Author Interviews, Boehringer Ingelheim, FDA, Pulmonary Disease, Rheumatology / 03.04.2018

MedicalResearch.com Interview with: Dr. Thomas Leonard, Ph.D. Executive director, Clinical Development and Medical Affairs, Specialty Care Boehringer Ingelheim MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by systemic sclerosis? What are the disease symptoms and manifestations? Response: The FDA recently granted Fast Track designation to nintedanib for the treatment of systemic sclerosis with interstitial lung disease (SSc-ILD) – paving the way for Boehringer Ingelheim to take an important step in advancing this potential therapy for those affected by this disease. The designation was based on Boehringer Ingelheim’s Investigational New Drug application (IND) and the anticipated efficacy and safety data from SENSCIS™ (Safety and Efficacy of Nintedanib in Systemic SClerosIS), a double-blind, randomized, placebo-controlled global Phase III trial which is fully enrolled and includes more than 520 patients from 32 countries. The FDA’s Fast Track designation facilitates the development of new therapies that treat serious conditions and fulfill an unmet medical need in an effort to get treatments to those in need sooner, like those living with systemic sclerosis. Systemic sclerosis, also known as scleroderma, is a rare disease characterized by thickening and scarring of connective tissue of multiple organs in the body, typically affecting women between ages 25 and 55. Most people with the disease will develop some degree of lung scarring, or interstitial lung disease (ILD), which is the leading cause of death among people with systemic sclerosis. Nintedanib, currently marketed as Ofev®, is approved for treatment of a rare lung disease called idiopathic pulmonary fibrosis, or IPF, and has been shown to slow disease progression as measured by annual rate of decline in lung function. Because SSc-ILD and IPF share similarities in how the underlying lung scarring, or fibrosis, forms in people with the disease, Boehringer Ingelheim is evaluating the impact of nintedanib on SSc-ILD. (more…)
Author Interviews, CMAJ, Heart Disease, Technology / 03.04.2018

MedicalResearch.com Interview with: Benjamin Hibbert MD PhD FRCPCz Interventional Cardiologist Clinician Scientist and Assistant Professor CAPITAL Research Group Vascular Biology and Experimental Medicine Laboratory University of Ottawa Heart Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: When we designed the study in 2014 we were routinely using the modified allen's test (MAT) to screen patients for transradial access for coronary angiography and PCI. We all had iPhones and we started using the HeartRate monitoring application as a photoplethysmograph. Quite quickly we found that using the application was simple, worked well and because we always had our iPhone with us we tended to use it more often. That being said - we wanted to test it in a scientifically rigorous method and thus we elected to perform an RCT to evaluate it's diagnostic accuracy. smart app measures blood flowThe current study is the first to use the photoplethysmographic capabilities of smartphones to assess blood flow - in this case in the hand to assess for blockages in arteries before accessing them for a procedure. The hand is supplied by two arteries - the radial artery and the ulnar artery. In many cases in medicine we use the radial artery, whether it be placing a catheter to monitor blood pressure, as a method of getting to the heart for angioplasty and in coronary artery bypass grafting it is removed and used as a bypass to restore blood flow to the heart. In many instances doctors assess the patency of the ulnar artery to decided if they are going to use the radial artery for a procedure - the concept being that if the ulnar is compromised and we use the radial then the hand can develop complications from not enough blood flow. To determine if a patient is eligible doctors would use a bedside physical exam test called the modified Allen's test in which they occlude both arteries to cause the hand to turn white. They then release pressure on the ulnar letting blood only pass through this vessel to see if the hand turns pink. However, there is a lot of variability in what doctors consider to be abnormal and determining if the test is positive can depend on numerous factors including skin tone, the amount of pressure applied and the size of the vessels. (more…)
Author Interviews, Surgical Research / 02.04.2018

