27 Oct Powerpoint of This Week’s Exclusive Medical Research Interviews
Posted at 23:54h
in Author Interviews
MedicalResearch.com Interview with:
Raquel C. Gardner, MD, Research Fellow
San Francisco VA Medical Center
Clinical Instructor
Memory and Aging Center, Department of Neurology
University of California, San Francisco
Medical Research: What are the main findings of the study?
Dr. Gardner: We found that people who experience a traumatic brain injury (TBI )when they are 55 or older have a 26% higher chance of getting dementia over the next 5 to 7 years compared to people who experience bodily trauma.
MedicalResearch.com Interview with:
Brian H. Rowe, MD, MSc, CCFP(EM), FCCP
Tier I Canada Research Chair in Evidence-based Emergency Medicine
Scientific Director, Emergency Strategic Clinical Network
Professor, Department of Emergency Medicine
University of Alberta
Medical Research: What is the background for this study? What are the main findings?
Dr. Rowe: The study was designed to evaluate non-pharmacological issues associated with relapse following discharge from the emergency department with acute asthma. Many years of high-quality research have shown that systemic and inhaled corticosteroids (ICS) in combination are required to reduce relapse. In this study all patients received systemic corticosteroids and the majority received inhaled corticosteroids (either as mono-therapy or in combination with long-acting beta-agonists {LABA}).
This study design permitted us to evaluate other factors associated with relapse as a guide for clinicians to use in planning discharge.
The main findings include identifying the key factors independently associated with relapse: female sex (OR = 1.9; 95% confidence interval [CI]: 1.2, 3.0), symptom duration of > 24 hours prior to emergency department visit (OR = 1.7; 95% CI: 1.3, 2.3), ever using oral corticosteroids (OR = 1.5; 95% CI: 1.1, 2.0), current use of an ICS/LABA combination product (OR = 1.9; 95% CI: 1.1, 3.2), and owning a spacer device (OR = 1.6; 95% CI: 1.3, 1.9).
MedicalResearch.com Interview with:
Dr. Sunni Mumford PhD
Earl Stadtman Investigator in the DESPR Epidemiology Branch
Eunice Kennedy Shriver National Institute of Health and Human Development
Medical Research: What are the main findings of the study?
Dr. Mumford: Depressive symptoms in healthy women who don’t have diagnosed clinical depression isn’t related to reproductive hormone levels, like estrogen, or impaired ovulation.
Medical Research: What was most surprising about the results?
Dr. Mumford: Earlier research indicates that changes in estrogen may be associated with depression, for instance during the menopausal transition. Our study identified significant associations between estrogen and depressive symptoms in models that didn’t account for confounding factors, but this relationship was completed eliminated when adjustments were made for common confounding factors like age, race, BMI, and also stress level in these premenopausal women. Another interesting finding was that a score describing mood-related menstrual symptoms indicated that such symptoms are highest in the premenstrual phase, but remain lower throughout the rest of women’s cycles. This tells us that altered mood symptoms are most frequent prior to menstruation.
MedicalResearch.com: Interview with:
Dr. Simon Corrie PhD
The University of Queensland, Australian Institute for Bioengineering and Nanotechnology, Delivery of Drugs and Genes Group
Australian Infectious Diseases Research Centre, St. Lucia, Queensland, Australia
Medical Research: What is the background for this study? What are the main findings?
Dr. Corrie: P. falciparum malaria is a major cause of morbidity and mortality around the world, particularly in developing countries. Some estimates also suggest that in developing countries, children under 5 account for ~90% mortality. As malaria is treatable, positive detection is important rule out other causes, avoid over-treatment leading to resistance, and to guide appropriate treatment. Our focus is on developing diagnostic devices for infectious diseases, which do not require needles, lancets or laboratory processing.
These devices are “microprojection arrays”, silicon chips that can be applied to the skin to capture circulating protein biomarkers in the interstitial fluid of the skin. In this publication we:
(a) developed methods to improve the sensitivity of the devices for capturing HRP2,
(b) confirmed that HRP2 protein injected intravenously is detectable in skin fluid and
(c) showed that we could capture both HRP2 and total IgG (as a positive control for penetration into skin) at the same time.
