Why is Blood Pressure in Women More Sensitive to High Salt Diet?

MedicalResearch.comInterview with:

Eric J. BELIN de Chantemèle, D.Sc.
Associate Professor
Department of Medicine, Cardiology
Augusta University

Eric JBelin de Chantemèle, D.Sc.
Associate Professor
Department of Medicine, Cardiology
Vascular Biology Center
Augusta University

Jessica L Faulkner, PhD
Post-doctoral Fellow
Vascular Biology Center
Augusta University

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: It is generally accepted in the medical community that women are more salt sensitive than men. By “salt sensitive” we mean that blood pressure increases with increases in salt in the diet.

While we have known for a long time that women are more likely to experience problems with their blood pressure that are associated with the salt that they eat, the reasons why remain largely unknown and, therefore, the best way to treat it is also unknown. With the average American eating roughly twice the salt recommended by the American Heart Association guidelines, the effects of dietary salt on blood pressure are very important. Our latest publication in the journal American Heart Association’s journal Hypertension shows that female mice are more prone to high blood pressure when on a high salt diet than males.

MedicalResearch.com: What should readers take away from your report?

Response: Our report begins to shed some light on why women may have a greater risk of developing high blood pressure due to eating too much salt. We recently found that a hormone, termed “aldosterone” is acting inappropriately in females in response to a lot of salt in the diet. In healthy individuals who are not salt sensitive, aldosterone is decreased by salt in the diet and is protective to the blood vessels. However, in female mice it is less likely that aldosterone will be decreased, and this lack of decrease of aldosterone leads to blood vessel damage and high blood pressure in our study.In contrast, our male mice in our study suppressed aldosterone when given a high salt diet, and did not develop blood vessel damage or high blood pressure.We believe this variation in aldosterone production in women may be a reason why they are clinically more likely to have a blood pressure response to high salt diets.

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Does Treatment with Vitamin D Reduce Cardiovascular Risk in Hemodialysis Patients?

MedicalResearch.comInterview with:

Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan
Dr. Shoji

Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Vitamin D is known to be associated with health and disease of various organs such as bone, heart, brain, and others. Vitamin D is activated by the liver and kidneys to a hormone called 1,25-dihydroxyvitamin D which binds to vitamin D receptor in cells to exert its functions.

Vitamin D activation is severely impaired in patients with kidney disease requiring hemodialysis therapy, leading to mineral and bone disorder(MBD). Therefore, active form of vitamin D is one of the standard choices of treatment for MBD caused by kidney function loss.

Previous observational cohort studies showed that the use of active vitamin D in hemodialysis patients was associated with lower likelihood of all-cause death, cardiovascular death, and incident cardiovascular disease.Potentially cardio-protective effects of active vitamin D were shown by basic studies using cultured cells and animal models. Then, many nephrologists began to believe that active vitamin D is a “longevity hormone” or a “panacea” for kidney patients requiring dialysis therapy, although there was no evidence by randomized clinical trials. 

To show evidence for it, we conducted a randomized clinical trial namedJ-DAVID in which 976 hemodialysis patients were randomly assigned to treatment with oral alfacalcidol or treatment without active vitamin D, and they were followed-up for new cardiovascular events during the four-year period. The risk of cardiovascular events was not significantly different between the two groups. The risk of all-cause death was not significantly different either.

To our surprise, the risk of cardiovascular event tended to be higher in the patients who continued treatment with active vitamin D than those who continued non-use of active vitamin D, although the difference was not statistically significant.

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Some Anti-Tumor Drugs May Promote Delayed Aggressive Cancers

MedicalResearch.comInterview with:
Alexandra Avgustinova PhD
Postdoctoral fellow at the Institute for Research in Biomedicine (IRBBarcelona)

Dr. Avgustinova
Dr. Avgustinova

MedicalResearch.com:  What is the background for this study?

Response: The basis of this study was the strong association between closed chromatin and high mutation rate reported several years ago. We were surprised to see this observation being widely interpreted as a causal association, as it was largely based on correlative studies without experimental backing. Therefore we decided to experimentally test for the first time whether indeed altering chromatin opening would affect mutation rate or distribution within tumours.

MedicalResearch.com: What are the main findings?

Response: We found that, despite significantly increasing chromatin opening, loss of the histone methyltransferase G9a did not have any major influence on the mutation rate or distribution within cutaneous squamous cell carcinomas. These results demonstrate that chromatin opening does not play a major role in determining the mutation rate within tumours, and we speculate that other, confounded factors (e.g. replication timing or H3K36me3 levels) are likely causal for the observed association. This, however, remains to be proven experimentally.

Another major conclusion of our study was that although tumour initiation was delayed and tumour burden decreased in the absence of G9a, the tumours that did develop were highly aggressive due to selection for more aggressive tumour clones. This finding was contrary to many published reports suggesting G9a as a good candidate for clinical targeting, highlighting the need for long-term follow-up in pre-clinical studies.

