knee pain. Anyone with a total knee replacement was classified as having frequent knee pain, ROA and SOA.
After collecting all the data, the researchers reported that runners, regardless of the age when they ran, had a lower prevalence of knee pain, ROA and SOA than non-runners. For people who had run at any time in their lives, 22.8 percent had SOA compared to 29.8 percent of non-runners. People with the lowest BMI scores were the most likely to report being habitual runners. Regular running, even at a non-elite level, not only does not increase the risk of developing knee osteoarthritis but may protect against it, the researchers concluded.
MedicalResearch.com Interview with:
Prof. Francesca Mallamaci
Professor of Nephrology
Head of the Hypertension Unit at the Department of Nephro-Urology, CNR-IBIM Research on Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy
Medical Research: What is the background for this study? What are the main findings?
Dr. Mallamaci: It is well known that physical activity is beneficial both in normal individuals and in patients with heart failure which represent a high risk category of patients. We have scanty information about physical activity in dialysis patients. So the aim of our study was to test the effectiveness of a low-intensity, easy to implement, home exercise program on physical performance in about 300 dialysis patients in a multicenter, randomized, controlled clinical trial (EXCITE, ClinicalTrials.gov NCT01255969). What we found in our study was that dialysis patients who performed exercise improved their physical performance and this was documented by 2 well known and validated performance tests such as the Six Minute Walking Test and the Sit-to-stand-to sit test. We found also that after 2 year follow-up dialysis patients who were in the active exercise arm had a lower rate of hospitalization and a trend to a better survival, compared to dialysis patients in the control arm of the study.
MedicalResearch.com Interview with:
Marie-Christine Aubry, M.D.
Professor of Laboratory Medicine and Pathology
Consultant, Department of Laboratory Medicine and Pathology,
Mayo Clinic in Rochester, Minn.
Medical Research: What is the background for this study? What are the main findings?
Dr. Aubry: Up to 20% of patients will present with multifocal lung cancer or will develop a second lung cancer. The main clinical issue is distinguishing between independent primaries from true intrapulmonary metastases since this distinction will drive the therapy of the patient. Currently no ancillary studies allows for this distinction and the distinction is provider specific based on a combination of clinical, radiologic and pathologic assumptions. Based on our prior research using a method called mate pair sequencing , we observed that the probability of detecting identical chromosomal breakpoints in two unrelated tumors, from 2 different patients was basically zero. Similarly, when assessing different components within a single tumor, we always found identical chromosomal breakpoints between these components. We thus hypothesized that if two tumors within a patient were related, i.e. true metastasis, we should always find a number of identical chromosomal breakpoints between the tumors. And in contrast, if 2 tumors were truly independent primaries, we should not observe any chromosomal breakpoints in common.
We first studied a control group of patients that had
1- a primary lung cancer with a known distant metastasis (usually brain metastasis),
2- two lung cancers of different histologic subtype, adenocarcinoma and squamous cell carcinoma which are accepted as true independent primaries and
3- 1 tumor with different portions of the tumor being analyzed individually and compared as true relatedness.
There were thus a total of 11 pairs of tumors with predetermined status of independent primaries versus relatedness (ie metastasis or same tumor). The mate pair generated data showed a perfect concordance with this status. We then studied 11 pairs of lung tumors of similar histology (2 adenocarcinomas or 2 squamous cell carcinomas). The current gold standard for the distinction between independent primaries and intrapulmonary metastasis relies on a pathologist’s comparative morphologic assessment. In order to strengthen this gold standard, 2 pulmonary pathologists independently made this assessment. Interestingly, the pathologists agreed on the status of independent primaries and intrapulmonary metastasis in 9 (of 11) cases demonstrating the shortcomings of this gold standard. Furthermore, there were discordance between the pathologists’ prediction and the clinicians’ assessment in 3 of the 11 patients and the clinician could not come to a final assessment in 1 patient. The MP data was concordant with the pathology assessment in 8 of these 9 cases, and supported the pathologists’ prediction in 2 (of the 3) discordance with the clinical assumptions.
MedicalResearch.com Interview with:
Weian Zhao PhD
Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine.
Medical Research: What is the background for this study?
Dr. Zhao: Bloodstream infections are a major cause of illness and death. In particular, infections associated with antimicrobial-resistant pathogens are a growing health problem in the U.S. and worldwide. According to the Centers for Disease Control & Prevention, more than 2 million people a year globally get antibiotic-resistant blood infections, with about 23,000 deaths. The extremely high mortality rate for blood infections is due, in part, to the inability to rapidly diagnose and treat patients in the early stages. The present gold standard to detect a blood infections, is a blood culture and it takes 2-5 days for the detection and the identification of the bacteria. Recent molecular diagnosis methods, including polymerase chain reaction, can reduce the assay time to hours but are often not sensitive enough to detect bacteria that occur at low concentrations in blood, as is common in patients with blood infections. Therefore, less expensive and less technically demanding methods are urgently needed for the rapid and sensitive identification of blood infections.
