MedicalResearch.com: Interview with
Leonardo Trasande, MD, MPP
Departments of Pediatrics, Environmental Medicine, Population Health, and Medicine, School of Medicine, and Wagner School of Public Service, and Steinhardt School of Culture, Education, and Human Development, Department of Nutrition
MedicalResearch.com: What are the main findings of the study?
Answer: We detect associations of urinary phthalate metabolites in a cross-sectional study of US adolescents. The association is highly robust to multiple sensitivity analyses, and specific to phthalates commonly found in food. Further, longitudinal study of dietary phthalate exposures is needed.
Dr.Csaba P. Kovesdy MD FASN.
The Fred Hatch Professor of Medicine
Director, Clinical Outcomes and Clinical Trials Program in Nephrology
University of Tennessee Health Science Center
Chief of Nephrology
Division of Nephrology, Memphis VA Medical Center
MedicalResearch.com: What are the main findings of the study?
Dr. Kovesdy: In this study of >650,000 US veterans with CKD we found that categories of lower SBP/DBP combinations are associated with lower mortality only as long as the DBP component remains above a threshold of approximately 70 mmHg, and that patients with BP values in the range of 130-159/70-89 mmHg had the lowest mortality. Patients who might be considered to have “ideal” blood pressure (<130/80) actually had increased mortality due to the inclusion of individuals with low systolic and diastolic blood pressures.
MedicalResearch.com Interview with:
Leora I. Horwitz, MD, MHS
Section of General Internal Medicine, Department of Medicine,
Yale School of Medicine,
Center for Outcomes Research and Evaluation,
Yale–New Haven Hospital, New Haven, Connecticut
MedicalResearch.com: What are the main findings of the study?
Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:
MedicalResearch.com Interview with:
Sandra Ryeom, PhD,
Assistant professor of Cancer Biology,
Perelman School of Medicine, University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?
Answer: We identified an important pathway (calcineurin-NFAT-Angiopoeitin2) in the vasculature of early metastatic lung lesions that is critical for promoting lung metastases.
MedicalResearch.com: Were any of the findings unexpected?
Answer: Since there is limited understanding of regulation of tumor angiogenesis at metastatic sites, identification of the calcineurin pathway and a newly identified target of calcineurin-NFAT signaling was all unexpected.
MedicalResearch.com Interview with:
Dr. Finlay McAlister
Division of General Internal Medicine
Patient Health Outcomes Research and Clinical Effectiveness Unit
University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.
MedicalResearch.com: What are the main findings of the study?
Answer: Heart Failure carries a high risk of readmission/death in the first 30 days after hospital discharge (approximately 20%) - even in this cohort of patients with first time diagnosis of heart failure who were discharged home to the community. Patients who do not have an outpatient physician follow-up visit in the first 30 days after discharge have poorer outcomes at 30 days, 3 months, 6 months, and 12 months. Although outcomes are similar for patients who see an unfamiliar or a familiar physician in that first 30 days, over the longer term follow-up with a familiar physician is associated with better outcomes than follow-up with unfamiliar physician(s).
John P. Cooke MD PhD
Chair, Department of Cardiovascular Sciences
Director, Center for Cardiovascular Regeneration
Houston Methodist Research Institute
6670 Bertner St MS: R6-414, Houston, TX 77030
MedicalResearch.com: What are the main findings of the study?
Answer: We discovered that the proton pump inhibitors PPIs), as a class, impair vascular relaxation. The PPIs have this effect by suppressing the activity of a key enzyme required for cardiovascular health. The enzyme is known as DDAH (for dimethylarginine dimethylaminohydrolase). This enzyme is critical in clearing ADMA (asymmetric dimethylarginine) from tissues and the circulation. Because ADMA is an endogenous inhibitor of nitric oxide synthase, accumulation of ADMA impairs vascular relaxation and vascular homeostasis. Previously, we and others have found that, by inhibiting endothelium-derived nitric oxide, ADMA accelerates vascular disease in preclinical models. In humans, ADMA is linked to the severity of vascular disease, and is an independent risk factor for major adverse cardiovascular events (MACE). Thus, the effect of PPIs to inhibit DDAH would be anticipated to impair cardiovascular health, and to increase the risk of MACE.