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Novel Subtypes in B Progenitor Acute Lymphoblastic Leukemia

MedicalResearch.comInterview with:

Zhaohui Gu, PhD
Postdoctoral Research Associate
 St. Jude Children’s Research Hospital, TN

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response:B-progenitor acute lymphoblastic leukemia (B-ALL) is the most common pediatric malignancy and the leading cause of childhood cancer death. B-ALL includes multiple subtypes that are defined by distinct genetic alterations and that play an important role in diagnosis, prognosis and therapy of patients.  Advances in transcriptome sequencing (RNA-seq)have helped researchers discover additional subtypes and driver mutations inB-ALL and identify possible new therapeutic targets.  Still, up to 30% of B-ALL cases do not fit into established subtypes. These patients lack targeted therapeutic approaches and commonly relapse.

Fort his study, we used integrated genomic analysis of 1,988 childhood and adult cases to revise the classification system of B-ALL. The system includes eight new subtypes and a total of 23 B-ALL subtypes. The subtypes are defined by chromosomal rearrangements, sequence mutations, or heterogeneous genomic alterations. Many show a marked variation in prevalence according to age.

The newly identified subtypes included one (n=18) defined by rearrangements of gene BCL2, MYC and/or BCL6 anda distinctive gene expression profile (GEP). Patients in this subtype were mostly adults (n=16) with very poor outcomes.

Another novel subtype was defined by IKZF1 N159Y missense mutation. N159Y is in the DNA-binding domain of IKZF1, and is known to disrupt IKZF1 function, with distinct nuclear mis-localization and induction of aberrant intercellular adhesion. There were eight cases in this subtype that shared highly similar GEPs.

We also identified two subtypes with distinct GEP and characterized by PAX5 alterations. One, PAX5 altered (PAX5alt), included 148 cases. PAX5alt was characterized by diverse PAX5 alterations including rearrangements (n=57), sequence mutations (n=46) and/or focal intragenic amplifications (n=8). These PAX5 alterations were found in 73.6% of PAX5alt cases. The second distinct subtype comprised 44 cases, all with PAX5 P80R missense mutations. Bi-allelic PAX5 alterations were commonly seen in this subtype in the form of PAX5 P80R coupled with a second sequence mutation or deletion of the wild-type PAX5 allele.

Adult PAX5 P80R cases showed better 5-year OS (61.9±13.4%) than those in PAX5alt subtype (42.1±10.2%). In addition, Pax5 P80R heterozygous and homozygous mice developed B lineage leukemia with a median latency of 166 and 87 days, respectively.  The heterozygous mice acquired alterations on the second allele, which faithfully recapitulated the condition of the patient leukemia.

MedicalResearch.com: What should readers take away from your report?

Response: Identification of subtypes accurately is very important for diagnosis, intensity-tailored therapy, and to identify targetable lesions. In this large scale genomic study, we demonstrated the power of using RNA-seq to classifying B-ALL and established a revised B-ALL taxonomy with 23 distinct subtypes. We identified 8 novel subtypes, including two defined by PAX5 alterations. Through in vitro and in vivo experiments, we demonstrated that PAX5 P80R could impair B cell differentiation and initiate leukemia.

Together with the subtype defined by IKZF1 N159Y mutation, we showed for the first time that transcription factor missense mutations could be a subtype defining genetic lesions.

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Immunotherapy Gel Sprayed on Surgical Site May Reduce Cancer Recurrence

MedicalResearch.comInterview with:

Zhen Gu, Ph.D.
Professor, Department of Bioengineering
University of California, Los Angeles (UCLA)
Dr. Zhen Gu

Zhen Gu, Ph.D.
Professor, Department of Bioengineering
University of California, Los Angeles (UCLA)

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Despite improvements in surgical techniques, local residual tumor micro infiltration and circulating tumor cells continue causing tumor recurrence after resection. 

Calcium carbonate nanoparticles could scavenge H+ in the surgical wound, reserving the immunosuppressive tumor microenvironment and promoting the antitumor immuneresponses. 

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Data Support Venclexta Combinations As New Treatment Option for AML

MedicalResearch.com Interview with:

Nancy Valente, M.D.,
Vice President, Global Hematology Development
Genentech

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Acute myeloid leukemia, or AML, is a particularly aggressive blood cancer with the lowest survival rate for all types of leukemia.

Many people with this disease are unable to tolerate intensive induction chemotherapy, so additional treatment options are needed and welcomed in this patient population.

At ASH, we presented updated data from two Phase Ib/II studies with longer follow up for Venclexta combinations. These data supported the recent accelerated approval of Venclexta by the FDA for people newly-diagnosed with AML who are unable to tolerate aggressive therapies.

These updated results showed that Venclexta demonstrated complete remission rates (with at least partial blood count recovery, CR+CRh) of 67 percent and 71percent when used in combination with azacitidine or decitabine, respectively ,and 54 percent when used in combination with low-dose cytarabine (LDAC). These responses were durable with a median duration of response of 16 months for patients treated with Venclexta plus azacitadine and 8 months for those treated with Venclexta plus LDAC.

AML is a difficult-to-treat disease and these Venclexta combinations represent an important new treatment option for patients. Venclexta has been granted four breakthrough therapy designations by the FDA, two in AML and two in chronic lymphocytic leukemia (CLL).

MedicalResearch.com: What should readers take away from your report?