MedicalResearch.com Interview with:with
Stuart M. Sprague, DO, FACP, FASN, FNKF
Chairperson, Division of Nephrology and Hypertension
NorthShore University HealthSystem
Evanston, Illinois 60201
Medical Research: Congratulations, Dr. Sprague, on your presentation of another successful phase 3 clinical trial program at the recently concluded Annual Meeting of the American Society of Nephrology. Your presentation unveiled a new vitamin D repletion therapy that effectively controls secondary hyperparathyroidism in chronic kidney disease. Can you give us a little background for the presented studies?
Dr. Sprague: Thanks! Vitamin D insufficiency is a big problem in chronic kidney decease (or CKD): it afflicts more than 20 million adults in the United States who have stages 1 through 4 CKD. Its prevalence increases with CKD severity and it drives secondary hyperparathyroidism. The studies which I presented evaluated a novel therapy to treat secondary hyperparathyroidism (SHPT) arising from vitamin D insufficiency in patients diagnosed with stage 3 or 4 CKD. This new therapy is a modified-release formulation of calcifediol.
Medical Research: Can you tell us more about vitamin D insufficiency?
Dr. Sprague: Vitamin D insufficiency is a condition in which the body has low vitamin D stores. It is characterized by inadequate blood levels of the vitamin D, known as 25-hydroxyvitamin D. An estimated 70-90% of CKD patients have vitamin D insufficiency, which can lead to SHPT and resultant debilitating bone diseases. Vitamin D insufficiency has also been associated with increased mortality in CKD.
MedicalResearch.com Interview with: Alexander Janke BS School of Medicine at Wayne State University Medical Research: What is the background for this study? What are the main findings? Response: Health insurance by itself does not guarantee quality healthcare; patients need accessible primary care options. Without them, patients newly-enrolled in health insurance may not be able...
MedicalResearch.com Interview with:
Dr. Lars H. Lund
Department of Medicine, Karolinska Institutet
Department of Cardiology, Karolinska University Hospital
Stockholm, Sweden
Medical Research: What is the background for this study?
Dr. Lund: Heart Failure and Preserved Ejection Fraction is common and associated with poor prognosis and there is no therapy.
Beta-blockers reduce mortality in Heart Failure and Preserved Ejection Fraction and we hypothesized that they may be associated with reduced mortality also in Heart Failure and Preserved Ejection Fraction.
MedicalResearch.com Interview with:
Anne Stephenson MD, PhD
Division of Respirology
The Toronto Adult Cystic Fibrosis Centre
St. Michael's Hospital Toronto, ON
Medical Research: What is the background for this study? What are the main findings?
Dr. Stephenson: Cystic Fibrosis is progressive genetic disease that results in very thick secretions in various organs such as the lungs, pancreas, and digestive tract. Over time, these thick secretions damage organs in particular, the lungs, which results in respiratory failure due to recurrent chest infections. Cystic Fibrosis patients are also at high risk for malnutrition due to the inability to absorb food which is associated with poor survival. In the 1960s, people with Cystic Fibrosis died at a very young age and in fact, parents who had a child born with Cystic Fibrosis at that time were told that there was a 50% chance their child would not live to attend kindergarten. Over the last several decades, we have seen a significant increase in the survival of individuals with CF. Individuals born with Cystic Fibrosis today can expect to not only attend kindergarten, but complete high school, perhaps attend college or university, have a career, get married or have children as people are living well into adulthood with this disease. The median age of survival in Cystic Fibrosis today is approximately 50 years of age in Canada which is quite remarkable.
MedicalResearch.com Interview with:
Dr. Abhay Lodha, MBBS, MD, DM, MSC
Assistant Professor, Department of Pediatrics and Community Health Sciences, University of Calgary,
Staff Neonatologist and Clinical Epidemiologist, Section of Neonatology, Alberta Health Services, Chairman, CME
Foothills Medical Centre, Calgary, Alberta, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Lodha: Apneic episodes (cessation of breathing) occur in the premature infants. Caffeine is the most commonly used medication for apnea of prematurity. Normally caffeine started on day 3 of life for apnea. However, there is no strong evidence that starting caffeine on day 1 or 2 life has some extra advantages in premature infants. Our study has a large number of premature infants. Our study determined the association of early initiation of caffeine therapy in very preterm neonates and neonatal outcomes.
The main finding of our study was that early use of caffeine was associated with a reduction in the rate of death or bronchopulmonary dysplasia and patent ductus arteriosus. We did not find any adverse impact on any other outcomes.