MedicalResearch.com Interview with: Michael Sawyer, MD, FACS General Surgeon Comanche County Memorial Hospital Lawton, Oklahoma  MedicalResearch.com: What is the background for this study?   Response: Repair of complex incisional hernias is a challenging surgical task. Abdominal wall surgeons are utilizing advanced abdominal wall reconstruction (AWR) techniques including myofascial advancement flap creation with reinforcement by biologic or synthetic prostheses with greater frequency. Numerous synthetic or biologic surgical mesh products are currently available to reinforce these soft tissue repairs. Each type of biologic or synthetic material has its own advantages and limitations. OviTex Reinforced BioScaffolds (RBSs) are unique in that they interweave polymer in a custom "lock-stitch" pattern through layers of biologic tissue in an embroidered construction, aiming to incorporate the salutary properties of both biologic and synthetic repair materials. The biologic material, derived from ovine rumen, has been optimized to minimize foreign body response and enables functional tissue remodeling. The polymer provides additional strength, along with improved handling and load‑sharing capability. (more…)
Author Interviews, Cannabis, JAMA, Opiods / 02.04.2018

MedicalResearch.com Interview with: Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Marijuana is one of the potential, non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Medical and adult-use marijuana laws, has made marijuana available to more Americans. Yet no study to date has focused on the effect of medical and adult-use marijuana laws on opioid prescribing in particular. Our study provides some of the first empirical evidence that the implementation of medical and adult-use marijuana laws between 2011 and 2016 was associated with lower opioid prescribing rates and spending among Medicaid enrollees.   (more…)
Author Interviews, Gender Differences, JAMA, Surgical Research / 02.04.2018

MedicalResearch.com Interview with: Neel Mansukhani, MD Department of Surgery Northwestern University and Melina R. Kibbe, MD, FACS, FAHA Colin G. Thomas Jr. Distinguished Professor and Chair Department of Surgery Professor, Department of Biomedical Engineering The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7050 Editor in Chief, JAMA Surgery  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: This study is a follow-up to our previous work that examined sex bias in surgical research. Previously, we examined sex bias in basic and translational science surgical research, as well as in clinical surgical research. We discovered previously that sex bias exists in basic and translational surgical research in the unequal inclusion of male and female research subjects. In clinical research, we found sex bias in the degree of sex matching of included subjects, and in the frequency of sex-based reporting, analysis, and discussion of the data. In this current work, we sought to understand the effect of author gender on sex bias in surgical research. In this work, we found that most authors are male, most authors work with other authors of the same gender, and sex bias is prevalent regardless of author gender. Most importantly, we found that sex inclusive research receives more citations after publication compared to sex-biased research.  (more…)
Author Interviews, Cannabis, JAMA, Opiods / 02.04.2018

MedicalResearch.com Interview with “Cannabis sativa” by Manuel is licensed under CC BY 2.0 David Bradford, Ph.D. Busbee Chair in Public Policy Department of Public Administration and Policy University of Georgia Athens, GA 30602 MedicalResearch.com: What is the background for this study? Response: To give you some background, in 2016, part of our research team (Bradford and Bradford) published the first study to directly examine the impact that medical cannabis laws (MCLs) may be having on prescription use. We used yearly physician-level Medicare Part D data, looked at nearly all prescription drugs used to treat 9 broad categories of illness/diagnoses, and found substantial reductions in prescriptions. We published a follow-up study in 2017, this time using data from Medicaid Fee-for-Service. Again, we found significant substitution away from prescription medications. In both of these studies, pain was included in the list of conditions for which cannabis may be used in patients, and in both studies, pain prescriptions fell. One of the unanswered questions from both of those studies, though, was what *type* of pain medications were being reduced.  From a public health standpoint, when we're worried about opioid overdose, it matters whether the substitution away from pain medications is coming from substitutions away from things like NSAIDs or whether there is substitution away from opioids. (more…)
Author Interviews, Cost of Health Care, Pediatrics, Sexual Health / 02.04.2018

MedicalResearch.com Interview with: Dr. Xiangming Fang, PhD Associate professor of Health Management and Policy School of Public Health Georgia State University MedicalResearch.com: What is the background for this study? Response: Child sexual abuse is a serious public health problem in the United States. The estimated prevalence rates of exposure to child sexual abuse by 18 years old are 26.6 percent for U.S. girls and 5.1 percent for U.S. boys. The effects of child sexual abuse include increased risk for development of severe mental, physical and behavioral health disorders; sexually transmitted diseases; self-inflicted injury, substance abuse and violence; and subsequent victimization and criminal offending. (more…)
Author Interviews, PLoS / 30.03.2018