Response: These results further support Venclexta combinations as a new treatment option for people with AML. Venclexta is the first and only FDA-approved medicine designed to selectively bind and inhibit the BCL-2 protein, which helps trigger a natural process that helps cells self-destruct. It represents a new way to help people who have not received treatment for this aggressive type of blood cancer and are unable to tolerate intensive induction chemotherapy.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: A robust clinical development program for Venclexta in AML is ongoing, including two ongoing Phase III studies (Viale-A,Viale-C) evaluating Venclexta in combination with azacitidine or with LDAC for people with previously untreated AML who are ineligible for intensive chemotherapy. This is part of a larger development program for Venclexta in multiple blood cancers including CLL, multiple myeloma and non-Hodgkin’s lymphoma (NHL).The benefit of Venclexta has already been demonstrated in adults with previously treated CLL, with or without 17p deletion, with its approval in the U.S. and EU.

Citation:

Venetoclaxin Combination with Hypomethylating Agents Induces Rapid, Deep, and DurableResponses in Patients with AML Ineligible for Intensive Therapy

ASH 2018 Sunday, December 2, 2018: 8:00 AM

https://ash.confex.com/ash/2018/webprogram/Paper117179.html

Dec 11, 2018 @ 10:46 pm

The information onMedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Combination of Two Coffee Components Could Slow Parkinson’s Brain Degeneration

MedicalResearch.comInterview with:

M. Maral Mouradian, M.D.
William Dow LovettProfessor of Neurology
Vice Chancellor for Faculty Development, Rutgers Biomedical and Health Sciences
Director, RWJMS Institute for Neurological Therapeutics
Rutgers -Robert Wood Johnson Medical School
Piscataway, NJ 08854
Editor-in-Chief, Neurotherapeutics

M. Maral Mouradian, M.D.
William Dow Lovett Professor of Neurology
Vice Chancellor for Faculty Development, Rutgers Biomedical and Health Sciences
Director, RWJMS Institute for Neurological Therapeutics
Rutgers -Robert Wood Johnson Medical School
Piscataway, NJ 08854
Editor-in-Chief, Neurotherapeutics

MedicalResearch.com:  What is the background for this study?

Response: Drinking coffee has been known from epidemiological studies to be linked with reduced risk of developing Parkinson’s disease (PD).This protective effect has been traditionally attributed to caffeine, the best known compound present in coffee.

But coffee has more than a thousand different compounds. And among people with early PD, the amount of caffeine consumption does not impact how fast the disease progresses, raising some question about the protective effect of just caffeine in coffee. We previously found another compound in coffee, Eicosanoyl-5-hydroxytryptamide (EHT), which protects the brain in laboratory mice against a protein called alpha-synuclein that accumulates in abnormal forms in  Parkinson’s disease and in Dementia with Lewy Bodies (DLB).

EHT is a fatty acid derivative of the neurotransmitter serotonin and is a principal constituent of coffee wax that coats the coffee bean. We had purified EHT from coffee in search for compounds that boost the activity of a catalyst enzyme called PP2A (B55alpha) that helps reduce the aggregation of alpha-synuclein. Our investigations had also shown that PP2A is less active in brains affected with PD and DLB than in normal age-matched controls. So, we hypothesized that enhancing PP2A activity may mitigate alpha-synuclein related pathology. In the present study, we wanted to find out if these two components of coffee, caffeine and EHT, can work together or cooperatively to protect the brain against the negative effects of abnormal alpha-synuclein.

MedicalResearch.com: What are the main findings?

Response: We tested this idea in two models of alpha-synuclein related pathology in laboratory mice. One model has excess of this protein throughout the brain (transgenic), and the other model is generated by injecting the abnormal fibrillar form of alpha-synuclein in a brain region connected with dopamine producing neurons that degenerate in PD. In the latter model, abnormal alpha-synuclein aggregates have been shown to propagate to other brain regions including dopamine neurons.

We found that small doses of either EHT or caffeine given alone were ineffective in preventing alpha-synuclein aggregation or propagation, and could not protect the brain against the toxicity of alpha-synuclein. On the other hand, the combination of the two compounds could. This was accompanied with preserved neuronal integrity and function, diminished neuroinflammation, and improved behavioral performance on motor and memory tasks. We also found that this synergistic beneficial action between EHT and caffeine is through boosting the activity of PP2A.

MedicalResearch.com: What should readers take away from your report?

Response: Our findings suggest a potential therapeutic option to slow down or stop the progression of Parkinson’s disease and Dementia with Lewy Bodies. This is in contrast to the currently available treatments for PD that only help some of the motor symptoms but do not impact the brain degeneration.  

The treatment approach we tested in this study uses two natural products that people normally ingest. But it will be important for us to find the proper amount that could be protective for the brain in people. Our findings from the combination of the two compounds also mean that caffeine does not need to be consumed in large amounts for it to protect the brain in  Parkinson’s disease and DLB so long as it is taken in combination with EHT. This can minimize the negative health consequences of consuming too much caffeine.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: As in any research and development effort in the discovery of new treatments for diseases, the next necessary step is to test this combination treatment in people with  Parkinson’s disease and DLB in properly designed clinical trials. Importantly, the amounts of EHT and caffeine in combination needed for the protective effect in people with these diseases have to be determined.

MedicalResearch.com: Is there anything else you would like to add?