MedicalResearch.com Interview with:
Prof. Zvi Laron
Professor Emeritus of Pediatric Endocrinology
TAU's Sackler Faculty of Medicine,
Director of the Endocrinology and Diabetes Research Unit
Schneider Children's Medical Center of Israel
Head WHO Collaborating Center for the Study of Diabetes in Youth
Medical Research: What are the main findings of the study? What was most surprising about results?
Prof. Laron: The main findings were the finding of specific antibodies to the pancreatic insulin secreting beta cells together with antibodies against rota-virus in both the mother at delivery and in the newborn's cord blood. We were not surprised, but pleased to find proof to our hypothesis that part, if not the majority of childhood onset Type 1 (autoimmune diabetes) starts "in utero".
MedicalResearch.com Interview with:
Dr. Christine Marie Veenstra MD
Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery
Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team
University of Michigan, Ann Arbor
Medical Research: What is the background for this study?
Dr. Veenstra: Nearly 50,000 patients are diagnosed with stage III colorectal cancer each year. Chemotherapy is known to increase survival by up to 20% and is the standard recommendation for these patients after surgery. However, use of chemotherapy may be associated with financial strain.
In order to better understand the financial burden and worry associated with colorectal cancer treatment, we surveyed 956 patients being treated for stage III colorectal cancer. We asked patients to answer questions about financial burden such as whether they had used savings, borrowed money, skipped credit card payments, or cut back on spending for food, clothing or recreational activities because of their cancer treatment. We also asked patients how much they worry about financial problems because of their cancer or its treatment.
MedicalResearch.com Interview with:
Dr R.E.W. (Bob) Hancock, OC, OBC, FRSC
{Canada Research Chair and Professor, Department of Microbiology and Immunology,UBC}
Director, Centre for Microbial Diseases and Immunity Research
University of British Columbia,
Vancouver, British Columbia, Canada
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Hancock: We wanted to understand how patients transitioned from the hyperinflammatory phase (cytokine storm) of sepsis to the hypoinflammatory (immunosuppressive) phase of sepsis (inability to respond appropriately to infections). About 15% of patients die in this first phase and 20% in the second phase, making sepsis one of the most deadly syndromes (35% overall mortality, 5 million deaths [8.3% of all deaths] annually worldwide). We hypothesized that immunosuppression was characterized by a state termed endotoxin tolerance a cellular amnesia (termed cellular reprogramming) in which cells fail to respond to microbial cues.
Overall we found that an Endotoxin Tolerance gene signature is significantly associated with the subsequent development of confirmed sepsis and new organ dysfunction in patients who had suspected sepsis. All 620 sepsis patients in retrospective and new analyses presented with an expression profile strongly associated with the endotoxin tolerance signature (p<0.01; AUC 96.1%). This occurred in fact very early in sepsis and in a new clinical study we found that the signature could be detected already in the emergency ward at first clinical presentation and 24-48 hours prior to definitive diagnosis. Importantly, this signature further differentiated between suspected sepsis patients who did, or did not, go on to develop confirmed sepsis, and predicted the development of organ dysfunction.
MedicalResearch.com Interview with:
A/Prof Dominique Cadilhac, MPH PhD
Head: Translational Public Health Division
Stroke and Ageing Research Centre (STARC)
Department of Medicine,
School of Clinical Sciences at Monash Health, Monash University
Melbourne, Australia
Medical Research: What are the main findings of the study?
Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH).
243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on.
The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]).
The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because
a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and
b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event.
MedicalResearch.com Interview with:
Dr. Toomas Kivsild PhD
Department of Archaeology and Anthropology
University of Cambridge, Cambridge
Medical Research: What is the background for this study? What are the main findings?