MedicalResearch.com Interview with: Ksenija Marinkovic and Lauren Beaton Psychology Department - College of Sciences Spatio-Temporal Brain Imaging Lab Center for Clinical and Cognitive Neuroscience San Diego State University San Diego CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In general, we subjectively perceive our actions to be under our deliberate and voluntary control. However, our results are consistent with other accruing evidence suggesting that a large portion of our behavior is automatic and not accessible to conscious experience. The automatic processing primarily underlies predictable daily routines when we seem to be on an “auto-pilot”. In contrast, situations that are ambiguous or that evoke incompatible response tendencies engage cognitive control which allows conscious override of the preplanned actions and results in flexible behavior. Our study used a multimodal imaging approach that combines perfect time sensitivity of magnetoencephalography (MEG) with structural magnetic resonance imaging (MRI) to investigate spatio-temporal stages of the seamless interplay between automatic and controlled processing. MEG is a highly sensitive method that records magnetic fields generated by the brain’s neural activity in real time. Young, healthy, participants performed a version of the Eriksen Flanker task, which presents two colored squares on either side of a centrally presented target square that appears after a short delay. Participants are instructed to press a button corresponding to the color of the target square in the middle and to pay no attention to the flankers. Although participants know that the flankers are irrelevant, they are unable to disregard them deliberately. Instead, flankers trigger an automatic preparation to respond. This is particularly apparent on mismatch trials on which the flanker color is misleading and it activates the wrong hand. Target appearance overrides the initial automatic response as the response plan is switched to the other hand to make a correct response. This process reflects recruitment of cognitive control or the decision-making capacity which includes a range of functions such monitoring contextual demands, selecting the correct response, and suppressing an automatic but irrelevant action. Our multimodal MEG imaging method has allowed us to track the neural response as the brain prepares an incorrect response to flankers and then “switches” motor preparation between hemispheres. This approach makes it possible to investigate the interplay between automatic and controlled processing and dissect decision making as it unfolds. The addition of a moderate dose of alcohol dysregulates this frontal network involved in motor decision making, which decreases accuracy when response conflict is present and lowers neural activity reflecting cognitive control. Related to this overall decrease, and of clinical importance, is the reduced ability to employ cognitive control to refrain from drinking excessively. However, the underlying patterns of response-switching were preserved under alcohol, suggesting that alcohol primarily induces deficits upstream during decision making and not during executing motor commands.  (more…)
Author Interviews, Dental Research, Pediatrics, Sugar / 29.03.2018

MedicalResearch.com Interview with: “Caries” by COM SALUD Agencia de comunicación is licensed under CC BY 2.0Teresa A. Marshall, PhD Professor in the Department of Preventive and Community Dentistry University of Iowa College of Dentistry Iowa City MedicalResearch.com: What is the background for this study? Response: Dental caries is a process during which oral bacteria ferment carbohydrates to produce acid. The acid demineralizes enamel and/or dentin at the tooth surface leading to white spots and eventually cavitation in the tooth. Added sugars – those not naturally present in foods or beverages, but rather added during processing – are the primary type of carbohydrate associated with caries. Sugar-sweetened beverages (SSBs; beverages with added sugars) are the food/beverage category most associated with dental caries. Historically, fluoride has protected against caries through remineralization of the enamel. However, there has been some question as to whether fluoride’s ability to protect against caries is overwhelmed by the quantity of added sugars currently consumed. Oral hygiene behaviors – brushing and flossing – are thought protect against caries by disrupting the oral bacteria on the tooth. Most studies have investigated dietary factors and caries during early childhood, with less attention paid to caries during adolescence. Our objective was to identify associations between longitudinal beverage intakes and adolescent caries experience, while also considering fluoride intake and tooth brushing behaviors. We followed a group of children from birth through age 17 years; during this time period, we looked at their beverage intakes, fluoride intakes and brushing behaviors every 3-6 months. We calculated their average milk, 100% juice, SSB, water/water-based beverage and fluoride intakes from 6 months through 17 years, and daily tooth brushing from 1 through 17 years. (more…)
AACR, Author Interviews, Cancer Research, Hepatitis - Liver Disease / 29.03.2018