Response: This study was carried out in collaboration with Princeton University and funded by a research grant from the National Institutes of Health. The senior scientists are inventors of a patent application relevant to this work.

The original publication is freely available at: https://www.pnas.org/content/early/2018/11/26/1813365115.long

Citation:

Run Yan, Jie Zhang, Hye-Jin Park, Eun S. Park, Stephanie Oh,Haiyan Zheng, Eunsung Junn, Michael Voronkov, Jeffry B. Stock, M. Maral Mouradian. Synergistic neuroprotection by coffee componentseicosanoyl-5-hydroxytryptamide and caffeine in models of Parkinson’s diseaseand DLBProceedings of the National Academy of Sciences,2018; 201813365 DOI: 10.1073/pnas.1813365115

Dec 12, 2018 @ 2:54 am

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Canadian Task Force Updates Breast Cancer Screening Guidelines

MedicalResearch.com Interview with:

Dr. Ainsley Moore MD, CFPC, MSc(HB), MSc(CLinEpi) Cand
Associate Professor,McMaster University
Associate Editor,Canadian Medical Education Journal
Vice-Chairof the Canadian Task Force on Preventive Health Care
Dr. Moore

Dr. Ainsley Moore MD, CFPC, MSc(HB), MSc(CLinEpi) Cand
Associate Professor,McMaster University
Associate Editor,Canadian Medical Education Journal
Vice-Chair,  Canadian Task Force on Preventive Health Care

MedicalResearch.com:  What is the background for this study?

Response: The Canadian Task Force for Preventive Health Care has updated its Breast Cancer Screening Guideline. It places an emphasis on shared decision-making between women and their health care provider so that women can make an informed decision based on how they prioritize the benefits and harms of screening with mammography.  

Screening may identify breast cancer earlier and lead to a reduction in breast cancer mortality; however, i talso has known harms such as false positive results, further testing including biopsy, and over diagnosis leading to unnecessary treatment with associated complications.

MedicalResearch.com: What are the main findings?

Response: An updated review of the evidence continues to show a close balance between potential benefits and harms of breast cancer screening; this balance appears to be less favourable for younger women than for women aged 50 to 74 years.

A separate review conducted for this guideline on women’s values and preferences about mammography screening suggests that many women aged 40 to 49 years would choose not to be screened if they were aware of the outcomes for their age group. On the other hand, women aged 50 to 74 years are more likely to choose screening given their more favourable balance of benefits and harms

The recommendations:

  • The TaskForce provides conditional recommendations against screening women age 40 to49 years who are not at increased risk of breast cancer, low certainty evidence shows a small potential reduction in breast cancer death along with higher risk of harms including false positive results, further testing including possible breast biopsy and overdiagnosis leading to unnecessary treatment with associated complications. Recommendations are conditional upon how an individual woman from this age group weighs the benefits and harms of screening
  • The TaskForce provides conditional recommendations in favour of screening women aged 50 to 74 years who are not at increased risk of breast cancer, very low-certainty evidence suggests a modest reduction in risk of breast cancer death and, while the risk of harms of screening are lower than for younger women, it remains a concern.  Recommendations are conditional upon who an individual woman of this age group weighs the benefits and harms of screening

MedicalResearch.com: What should readers take away from your report?

Response: The Task Force provides information on the benefits and harms of breast cancer screening and has developed tools on their website to help guide the discussion between women and their health care provider so that they can make the decision that is best for themFor more details on the Task Force’s findings and recommendations and patient tools, please visit: canadiantaskforce.ca

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: More and better-quality evidence is needed on the impact of breast cancer screening for women of all ages.  Additional studies on Canadian women’s values and preferences for screening that are based on accurate estimates of both benefits and harms conducted in a transparent and easily comparable manner would assist in guiding future recommendations.

MedicalResearch.com: Is there anything else you would like to add?

Response: The Public Health Agency of Canada established theCanadian Task Force for Preventive Health Care to make recommendations forCanadian primary care providers on a broad array of preventive health issues.The members of the Task Force were selected for their expertise in Preventive health care delivered in primary care settings. Task Force members adhere to the highest ethical standards including the avoidance of professional conflicts of interest in order to ensure the scientific credibility of its recommendations.

Citation:

Recommendations on screening for breast cancer in women aged 40–74 years who are not at increased risk for breast cancer

Scott Klarenbach, Nicki Sims-Jones, Gabriela Lewin, Harminder Singh, Guylène Thériault, Marcello Tonelli, Marion Doull, Susan Courage, Alejandra Jaramillo Garcia and Brett D. Thombs; for the Canadian Task Force on Preventive Health Care

CMAJ December 10,2018 190 (49) E1441-E1451; DOI:https://doi.org/10.1503/cmaj.180463

Dec 11, 2018 @ 8:44 pm

The information onMedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Paid Parental Leave Available to Medical School Faculty but Not Trainees

MedicalResearch.com Interview with:

Kirti Magudia, MD, PhD Diagnostic RadiologyResident, Brigham and Women’s Hospital Clinical Fellow, Radiology, Harvard University
Dr. Magudia


Kirti Magudia, MD, PhD
Diagnostic RadiologyResident, Brigham and Women’s Hospital
Clinical Fellow, Radiology, Harvard University




Debra F. Weinstein, M.D.
Vice President, Graduate Medical Education, Partners Health Care
Associate Professor of Medicine, Harvard Medical School

Christina Mangurian, MD,MAS
Professor and Vice Chair at the UCSF Department of Psychiatry
Weill Institute for Neurosciences
Core Faculty, UCSF Center for Vulnerable Populations
Affiliate Faculty, UCSFPhilip R. Lee Institute for Health Policy Studies

Reshma Jagsi, MD, DPhil
Professor and DeputyChair, Department of Radiation Oncology
Director, Center for Bioethics and Social Sciences in Medicine
University of Michigan

MedicalResearch.com:  What is the background for this study? 
What are the main findings?