Dr. Kivsild: Native populations of Siberia are known to have certain physiological
characteristics such as high basal metabolic
rate, and high blood pressure and low levels of serum lipids, that have
been explained as traits that have evolved
as a consequence of the adaptation of Siberians to their cold
environment. Genetic basis of cold adaptation is still poorly understood.
In our previous study using genome-wide genotyping scans we detected a 3
Mbp region of high haplotype homozygosity in chromosome 11 as a
candidate of strong positive selection in Northeast Siberians.
There were 79 protein coding genes mapping to this homozygosity region
but we could not determine which of the genes
was driving the signal we observed.
In this forthcoming paper we have used high coverage whole genome
sequences from 25 individuals from Northeast Siberia and we were able
to determine the most likely SNP that is responsible for the high
haplotype homozygosity in the chromosome 11 in Northeast Siberians maps
to CPT1A gene which is a key regulator of long-chain fatty-acid
oxidation in mitochondria. What makes this finding most interesting is
that the same SNP had previously been found in Greenland and Canadian
Inuits in association with high infant mortality and hypoketotic
hypoglycemia. There are only a few other similar cases, like the sickle
cell and APOL1 alleles, where disease associated genetic variants may
have risen to high frequency in modern day populations due to the
adaptive advantage they have presented in the past populations.
MedicalResearch.com Interview with:
Professor Pranas Serpytis
Vilnius University Hospital Santariskiu Clinic
Vilnius, Lithuania
Medical Research: What are the main findings of the study?
Professor Serpytis: The main findings of the study were that women are more likely to develop anxiety and depression after acute myocardial infarction. In our study depression was assessed by HADS scale: no depression (0-7 score), possible depression (8-10 score), definite depression (11+ score). The mean score of assessing depression were 6.87 (± 4.6) among men and 8.66 (± 3.7) among women (p <.05). Cardiovascular disease risk factors such as smoking increases patients anxiety levels, and low physical activity is associated with an increased risk to suffer from depression.
Louise-Anne McNutt, PhD
Associate Director, Institute for Health and the Environment
University at Albany, State University of New York
Jessica Nadeau, PhD
Epidemiologist, University at Albany, State University of New York
Medical Research: What are the main findings of the study?
Response: The study found that about 25% of infants consistently deviated from the routine vaccine schedule recommended by the American Academy of Pediatrics (AAP). Alterations included either consistently refusing a recommended vaccine or reducing the number of vaccines given at each visit.
These deviations are generally associated with intent to use an alternative vaccination schedule.
Infants who did not follow the AAP recommended schedule were more likely to be unprotected against vaccine preventable diseases for a longer period of time. Only 1 in10 infants vaccinated on an alternative schedule were up-to-date at 9 months of age.
MedicalResearch.com Interview with:
Dr. Steffie Woolhandler MD MPH
Professor of Public Health and City University of
New York, Lecturer (formerly Professor of
Medicine) at Harvard Medical School
Primary Care Physician Practicing in the South Bronx
Medical Research: What is the background for this study?
Dr. Woolhandler: Physicians like myself are extremely frustrated
by the administrative burdens of medical
practice. Many hours of physicians’ time each
week go to administrative work completely
unrelated to good patient care, but mandated by
private insurers and other payers. Colleagues
often tell me that they love seeing patients but
are getting burned out by the paperwork.
MedicalResearch.com Interview with:
Glenn T. Konopaske, MD
McLean Hospital, Belmont, Massachusetts
Department of Psychiatry, Harvard Medical School
Boston, Massachusetts
Medical Research: What are the main findings of the study?
Dr. Konopaske: Using postmortem human brain tissue this study did reconstructions of basilar dendrites localized to pyramidal cells in the deep layer III of the dorsolateral prefrontal cortex. Tissue from individuals with schizophrenia, bipolar disorder or controls was examined. Dendritic spine density (number of spines per μm dendrite) was significantly reduced in bipolar disorder and also reduced in schizophrenia at a trend level. The number of dendritic spines per dendrite and dendrite length were significantly reduced in subjects with schizophrenia and bipolar disorder.