MedicalResearch.com Interview with: Dr. Monica Kasting PhD first author Dr. Anna Giuliano PhD Susan. T. Vadaparampil, Ph.D., M.P.H. Senior Member/Professor Center for Infection Research in Cancer H. Lee Moffitt Cancer Center, Tampa, Florida.Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, Florida  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In the U.S., approximately 1 in 30 baby boomers are chronically infected with hepatitis C virus. Half of all cases of liver cancer are caused by hepatitis C and liver cancer is one of only three cancer types that are actually increasing in incidence in the US. Because of this, in 2012 the CDC issued a recommendation for universal screening for hepatitis C virus for everyone born between 1945 and 1965 (baby boomers). We wanted to look at the time period after that to see if the rates of screening in that population increased. From 2013-2015 screening among baby boomers only increased by 0.9% (from 11.8% to 12.7%) which indicates we still have a long way to go before we meet our goal of universal screening.  (more…)
Aging, Author Interviews, Circadian Rhythm, Sleep Disorders / 29.03.2018

MedicalResearch.com Interview with: “Woman sleeping” by Timothy Krause is licensed under CC BY 2.0Dr Gurprit S. Lall BSc, MSc, PhD, PGCHE, FHEA Medway School of Pharmacy Interim Deputy Head of School Senior Lecturer in Pharmacology Director of Graduate Studies (Research), University of Kent at Medway Chatham Maritime, Chatham, Kent MedicalResearch.com: What is the background for this study? What are the main findings? Response: Medical advancement in prevention and diagnosis of disease has increased life expectancy significantly, thus generating an ageing population far greater than previously seen.  Because of this, it is essential that we begin to understand the ageing process, together with the health implications associated with senescence.  Recent research has found that changes in the circadian clock, located in the brain, play a contributing role in the decline of many physiological and behavioural traits observed through the ageing process.  One example of this, which is commonly seen in the elderly is a decline in sleep-wake cycle regulation; typically presenting as disrupted sleeping patterns. The circadian clock, in mammals, possesses the ability to integrate our social lifestyle choices with the environmental day-night cycle to generate a 24-hour rhythm to which our physiological functions are synchronised.  It is this synchronisation that plays a vital role in regulating many of our behavioural outputs, such as sleeping-wake patterns.  This clock takes its strongest timing cue from the natural day night cycle governed by the duration of daily sunlight. Our study investigated the changes in the interpretation of this light signal by the circadian clock as we age and its impact on function.  We found that the clock became less responsive to light stimuli at both the level of clock cells and at driving behavioural activity.  We were able to narrow this down to changes in the proteins within cells that relay light information to the molecular time setting machinery.  In detail, light signals are relayed to the clock through an excitatory neurotransmitter called glutamate and this signal is predominantly relayed through NMDA receptors located on the surface of clock cells.  It is the configuration of the NMDA receptor that alters as we age and this leads to the clock becoming less responsive to light. (more…)
Author Interviews, CDC, HIV, Sexual Health / 29.03.2018

MedicalResearch.com Interview with: Sonia Singh, PhD, Epidemiologist Division of HIV/AIDS Prevention CDC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: HIV infection is a persistent health concern in the United States, particularly for people at high risk of infection such as gay and bisexual men. We used data from the National HIV Surveillance System to estimate HIV incidence and prevalence and the percentage of undiagnosed HIV infections overall and among gay and bisexual men. Estimated HIV incidence declined nearly 15% overall in the U.S. from an estimated 45,200 infections in 2008 to 38,500 in 2015. Estimated HIV incidence declined for both males (9%) and females (33%) over this period. Estimated HIV incidence declined 32% among heterosexuals, 42% among people who inject drugs and 20% among gay and bisexual men who also inject drugs. Estimated HIV incidence remained relatively stable among gay and bisexual men; however, it increased over 25% among Latino gay and bisexual men, almost 45% among gay and bisexual men ages 25 to 34 and 30% among gay and bisexual men ages 55 and older. The percentage of undiagnosed HIV infections decreased nearly 20%, from 18.1% in 2008 to 14.5% in 2015. The percentage of undiagnosed HIV infections among gay and bisexual men declined 21.6%, from 21.3% in 2008 to 16.7% in 2015. In 2015, the percentage of undiagnosed HIV infections was highest among gay and bisexual males ages 13-24 (52.2%) compared to other age groups and higher among Latino (20.1%) and African American (19.6%) gay and bisexual men, as well as Asian gay and bisexual men (20.5%), compared to white gay and bisexual men (11.9%). (more…)
AHA Journals, Author Interviews, Stroke, Surgical Research / 29.03.2018