Response: Training lengths for medical specialties are increasing and many people are starting training later. Hence, many more trainees are having children during training, an especially difficult time due to long and inflexible work hours. Given the match system, trainees may not have complete control over where they end up in training and thus may not have an optimal support system nearby. Many of the top training institutions are also in high cost of living areas. Since trainees are essentially temporary employees, changing policies to their benefit is challenging. For all of these reasons, prospective and current trainee parents are especially vulnerable.

Parental leave is important to both male and female trainees. We found that just over half of the 15 top graduate medical education (GME) sponsoring institutions associated with the top 12 medical schools did not have parental leave policies. Without these policies, trainees are at the mercy of their departments and program directors. Those institutions that do have parental leave policies for trainees offer significantly less leave to trainees than to faculty. Even then, trainees may not be encouraged to take leave afforded by policy as, depending on specialty board regulations, the leave may extend training time.

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Visual Inspection Alone Can Miss Some Skin Cancers

MedicalResearch.comInterview with:

polarized-light-dermatoscope-wikipedia-image

Jac Dinnes PhD, MSc, MA, PGDip
Senior Researcher
Test Evaluation Research Group
Institute of Applied Health Research
University of Birmingham

MedicalResearch.com:  What is thebackground for this study? Would you briefly explain the benefits of dermoscopy?

Response: This systematic review was one of a series of Cochrane Reviews of studies evaluating different tests for diagnosing skin cancer. Within creasing rates of skin cancer and an increasing number of more specialised tests becoming available in both primary care and in specialist settings, a thorough review of all available evidence was timely.

The diagnosis of melanoma and other skin cancers fundamentally relies on clinical examination, including history taking, and visual inspection of the concerning skin lesion (mole or patch of skin) and surrounding skin (and other lesions). A dermatoscope is a handheld device using visible light (such as from incandescent or LED bulbs), that allows more detailed examination of the skin compared to examination by the naked eye alone.

Knowing the diagnostic accuracy of dermoscopy added to visual inspection alone, across a range of observers and settings, is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques.

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Racial and Gender Disparities in Stroke Risks

MedicalResearch.com Interview with:

Virginia J. Howard,PhD, FAHA, FSCT   
 Professor of Epidemiology
The University of Alabama at Birmingham

MedicalResearch.com:  What is the background for this study?

Response: This study comes from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort study of 30,239 non-Hispanic black and white community-dwelling participants aged 45 years and older who lived in the 48 contiguous US states. 

REGARDS was designed to study risk factors for the development of stroke, with a focus on black and white comparisons as well as comparisons across geographic regions of the US.

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Despite More Insurance, Medicaid Recipients Still Use ER Over Primary Care

MedicalResearch.comInterview with:
Lisa M. Lines, PhD, MPH
University ofMassachusetts Medical School
Worcester
RTI International,Waltham, MA

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: The problem of potentially avoidable emergency department (ED) visits has been linked to barriers in access to high-quality, timely primary care. In Massachusetts ,about half of all ED visits were considered potentially avoidable, or primary-care sensitive (PCS), in the mid-2000s. Indeed, improving access to primary care was a prime motive for the state’s – and the nation’s – first universal coverage health insurance program in 2006. Now, the state has the highest coverage rate in the country.

We used Massachusetts All-Payer Claims Data to study characteristics of insured Massachusetts residents associated with primary-care sensitive ED use and compared such use among people under age 65 with public (Medicaid[MassHealth]) versus private insurance. We studied more than 2.2 million individuals in 2011-12; about 40% had public insurance in 2011, and the rest had private insurance. Our PCS ED measure included nonurgent, urgent but primary care treatable, and urgent but potentially avoidable ED visits.

We found that primary-care sensitive ED use was more than 4 times higher among the publicly insured (public insurees: 36.5 PCS ED visits per 100 person-years; private insurees: 9.0). After adjusting for a range of potential confounders, such as the vastly different morbidity burden of the two groups, public insurance in2011 was associated with about 150% more primary-care sensitive ED use. We also found that 70% of people with public insurance had at least 1 primary care visit, compared with 80% of those with private insurance. The public group also had fewer visits to their PCP of record, even though nearly all of them had an officially designated PCP.

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Using of Big Data to Estimate Prevalence of Defective DNA Repair Variants in the US

MedicalResearch.com Interview with:

Kenneth H. Kraemer,M.D.
Chief DNA Repair Section
Laboratory of Cancer Biology and Genetics, Center for Cancer Research
National Cancer Institute

MedicalResearch.com:  What is the background for this study?