MedicalResearch.com Interview with:
Nandita Bhan, ScD MSc MA
Research Scientist & Adjunct Assistant Professor
Public Health Foundation of India (PHFI)
Medical Research: What are the main findings of the study?
Dr. Bhan: We found that the last decade in the US has seen a rise in racial/ethnic disparities in asthma. Compared to Non-Hispanic White populations, greater rates of asthma were seen among African Americans and lower rates among Hispanic populations. But more importantly, we found that it is not just a question of who you are, but where you live. Results showed heterogeneity by region and place of origin - highlighting that it will be simplistic to assume that asthma rates for Hispanic populations are the same across all states in the US.
While data is unable to explore further granularity by ethnicity, our results add to the developing evidence that state policies and politics have impacts on socioeconomic and racial/ethnic inequalities manifesting in health disparities in the US.
MedicalResearch.com Interview Invitation
Dr Ken Ong, Programme Leader & Paediatric Endocrinologist
MRC Epidemiology Unit, University of Cambridge
Box 285 Institute of Metabolic Science
Cambridge Biomedical Campus, Cambridge
Medical Research: What are the main findings of this report?
Dr. Ong: We found that genetic factors that predict adult obesity were associated with faster weight gain and growth during infancy – the findings indicate that the biological mechanisms that predispose to later obesity are already active from birth.
MedicalResearch.com Interview with:
Karl Ole Köhler, Research assistant
Department of Clinical Medicine
The Department of General Psychiatry
Aarhus University
Medical Research: What are the main findings of the study?
Response: We found that anti-inflammatory drugs and ordinary analgesics, which mainly are used against physical disorders, may have treatment effects against depression when used in combination with antidepressants. Thereby, our results furthermore support the hypothesis regarding a comorbidity between inflammatory diseases and depression, i.e. a connection between somatic and mental disorders.
MedicalResearch.com Interview with:
Mary Ann Honors, Ph.D.
Postdoctoral Research Fellow
Division of Epidemiology and Community Health
University of Minnesota
Medical Research: What are the main findings of the study?
Dr. Honors: The American Heart Association and USDA have made recommendations on what we should and should not eat in order in reduce our cardiovascular disease risk. We wanted to know whether Americans are currently meeting these recommendations, as well as how our diets have changed over time. In particular, we were interested in several specific nutrients, including trans fats, saturated fats, and the omega-3 fatty acids, DHA and EPA. We examined trends in fatty acid intake in participants from the Minnesota Heart Survey. The Minnesota Heart Survey is a an ongoing, cross-sectional study of adults in the Minneapolis-St. Paul metro area that was designed to monitor cardiovascular disease risk factors, including diet.
We found that intake of trans fats and saturated fats has declined substantially over the last 30 years. However, intake levels are still above current recommendations. With DHA and EPA, we found that levels of intake were pretty steady over time and below what is recommended. Overall, while we saw some encourage trends, there is still some room for improvement in our diets.
MedicalResearch.com Interview Invitation
Julian Walters
Professor of Gastroenterology
Section of Hepatology & Gastroenterology | Imperial College London
Consultant Gastroenterologist
Imperial College Healthcare Hammersmith Hospital
London W12 0HS | UK
Medical Research: What is the background for this study? What is Bile acid diarrhoea (BAD)?
Dr. Walters: Bile acid diarrhoea accounts for about a third of the patients who would otherwise be diagnosed as IBS-D (irritable bowel syndrome – diarrhoea predominant). We estimate about 1% of the adult population have this primary disorder; others may have it secondary to previous surgery such as ileal resection in Crohn’s disease or post-cholecystectomy. There are unmet needs to improve diagnosis rates and to improve the current treatment with bile acid sequestrants which can be poorly tolerated and do not address the primary pathology. We have shown that primary BAD patients have reduced levels of Fibroblast Growth Factor 19 (FGF19) the ileal hormone that regulates bile acid synthesis.
MedicalResearch.com Interview with
Dr. Michelle Lent PhD
Geisinger Health System
Medical Research: What is the background for this study?