MedicalResearch.com Interview with: J.H.L. Mulder, MD PhD Neurology resident Erasmus MC  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current information about safety and efficacy of endovascular treatment (EVT) for acute ischemic stroke is primarily derived from patients treated in the setting of a randomized controlled trial. However, inherent to this setting, external validity of the results can be jeopardized by patient selection and intensive monitoring. Therefore, an important question remained unanswered: could the positive effect of endovascular treatment be reproduced in standard clinical practice?  (more…)
Author Interviews, JAMA, Schizophrenia / 29.03.2018

MedicalResearch.com Interview with: Silvana Galderisi MD President of the European Psychiatric Association Professor of Psychiatry University of Campania "Luigi Vanvitelli" Italy MedicalResearch.com: What is the background for this study? Response: The goal of schizophrenia treatment has gradually shifted from reduction of symptoms and prevention of relapse to improvement of real-life functioning. In fact, these outcomes not always coincide and, in spite of progress in treatments reducing symptoms and preventing relapses, people with schizophrenia live 15-20 years less than the general population, are often unemployed, and show severe disabilities. Enhanced understanding of factors associated with real-life functioning is instrumental to design effective integrated and personalized treatment plans for persons with schizophrenia. To this aim, the Italian Network for Research on Psychoses, including 26 twenty-six Italian university psychiatric clinics and/or mental health departments, has focused on the identification of variables influencing real-life functioning, in particular on the interrelationships among illness-related variables, personal resources, context-related variables and real-life functioning. The number of variables and subjects included in the study was larger than in any other study on this topic, and for the first time the network analysis was used to model the interplay among cognitive, psychopathological and psychosocial variables in a large sample of community dwelling subjects with schizophrenia. The network analysis is a data-driven approach; it does not rely on an a priori model of relationships among variables, provides quantitative measures of variable centrality within the network, thus indicating which variables play a key role in the network, and which ones are instead more peripheral. In addition, by inspecting the network, it is possible to understand the extent to which variables belonging to the same construct are connected, and how different constructs are mutually interacting and reinforcing each other.  (more…)
Author Interviews, Blood Pressure - Hypertension, Dermatology, NIH / 29.03.2018

MedicalResearch.com Interview with: Dr. Beth Kozel M.D. Ph.D The Laboratory of Vascular and Matrix Genetics LASKER CLINICAL RESEARCH SCHOLAR NIH MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elastin is a protein that allows the blood vessels to stretch and recoil. It is made as a child grows but once the child reaches adolescence, the body stops making elastin. With age, the body slowly begins to lose elastin and blood vessels become less flexible. In order to study what happens when a vessel has less elastin, we used a mouse that makes half of the normal amount of elastin, the Eln+/- mouse. These mice have higher blood pressure, stiffer blood vessels and decreased blood flow to end organs such as the brain. We then used a blood pressure medication, minoxidil (this same medicine when used in topical form helps hair growth), and treated mice from weaning until 3 months of age. With treatment, Eln+/- blood pressure was lower, the vessels were less stiff and blood flow to the brain increased. That effect remained for weeks after the medication was stopped. Additional studies showed that more elastin was present in the vessel wall after treatment and more than 100 other connective tissue genes were also changed, suggesting vessel remodeling. Minoxidil works by causing cells in the blood vessel to relax, leading to a more open, or dilated artery. When taken chronically, our data suggest that the connective tissue associated with a blood vessel remodels, fixing it in a more open state and allowing better blood flow to the organ on the other side, in this case, the brain. (more…)
Author Interviews, Memory, Technology / 28.03.2018

MedicalResearch.com Interview with: Robert E. Hampson, PhD Professor, Physiology & Pharmacology School of Medicine Wake Forest MedicalResearch.com: What is the background for this study? What are the main findings? Response: There are many diseases and injuries that affect human memory, and many types of memory deficits, from inability to recall stored memories to the inability to make new memories.  We focused on problems with making new memories, and identifying the brain activity associated with those memories.  We found that we could identify when the brain formed "codes" for new memory, and when those codes were incorrect or faulty.  By identifying what both "strong" and "weak" naturally occurring codes should be, we influence the process to strengthen the weak codes, resulting in better memory. (more…)
Author Interviews, Opiods, Pediatrics / 28.03.2018