Response: At the National Cancer Institute, we have been examining patients with xeroderma pigmentosum (XP), a rare, recessively inherited, cancer-prone disease for many years. Therefore, with the increasing use of exome sequencing, we decided to see how closely”big data” corresponded with our clinical observations.  

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Single Session of Exercise Can Boost Metabolism for Days

MedicalResearch.comInterview with:

Dr. Kevin Williams
Dr. Williams

Kevin W. Williams, Ph.D.
Assistant Professor
Division of Hypothalamic Research
Department of Internal Medicine
The University of Texas Southwestern Medical Center
Dallas, Texas 75390-9077

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: Exercise (single bout and/or chronic training) has valuable effects on metabolism. Important in the treatment of Diabetes, metabolic improvements in response to exercise include improved blood glucose regulation. However, the metabolic related circuits in the brain that are altered in response to exercise remain undefined.  Within the brain, the melanocortin system is an interface between signals that relay metabolic state and neural pathways governing metabolism.

In this study, we measured the effects of short- and long-term exercise on two types of neurons that comprise the melanocortin brain circuit, which is shared by both humans and mice. Normally, these two neurons — thePOMCs and the NPY/AgRP neurons — have opposing effects on appetite and energy burning. When activated, POMC neurons are associated with reduced appetite, lower blood glucose levels, and higher energy burning.  The other type(NPY/AgRP) increases appetite and diminishes metabolism when activated. We found that POMC neurons were activated in response to exercise, while NPY/AgRPwere inhibited. 

Interestingly, POMC neurons exhibited sustained activity for up to 2 days after a single bout of exercise.

Mediterranean Diet Linked to Lower Long-Term Cardiovascular Events in Women

MedicalResearch.com Interview with:

Samia Mora, MD, MHS Associate Professor of Medicine Harvard Medical School Director, Center for Lipid Metabolomics Brigham and Women’s Hospital Boston, MA

Dr. Mora

Samia Mora, MD, MHS
Associate Professor of Medicine
Harvard Medical School
Director, Center for Lipid Metabolomics
Brigham and Women’s Hospital
Boston, MA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Mediterranean diet is rich in plants (nuts, seeds, fruits, vegetables, whole grains, legumes) and olive oil, and includes moderate intake of fish, poultry, dairy, and eggs, and alcohol, and rare use of meats and sweets.The Mediterranean diet has been associated with lower risk of cardiovascular disease (CVD) events but the precise mechanisms through which Mediterranean diet intake may reduce long-term risk of CVD are not well understood. We aimed to investigate the biological mechanisms that may mediate this cardiovascular benefit.

Using a prospective study of 25,994 initially healthy women enrolled in the Women’s Health Study who were followed up to 12-years, we evaluated potential mediating effects of a panel of biomarkers (in total 40 biomarkers) that represent different CVD pathways and clinical factors.

Higher baseline intake of a Mediterranean-type diet was associated with approximately one quarter lower risk of CVD events during the 12 year follow up. For the MED-CVD risk reduction, biomarkers of inflammation, glucose-metabolism/insulin-resistance, and adiposity contributed most to explaining the association, with additional contributions from pathways related to blood pressure, lipids – in particular HDL or triglyceride-rich lipoprotein metabolism, and to a lesser extent LDL cholesterol, branched chain amino acids, and small molecule metabolites.  Continue reading

Younger Siblings of Children with Autism or ADHD More Likely To Be Similarly Diagnosed

MedicalResearch.com Interview with:

Meghan Miller, Ph.D. Assistant Professor Department of Psychiatry & Behavioral Sciences UC Davis MIND Institute Sacramento, CA 95817

Dr. Miller

Meghan Miller, Ph.D.
Assistant Professor
Department of Psychiatry & Behavioral Sciences
UC Davis MIND Institute
Sacramento, CA 95817

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study evaluated within-diagnosis sibling recurrence and sibling cross-aggregation of ADHD and autism spectrum disorder among later-born siblings of diagnosed children. We specifically chose to include only families who had at least one subsequent child after the diagnosis of an older child because failing to do so could bias recurrence risk estimates.

We found that, compared to later-born siblings of non-diagnosed children, later-born siblings of children with autism were more likely to be diagnosed with autism or with ADHD. Likewise, compared to later-born siblings of non-diagnosed children, later-born siblings of children with ADHD were more likely to be diagnosed with ADHD or with autism.

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H.pylori: Triple Therapy Pill TALICIA® Has Potential To Become Best Treatment Option

MedicalResearch.com Interview with:

Ira Kalfus, M.D., 
Medical Director
RedHill BioPharma

Immunohistochemical staining of H. pylori from a gastric biopsy  – Wikipedia  image

MedicalResearch.com: What is the background for this announcement? Would you briefly explain the significance of H. pylori infections?  What are the potential complications of infection with this bacteria?