MedicalResearch.com Author Interview:
Steven A. Narod, MD
Women’s College Research Institute
790 Bay St, 7th Floor
Toronto, ON, M5G 1N8 Canada
MedicalResearch.com: What are the main findings of the study?
Answer: We found that the survival of women with breast cancer and a brca1 mutation was similar to that of women with breast cancer and no mutation.
Dr. Ramon Trullas
MedicalResearch.com Interview with:
Marina Klein, MD, MSc, FRCP(C)
Associate Professor of Medicine
McGill University Health Centre
Division of Infectious Diseases and Chronic Viral Illness Service
3650 Saint Urbain
Montreal, Quebec H2X 2P4
Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis
MedicalResearch.com: What are the main findings of the study?
Dr. Klein: We showed that people with HIV and hepatitis C infection who smoked marijuana did not tend to progress more rapidly to liver fibrosis, liver cirrhosis or end-stage liver disease, even with increasing numbers of joints smoked per week. Previous studies that reported that marijuana was harmful to the liver were likely biased because they did not ensure that marijuana smoking occurred before the development of liver problems.
Prof. Steve Allen
Professor of Paediatrics and International Health; RCPCH International Officer and David Baum Fellow
Room 314, The College of Medicine, Swansea University,
Swansea, SA2 8PP, UK.
MedicalResearch.com: What are the main findings of the study?
Answer: Overall, diarrhoea occurred in just over 10% participants and diarrhoea caused by C. difficile in about 1%. These outcomes were equally common in those taking the microbial preparation and those taking placebo.
Other outcomes (e.g. common GI symptoms, length of hospital stay, quality of life) were also much the same in the two groups. So, there was no evidence that the microbial preparation had prevented diarrhoea or had led to any other health benefit.
In agreement with previous research, serious adverse events were also similar in the two groups – so we found no evidence that the microbial preparation caused any harm.
MedicalResearch.com Interview with: Miles D. Witham, PhD
Aging and Health, University of Dundee, Dundee, United Kingdom
MedicalResearch.com: What are the main findings of the study?
Answer: We gave high dose vitamin D3 (100,000 units) or placebo every 3 months to people aged 70 or over, who all had isolated systolic hypertension (ISH). The main focus of the trial was to test whether vitamin D supplementation could reduce blood pressure in this group of patients – this pattern of blood pressure, whether the systolic (top number) is high, and the diastolic (bottom number) is normal, is very common in older people. Previous studies have suggested a link between low vitamin D levels and higher blood pressure, but no trial has yet tested this idea in older patients with ISH.
Despite the treatment causing a significant increase in circulating vitamin D levels, we saw no significant reduction in blood pressure with vitamin D supplementation, despite the trial running for a year. We tested whether certain groups might still benefit – e.g. those with very high blood pressure or very low vitamin D levels, but even these groups did not show a reduction in blood pressure.
We also tested whether vitamin D supplementation reduced the health and stiffness of arteries – both important predictors of future heart attack or stroke. Unfortunately, vitamin D did not affect these measures either, and didn’t reduce cholesterol or glucose levels.
On the more positive side, vitamin D supplements did appear safe, and the number of falls in the vitamin D group was slightly lower than in those people who received placebo. This is reassuring, as an earlier study (Sanders et al) had suggested that very high doses of vitamin D might make falls more likely, in contrast to previous low dose studies that show a protective effect of vitamin D against falls.
MedicalResearch.com: Interview with Alice Chen-Plotkin, MD
Assistant Professor
Department of Neurology
University of Pennsylvania School of Medicine
MedicalResearch.com: What are the main findings of the study?