MedicalResearch.com Interview with: http://www.phc4.org/reports/researchbriefs/neonatal/17/ Joe Martin Executive Director PA Health Care Cost Containment Council Commonwealth of Pennsylvania Harrisburg, PA 17101 MedicalResearch.com: What is the background for this study? Response: Several years ago, our agency noted that while mortality data for opioid addition was being reported, it did not include hospitalizations where death did not occur.  We believed our agency could make a valuable contribution to the data by beginning to report that.  We began with adults hospitalized in PA for opioid addiction, and supplemented that over time with reporting about maternity cases and newborns. Today’s report covers babies born with neonatal abstinence syndrome. (more…)
Author Interviews, Ophthalmology, Stem Cells, Stroke / 28.03.2018

MedicalResearch.com Interview with: Steven Levy MD CEO, MD Stem Cells Study Director, Stem Cell Treatment Studies MedicalResearch.com: What is the background for this study? Response: MD Stem Cells is the sponsor of the Stem Cell Ophthalmology Treatment Study II (SCOTS 2) the largest stem cell study currently addressing retinal and optic nerve disease (NCT 03011541). SCOTS uses autologous bone marrow derived stem cells (BMSC) typically provided to the eyes by combining retrobulbar, subtenons and intravenous injections. Many retinal and optic nerve diseases are eligible including Retinitis Pigmentosa (RP), Age Related Macular Degeneration (AMD), Stargardts, Ushers, Glaucoma, Ischemic Optic Neuropathy, Optic Atrophy and others. Statistically significant improvements have been documented in key diseases and positive responses have been noted across most conditions treated. Mechanisms of action may include differentiation of the CD34 cells into neurons, secretion of neurotrophic factors, transfer of mitochondria and release of mRNA. These may benefit existing stressed cells as well as provide replacement of damaged or absent cells. (more…)
AACR, Author Interviews, Microbiome, NYU, Pancreatic / 28.03.2018

MedicalResearch.com Interview with: Mautin Hundeyin MD Post-doctoral Research Fellow George Miller, MD is Principal Investigator and Director of the S. Arthur Localio Laboratory in the Department of Surgery at NYU School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pancreatic ductal adenocarcinoma (PDA) is the devastating disease with grim prognosis. The microbiome has emerged as a contributor to oncogenesis in a number of intestinal tract malignancies. We found that PDA is associated with a distinct stage-specific gut and pancreatic microbiome that drives disease progression by inducing intra-tumoral immune suppression. Targeting the microbiome protects against oncogenesis, reverses intra-tumoral immune-tolerance, and enables efficacy for check-point based immunotherapy. These data have implications for understanding immune-suppression in pancreatic cancer and its reversal in the clinic.  (more…)
Author Interviews, Ophthalmology, Technology / 28.03.2018

MedicalResearch.com Interview with: Dr. Caroline A. Blackie, OD PhD FAAO Medical Director, Dry Eye Johnson & Johnson Vision MedicalResearch.com: What is the background for these studies? Would you briefly explain the problem of dry eye, how common it is and why it is difficult to treat?  Response: Dry eye disease is a condition where the eyelids and/or the tear film are unable to protect the ocular surface from the negative effects of desiccating stress. If left untreated, a vicious cycle ensues resulting in a broad spectrum of sequelae, including ocular discomfort and compromised vision. The result is partial or pervasive reduced quality of life for the individual along with a significant economic burden on our society. Conversely, when the ocular surface is healthy, patients feel better, see better and live better. Meibomian gland health is essential for ocular surface health. Meibomian glands secrete the oils necessary to protect the ocular surface from the negative effects of desiccating stress. Predictably, meibomian gland dysfunction (MGD) is a leading cause of dry eye disease. MGD is almost always the result of thickened and stagnated gland secretions. These stagnated secretions obstruct and/or limit the flow of functional oil into the tear film. MGD is the most common form of dry eye disease and is also known as evaporative dry eye. While management of dry eye in general can be complex, the management of MGD affords a relatively straightforward approach, which is to improve meibomian gland function by treating obstruction. Dry eye disease is pretty common – more than 340 million people suffer from it globally. Short-term management of dry eye involves improving signs and symptoms of the condition, including the use of tear supplementation and reducing ocular surface inflammation. Long-term dry eye management requires that the cause (or causes) of the condition is also diagnosed and treated. That cause is often MGD, and MGD can be successfully managed with LipiFlow®.  (more…)
Author Interviews, Compliance, Kidney Disease, Transplantation / 27.03.2018