Dr. Lent: Previous study findings indicate that weight bias relates to a number of adverse outcomes in overweight and obese populations, including binge eating, psychological disorders and body image issues. In this study, we measured the degree to which people undergoing weight-loss surgery translate “anti-fat” attitudes into negative beliefs about themselves before surgery (known as “internalized weight bias”) and if this influences weight loss outcomes after surgery.
MedicalResearch.com: Interview
Barbara J. Drew, RN, PhD, FAAN, FAHA
David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology
University of California, San Francisco (UCSF)
Department of Physiological Nursing
San Francisco, CA 94143-0610
Medical Research: What is the background for this study?
Dr. Drew: Physiologic monitors used in hospital intensive care units (ICUs) are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue.” Alarm fatigue occurs when clinicians are desensitized by numerous alarms, many of which are false or clinically irrelevant. As a result, the cacophony of alarm sounds becomes “background noise” that is perceived as the normal working environment in the ICU. Importantly, alarms may be silenced at the central station without checking the patient or permanently disabled by clinicians who find the constant audible or textual messages bothersome. Disabling alarms creates an unsafe patient environment because a life-threatening event may be missed in this milieu of sensory overload.
To date, there has not been a comprehensive investigation of the frequency, types, and accuracy of physiologic monitor alarms collected in a “real-world” ICU setting. For this reason, nurse and engineer scientists in the ECG Monitoring Research Laboratory at the University of California, San Francisco (UCSF) designed a study to provide complete data on monitor alarms.
MedicalResearch.com Interview with: Matheus Victorm PhD candidate Dr. Andrew Yoo's Lab Graduate Program in Neuroscience Washington University School of Medicine Medical Research: What is the background for this study? What are the main findings? Answer: We have described a way to convert human skin cells directly into a specific type of brain cell called medium spiny...
MedicalResearch.com Interview with:
Alfredo Falcone MD
Chiara Cremolini Fotios Loupakis
University of Pisa and Azienda-Ospedaliero Universitaria Pisana
Italy
Medical Research: What are the main findings of the study?
Dr. Falcone: In the TRIBE study the main findings are that the use of an initial more intensive therapy with a triplet of cytotoxics (FOLFOXIRI) plus bevacizumab vs a doublet (FOLFIRI) + bevacizumab improves the outcome of metastatic colorectal cancer patients with unresectable metastases. In particular FOLFOXIRI + bevacizumab vs FOLFIRI+bevacizumab improved RECIST response-rate (65% vs 53%, p=0.006), progression-free survival which was the primary endpoint (median 12,1 vs 9,7 months, HR=0,75, p=0.003) and overall survival (median 31,0 vs 25,8 months, HR=0.79, p=0.054). These results, also compared to those reported in previous phase III studies in molecularly unselected patients, represent an important advance in the treatment of this disease.
MedicalResearch.com Interview with:
Ilina and Medha Krishen
Michigan high school students and sisters Ilina and Medha Krishen, have developed screening tools using electronic stethoscopes to detect lung and heart disease. Their research was presented at the 2014 CHEST national meeting. Ilina and Medha have kindly agreed to discuss their work for the MedicalResearch.com audience.
Medical Research: Ilina, please tell us a little about you and the background for your study.
Ilina: I am a senior at Port Huron Northern High School in Fort Gratiot, Michigan. I was exploring the effects of air pollutants on lungs using frequency analysis of lung recordings. My goal was to see if I could pick up early changes in healthy smokers and firefighters.
Dr. Sridhar Reddy, a local pulmonologist and occupational medicine expert mentored me. He lent me his electronic stethoscope. I am a violinist and a clarinet player, so initially had a lot of fun analyzing music frequencies. Later, I moved to lung sounds (a little more difficult!).
I used a Thinklabs Electronic Stethoscope for recording lung sounds. The inventor, Mr. Clive Smith, helped me understand the stethoscope.
I used the MATLAB program for analyzing frequencies. Mr. Charles Munson, a graduate student at the University of Michigan, helped me write the software program for it.