Response: Heliobacter pylori is one of the most prevalent human pathogens. H. pylori bacterial infection affects over 50% of the adult population worldwide1 and 30-40% of the U.S. population2, with an estimated 2.5 million patients treated annually in the U.S.3 People infected with H. pylori may suffer from gastritis and have an increased risk of developing ulcers and gastric cancers. In fact, H. pylori is classified as a group I carcinogen by the International Agency for Research on Cancer in part because it is the strongest risk factor for the development of gastric cancer.4

Eradication of H. pylori is becoming more difficult. Current standard-of-care therapies fail in approximately 30-40% of patients, who remain H. pylori positive. This is due to increasing resistance of H. pylori to antibiotics commonly used in standard combination therapies5. Clarithromycin-resistant H. pylori was formally categorized by the World Health Organization as a pathogen for which there is a high priority need to develop new treatments.6

The pervasive nature of H. pylori, the great health risks that it poses and the rapid development of resistance to currently available therapies speak to the great unmet medical need for new treatments that are effective at eradicating H. pylori infections. We set out to develop TALICIA®(RHB-105) as an answer to this growing public health concern with the hopes that it could someday be adopted as a new first-line therapy for all people affected by H. pylori infection.

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Vitamin D Deficient Babies More Likely To Develop Schizophrenia

Prof. John McGrath
Prof. McGrath

MedicalResearch.comInterview with:
Professor John McGrath
Niels Bohr Professor
National Centre for Register-based Research
Aarhus University
Queensland Brain Institute
University of Queensland
Brisbane AustraliaQueensland Centre for Mental Health Research
The Park Centre for Mental Health Australia

MedicalResearch.com:  What is the background for this study? 
What are the main findings?

Response: We know that people born in winter and spring have an increased risk of later developing schizophrenia. But, we were not sure why. We know that vitaminD, the sunshine hormone, is more likely to be low in winter and spring, so wedeveloped a way to test for vitamin D in stored neonatal blood sample.

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Pressure of Electronic Medical Record Documentation Contributing to Physician Burnout

MedicalResearch.com Interview with:

Rebekah L Gardner MD Associate Professor of Medicine Warren Alpert Medical School Brown University Providence, Rhode Island

Dr. Gardner

Rebekah L Gardner MD
Associate Professor of Medicine
Warren Alpert Medical School
Brown University
Providence, Rhode Island

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Burnout profoundly affects physicians, their patients, and the health care system.The role of technology in physician burnout, specifically health information technology (HIT), is not as well characterized as some of the other factors. We sought to understand how stress related to HIT use predicts burnout among physicians.

Our main findings are that 70% of electronic health record (EHR) users reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. We found that experiencing HIT-related stress independently predicted burnout in these physicians, even accounting for other characteristics like age, gender, and practice type. In particular, those with time pressures for documentation or those doing excessive “work after work” on their EHR at home had approximately twice the odds of burnout compared to physicians without these challenges. We found that physicians in different specialties had different rates of stress and burnout.

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Hysterectomy Can Impair Short Term Memory (at least in rats)

MedicalResearch.com Interview with:

Heather A. Bimonte-Nelson, Ph.D. Professor, Barrett Honors Faculty Department of Psychology Arizona State University

Dr. Bimonte-Nelson

Heather A. Bimonte-Nelson, Ph.D.
Professor, Barrett Honors Faculty
Department of Psychology
Arizona State University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The dogma in the field is that the nonpregnant uterus is dormant, and therefore it has not necessarily been of interest to study. Textbooks have described the nonpregnant uterus as “quiescent,” “dormant,” and “useless.” When I was in graduate school studying endocrinology, I read statements in books saying that the sole purpose of the uterus is for gestation.

However, all women aging into midlife will experience some type of menopause, and some of these women will undergo surgical menopause via removal of all, or a part of, their reproductive tracts. Research evaluating reproductive tract-brain connections has grown quite a bit in the last few decades. For example, the ovary-brain connection has been focused on quite a bit, and we now know that hormones coming from the ovaries (such as estrogens and progesterone) can affect more than reproduction, and can impact brain functioning. While the uterus-brain connection is not well understood, there is research indicating that the uterus and autonomic nervous system communicate directly.

We also know that hormones released from the ovaries impact the uterus. Therefore, there is a uterus-ovary-brain triad system. This uterus-ovary-brain triad has undergone little scientific investigation for functions outside of reproduction. Given that by age 60 one in three women experience hysterectomy, thereby interrupting this uterus-ovary-brain triad system, we believe it is important to understand the effects of variants of surgical menopause including hysterectomy.

This led to our current evaluation testing multiple variations in surgical menopause using a rat model, where we tested the effects of uterus removal alone (hysterectomy), ovarian removal alone, or uterus plus ovarian removal.

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Fluoxetine (Prozac) Did Not Reduce Risk of Depression After Stroke, But Did Raise Risk of Fractures

MedicalResearch.com Interview with:

Prof .Gillian Mead Chair of Stroke and Elderly Care Medicine

Prof. Mead

Prof. Gillian Mead
Chair of Stroke and Elderly Care Medicine

Prof Martin Dennis Chair of Stroke Medicine

Prof. Dennis

Prof. Martin Dennis
Chair of Stroke Medicine

Centre for Clinical Brain Sciences
The University of Edinburgh

 


MedicalResearch.com: What is the background for this study?