MedicalResearch.com Interview with: Bethany J. Foster, MD MSCE Montreal Children’s Hospital Department of Pediatrics, Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada MedicalResearch.com: What is the background for this study? Response: Adolescent and young adult kidney transplant recipients have the highest risk of graft loss of any age group. One of the main reasons for this is not taking their anti-rejection medications as prescribed. Our study had the goal of testing an intervention to try to improve young patients' adherence to their strict medication schedule. The intervention included feedback of how well they were taking their medications (which was monitored electronically), text message reminders for medication doses, and individualized coaching to address their personal barriers to taking their medications. (more…)
Author Interviews, Global Health, Weight Research / 27.03.2018

MedicalResearch.com Interview with:

Pepita Barlow, MSc, Department of Sociology University of Oxford, Manor Road Building, Manor Road, Oxford, United Kingdom 

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

Response: The escalating global prevalence of overweight and obesity, or “globesity,” is often described as a pandemic. Globalization via free trade agreements (FTAs) with the US has been implicated in this pandemic because of its role in spreading high-calorie diets rich in salt, sugar, and fat through the reduction of trade barriers like tariffs in the food and beverage sector.  

We used a “natural experiment” design (that mimics a randomized controlled trial as closely as possible) and data from the United Nations Food and Agricultural Office to evaluate the impact of the 1989 Canada-US Free Trade Agreement on caloric availability in Canada (CUSFTA).  

We found that CUSFTA was associated with an increase in caloric availability and likely intake of approximately 170 kilocalories per person per day in Canada. Additional models showed that this rise in caloric intake can contribute to weight gain of between 1.8-9.3 kg for men and 2.0-12.2 kg for women aged 40, depending on their physical activity levels and the extent to which availability affects caloric intake.  (more…)

Alzheimer's - Dementia, Author Interviews, JAMA, Parkinson's / 27.03.2018

MedicalResearch.com Interview with: Benjamin Dawson, B.Sc. MD Candidate 2020 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dementia in Parkinson’s Disease is one of its most feared complications, and may happen eventually to most patients if they reached advanced age. Identifying those at especially high risk of dementia has important potential implications - it would facilitate clinical counselling, it has treatment implications (e.g. knowing a person is likely to get dementia in the near future would probably steer you away from certain medications and towards others).  Most critically, it can help select patients for trials to prevent dementia. While several factors that show high risk for dementia in Parkinson’s disease have previously been described, these have yet to shape patient-care, either because they are not very strong predictors, or they are not user-friendly.  So, we designed a very simple clinical screening tool, called the Montreal Parkinson’s Risk of Dementia Scale (MoPaRDS).  It took predictors of dementia that were established from large-scale studies and boiled them down into a simple 8-point scale that uses information that you can get in a simple office visit.  The 8 predictors were being over 70, being male, having a blood pressure drop with standing, showing early mild cognitive changes, having a symmetric bilateral disease (that is, one side not clearly worse than the other), experiencing falls or freezing, having experienced hallucinations, and having symptoms of REM sleep behavior disorder ('acting out' the dreams at night). When we tested the scale in a combined cohort of 607 patients with Parkinson’s (of whom 70 developed dementia over mean follow-up of 4.4-years) a positive MoPaRDS screen (≥4 out of 8 items) identified 14-fold increased risk of dementia compared to a negative screen. We recommend dividing the scale into three categories; low-, intermediate- and high-risk. Those in the highest score group (MoPaRDS, 6-8) had a 14.9% risk of developing dementia each year, while those with the lowest scores (MoPaRDS, 0-3) had only 0.6% annual risk.  So, these simple measures can be pretty powerful predictors of dementia. (more…)
Author Interviews, Education / 27.03.2018