Answer: Parkinson's disease (PD) is an incurable neurodegenerative disease. Many neurons die, but the neurons that make dopamine (dopaminergic neurons) are particularly vulnerable. We think that the disease actually starts well before the time when people show clinical symptoms. We were therefore interested in finding proteins from the blood that correlated with better or worse dopaminergic neuron integrity. Since it's hard to access the dopaminergic neurons directly, we looked at a tracer that labels the ends of the dopaminergic neurons in people who do not have Parkinson's disease but are at high risk for developing it, and we also looked at the age at onset of PD in people who are already symptomatic. Screening just under 100 different proteins from the blood, we found that higher plasma levels of apolipoprotein A1 (ApoA1) were correlated with better tracer uptake in the people who did not yet have PD, and with older ages at onset in the people who already had PD. These data suggest that plasma ApoA1 may be a marker for PD risk, with higher levels being relatively protective.
MedicalResearch.com Interview with: Kornelia Polyak, MD, PhD
Professor of Medicine
Dana-Farber Cancer Institute
Harvard Medical School
Boston, MA 02215
MedicalResearch.com: What are the main findings of the study?
Dr. Polyak: We found that when comparing normal breast tissue of women who have not had children (nulliparous) and those who had children in their early 20s, the largest changes are in breast epithelial progenitors. The frequency of these cells is lower in parous women (women who had children) and the properties are also altered in a way that they are less likely to proliferate. Women with high risk of breast cancer, such as BRCA1 and BRCA2 mutation carriers, have very high frequency of these cells, and also parous women who did get cancer have more than those who did not. These results indicate that the frequency of these cells may predict breast cancer risk.
Dr. Wen-Ya Ko, Ph.D.
Postdoctoral Fellow, First author of the paper
Department of Genetics
School of Medicine
University of Pennsylvania
426 Clinical Research Building
415 Curie Boulevard
Philadelphia, PA 19104-6145
Dr. Sarah Tishkoff, Ph.D., Senior author of the paper
David and Lyn Silfen University Professor
Departments of Genetics and Biology
School of Medicine
School of Arts and Sciences
University of Pennsylvania
MedicalResearch.com: What are the main findings of the study?
Answer: In humans the APOL1 gene codes for Apolipoprotein L1, a major component of the trypanolytic factor in serum. The APOL1 gene harbors two risk alleles (G1 and G2) associated with chronic kidney disease (CKD) among individuals of recent African ancestry. We studied APOL1 across genetically and geographically diverse ethnic groups in Africa. We have discovered a number of novel variants at the APOL1 functional domains that are required to lyse trypanosome parasites inside human blood vessels.
We further identified signatures of natural selection influencing the pattern of variation on chromosomes carrying some of these variants. In particular, we have identified a haplotype (a cluster of genetic variants linked along a short region of a chromosome), termed G3, that has evolved adaptively in the Fulani population who have been practicing cattle herding which has been historically documented as early as in the medieval ages (but which could have begun thousands of years earlier). Many of the novel variants discovered in this study are candidates to play a role conferring protection against trypanosomiasis and/or to play a role in susceptibility of CKD in humans.
MedicalResearch.com Interview with: Simon Maltais MD PhD
Vanderbilt University Medical Center
Division of Cardiovascular Surgery
1215 21st Ave S, MCE 5th Flr
Nashville, TN 37232-8808.
MedicalResearch.com: What did your study evaluate and why is this important?
Answer: We performed a rigorous, retrospective review of the Scientific Registry of Transplant Recipients (SRTR) data base to evaluate donor, recipient, and technical characteristics associated with graft survival in patients undergoing mechanical circulatory support (MCS) device explantation at the time of heart transplantation surgery.
Donor and recipient characteristics has been well described in the medical literature for routine heart transplantation, however these characteristics in patients who were supported with a long term MCS device at the time of heart transplant was not known. Additionally, due to chronic donor heart shortages, an increasing number of patients with advanced heart failure are being bridged with MSC devices until a suitable donor heart can be obtained.