Response: We are both practicing stroke physicians as well as clinical trialists. Therefore our interest in this area was triggered by the exciting results of the FLAME trial in 2011. This appeared to indicate that fluoxetine might boost the recovery of stroke patients. Potentially this was very important given the increasing numbers of people having disability due to stroke, and the fact that fluoxetine is inexpensive and could be introduced very easily into clinical practice. We were further encouraged by the large numbers of small RCTs we identified when we carried out a Cochrane systematic review on the topic. These trials provided more evidence of potential benefit but there was evidence that trials of greater quality showed less benefit, and benefits were greater in patients who were depressed. We felt there was a need for more evidence derived from much larger numbers of patients.

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After Menopause, High Body Fat Associated with Doubled Risk of Estrogen+ Breast Cancer

MedicalResearch.com Interview with:

Neil M. Iyengar, MD Breast Medicine Service Department of Medicine Memorial Sloan Kettering Cancer Center Evelyn H. Lauder Breast And Imaging Center New York, NY

Dr. Neil Iyengar

Neil M. Iyengar, MD
Breast Medicine Service
Department of Medicine
Memorial Sloan Kettering Cancer Center
Evelyn H. Lauder Breast And Imaging Center
New York, NY 

MedicalResearch.com: What is the background for this study?

Response: Obesity is one of the leading modifiable risk factors for the development of hormone receptor positive breast cancer in postmenopausal women.

Traditionally, physicians use a person’s body mass index (weight in kilograms divided by height in squared meters, kg/m2) to estimate body fat levels. A BMI of 30 or greater is considered to be obese, and this level of BMI increases the risk of at least 13 different cancers.

However, BMI is a crude measure of body fat and can be inaccurate. For example, some normal weight individuals (BMI less than 25) have obesity-related problems like diabetes and high blood pressure. Before our study, it was unknown whether high body fat levels in normal weight women contributes to obesity-related cancers such as breast cancer.

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Heart Attacks Spike During Holiday Season – How Can You Minimize Your Risk?

MedicalResearch.com Interview with:

Dr. Lowell H. Steen, Jr., M.D. Interventional Cardiologist Loyola University Medical Center

Dr. Steen

Dr. Lowell H. Steen, Jr., M.D.
Interventional Cardiologist
Loyola University Medical Center

Dr. Steen discusses how holiday treats & stress can increase the risk of heart attack.

MedicalResearch.com: What are the main factors that are linked to an increase in heart related adverse events during the Christmas holiday season? Who is most at risk? 

Response: The increase in holiday season heart-related hospitalizations and deaths are due to a variety of behaviors such as putting off seeking medical help until after the holidays, overeating rich foods, strenuous travel, excessive alcohol consumption and stressful family interactions. These factors can all trigger heart issues.

Factors such as age, diabetes, high cholesterol and smoking all increase heart risk. Additionally, those with high blood pressure, which is a leading risk factor for heart disease and stroke, are exceptionally at risk and should celebrate the hectic holiday season with caution.  Continue reading

Mental Health and Substance Abuse Drive Hospitalizations Among Homeless

MedicalResearch.com Interview with:

Dr. Rishi Wadhera, MD  Cardiology Fellow Brigham and Women's Hospital Harvard Medical School.

Dr. Wadhera

Dr. Rishi Wadhera, MD 
Cardiology Fellow
Brigham and Women’s Hospital
Harvard Medical School.

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In the United States, an estimated half a million people are homeless on any given night. In recent years, policy efforts to improve the health of homeless individuals have intensified, but there is little large-scale, contemporary data on how these efforts have impacted patterns of acute illness in this vulnerable population.

In this study, we examined trends, causes, and outcomes of hospitalizations among homeless individuals in three states – Massachusetts, Florida, and California – from 2007 to 2013. We found that hospitalization rates among homeless adults increased over this period of time.

Strikingly, over one-half of these hospitalizations were for mental illness and substance use disorder. More broadly, homeless adults were hospitalized for a very different set of reasons compared with demographically similar non-homeless adults. In addition, homeless individuals had longer lengths of hospitalization but lower total costs per hospitalization.

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Diversity Standards Linked to More Female, Black and Hispanic Students in Medical Schools

MedicalResearch.com Interview with:

Dr. Dowin H. Boatright, MD Assistant Professor of Emergency Medicine Yale School of Medicine

Dr. Boatright

Dr. Dowin H. Boatright, MD
Assistant Professor of Emergency Medicine
Yale School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: This observational study looked at changes in student makeup by sex, race and ethnicity at U.S. medical schools after an accrediting organization introduced diversity standards in 2009.

An analysis of data from 120 medical schools suggests implementation of the diversity standards were associated with increasing percentages of female, black students, and Hispanic students.

MedicalResearch.com: What should readers take away from your report? 

Response: Accreditation standards may be an effective policy lever to increase diversity in the physician workforce. Nevertheless, while study results are promising, women, black, and Hispanic physicians remain underrepresented in the physician workforce.  

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future studies should evaluate changes in student demographics at individual medical schools. Institutions that have proven to be successful in recruiting diverse medical school classes could serve as a model for other schools looking to improve medical student diversity.

No dislosures

Citation:

Boatright DH, Samuels EA, Cramer L, et al. Association Between the Liaison Committee on Medical Education’s Diversity Standards and Changes in Percentage of Medical Student Sex, Race, and Ethnicity. JAMA.2018;320(21):2267–2269. doi:10.1001/jama.2018.13705

Dec 5, 2018 @ 12:58 pm 

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