MedicalResearch.com Interview with: “Classroom” by frankjuarez is licensed under CC BY 2.0Dr Anna Mazenod Institute of Education University of London UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this paper we report baseline findings from a large study of grouping practices in state-funded secondary schools in England. The study seeks to improve our understanding of how students are grouped for their English and mathematics classes, and the potential impact of different grouping practices on student outcomes and experiences of schooling. This paper draws on a survey of 597 teachers and 34 teacher interviews in schools where students are grouped by their attainment for the subject. It focuses on teacher perspectives on teaching and learning in the lower attainment groups. We found that students in the lower attainment groups were typically constructed as learners who benefit from specific approaches to learning justified through discourses of nurturing and protection. Most teachers felt that students in the lower attainment groups were not able to access learning independently from their teachers in comparison with their peers in the higher attainment groups. Some teachers for example described students in the lower attainment groups as ‘more dependent on people’ and students in the higher attainment groups as ‘independent learners.’ (more…)
Author Interviews, Breast Cancer, Chemotherapy, JAMA, Novartis / 26.03.2018

MedicalResearch.com Interview with: Melanie E. Royce, MD, PhD Division of Hematology/Oncology University of New Mexico Comprehensive Cancer Center Albuquerque MedicalResearch.com: What is the background for this study? What are the main findings? Response: BOLERO-4 is an open label, single-arm, Phase II study that evaluates the combination of everolimus plus letrozole as a first-line treatment for hormone receptor (HR)-positive/human epidermal growth factor receptor (HER2)-negative advanced breast cancer patients, as well as the use of everolimus plus exemestane beyond initial progression. Results of the BOLERO-4 trial published in JAMA Oncology showed that everolimus in combination with endocrine therapy is an effective first-line treatment option for postmenopausal women with HR+/HER2- advanced breast cancer. A total of 202 patients received everolimus in combination with letrozole as first-line treatment between March 7, 2013 and December 17, 2014. Median progression-free survival (PFS) in the first-line setting was 22.0 months (95% CI 18.1-25.1) with an overall response rate of 45% (95% CI 38.1-52.2) and clinical benefit rate of 74% (95% CI 67.7-80.1). A total of 152 (75%) discontinued treatment, primarily due to disease progression (51%) or adverse events (16%). Data from a smaller number of patients in BOLERO-4 also show limited efficacy with continued everolimus, combined with exemestane, following disease progression. Second-line treatment was ongoing in 16 (32%) patients, while 34 (68%) had discontinued. The most frequent reason for second-line treatment discontinuation was disease progression (56%). In the second-line setting, median PFS was 3.7 months (95% CI 1.9-7.4) with an overall response of 6% (95% CI 1.3-16.5) and clinical benefit rate of 28% (95% CI 16.2-42.5). Safety findings from BOLERO-4 are consistent with previous studies of Afinitor in advanced breast cancer. The most common (≥ 20% incidence) first-line all-grade adverse events were stomatitis (69%), weight loss (44%), nausea (37%) and anemia (35%). Most were ‘low grade’ in severity (grade 1 or 2) and generally well managed. Safety findings show the most common (≥ 10% incidence) second-line adverse events were stomatitis (20%) and weight loss (20%). Lower rates of stomatitis in second-line were noted.  (more…)
Author Interviews, Environmental Risks, Pediatrics, Toxin Research / 26.03.2018

MedicalResearch.com Interview with: Dr. Hernan F. Gomez MD Department of Emergency Medicine, Hurley Medical Center Flint, MI Department of Emergency Medicine, University of Michigan Ann Arbor, MI  MedicalResearch.com: Why did you decide to do this study? Response: Although the Flint water crisis drew recent, national attention to childhood lead exposure, environmental lead exposure has been a longtime, widespread problem in the United States. I have recollections of far higher blood lead levels in children during my training as a young pediatrician in an economically challenged city with roughly the same population as Flint. As a medical toxicologist I have not seen any children with lead levels requiring medical treatment in years. The last time a child required inpatient chelation treatment for elevated lead levels in Flint was during the 1980s. (more…)
Author Interviews, CDC, Infections, JAMA / 26.03.2018

MedicalResearch.com Interview with: Dr. Katherine Fleming-Dutra, MD, senior author Deputy Director Office of Antibiotic Stewardship CDC MedicalResearch.com: What is the background for this study? What are the main findings? Response: As noted in a previous study, antibiotics are prescribed more for sinus infections than any other illness in the United States. We found that almost 70% of antibiotic prescriptions were for 10 days or longer, whereas 5-7 days is recommended for most patients when antibiotics are needed. In addition, more than 20% of antibiotic prescriptions for sinus infections were for 5 days of azithromycin, even though guidelines recommend against prescribing azithromycin for sinus infections. (more…)