Author Interviews, Heart Disease, JAMA, Race/Ethnic Diversity, Technology / 27.01.2017

MedicalResearch.com Interview with: Lucas Marzec MD Instructor of Medicine Section of Cardiac Electrophysiology Division of Cardiology University of Colorado School of Medicine Aurora, CO 80045 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The addition of cardiac resynchronization therapy (CRT) to an implantable cardioverter defibrillator (ICD) reduces the risk of mortality and heart failure events in select patients with left ventricular systolic dysfunction. Given these benefits, it is important to ensure patients who have a guideline recommendation for CRT are considered for this therapy at the time of ICD implantation. Previously, little data were available on the contemporary use of CRT among guideline eligible patients undergoing ICD implantation. Although ICDs alone reduce the risk of mortality in patients with heart failure and reduced systolic function, prior work shows these devices are not uniformly provided to eligible patients and that rates of ICD implantation vary widely by hospital. Prior to our study, it was unknown whether similar variation in the use of the combination of ICD and CRT (CRT-D) exists. We analyzed data from the National Cardiovascular Data Registry (NCDR) ICD Registry to identify patient, provider, and hospital characteristics associated with CRT-D use and to determine the extent of hospital level variation in the use of CRT-D among patients eligible for CRT undergoing implantation of an ICD. (more…)
Author Interviews, OBGYNE, Pediatrics, PLoS, Weight Research / 27.01.2017

MedicalResearch.com Interview with: Dr Rebecca Richmond PhD Senior Research Associate in the CRUK Integrative Cancer Epidemiology Programme MRC Integrative Epidemiology Unit School of Social and Community Medicine University of Bristol MedicalResearch.com: What is the background for this study? What are the main findings? Response: We have been involved in earlier work which applied the same methods used here (using genetic variants to provide causal evidence) and showed that higher maternal pregnancy body mass index (BMI) causes greater infant birth weight. The paper here aimed to build on that earlier research and asked whether maternal BMI in pregnancy has a lasting effect, so that offspring of women who were more overweight in pregnancy are themselves likely to be fatter in childhood and adolescence. Our aim was to address this because an effect of an exposure in pregnancy on later life outcomes in the offspring could have detrimental health consequences for themselves and future generations. However, we did not find strong evidence for this in the context of the impact of maternal BMI in pregnancy on offspring fatness. (more…)
Author Interviews, Diabetes, Heart Disease, JACC, Stanford / 27.01.2017

MedicalResearch.com Interview with: Fumiaki Ikeno M.D. Program Director (U.S.) Japan Biodesign Stanford Biodesign Medical Director/Research Associate Experimental Interventional Laboratory Division of Cardiology Stanford University MedicalResearch.com: What is the background for this study? What are the main findings? Response: We sought to determine whether the extent of coronary disease in terms of the number of lesions and their complexity in Type 2 Diabetes patients could predict major cardiovascular events, and hypothesized that revascularization would have greater effectiveness relative to medical therapy among patients with more number of lesions and higher complexity in coronary artery disease. Coronary bypass surgery, catheter-based treatment, and medical therapy all had similar cardiovascular outcomes among patients with less complexity of coronary artery disease who had type 2 diabetes mellitus, stable ischemic heart disease, and no prior coronary revascularization. Among patients with mid or high complexity coronary artery disease, coronary revascularization with bypass surgery significantly reduced the rate of major cardiovascular events during 5 years of follow-up. (more…)
Author Interviews, Diabetes, Exercise - Fitness, Lifestyle & Health, Weight Research / 27.01.2017

MedicalResearch.com Interview with: Arch G. Mainous III, PhD HSRMP Department Chair Florida Blue Endowed Professor of Health Administration University of Florida Health MedicalResearch.com: What is the background for this study? Response: As our post-industrial society becomes more and more sedentary, there is a concern that a lack of activity is associated with poor health outcomes like diabetes. At the same time, the medical community has a strong focus on determining whether patients are overweight or obese as a way to classify them as  being at higher risk for poor health outcomes. However, individuals at a “healthy weight” in general, are considered to be at low risk. Some recent studies have shown that many individuals at “healthy weight” are not metabolically healthy. How then might we predict who at “healthy weight” would be unhealthy? We hypothesized that individuals at “healthy weight” who had a sedentary lifestyle would be more likely to have prediabetes or undiagnosed diabetes. (more…)
Author Interviews, JAMA, Mental Health Research, PTSD / 27.01.2017

MedicalResearch.com Interview with: David Mataix-Cols PhD Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council Stockholm, Sweden MedicalResearch.com: What is the background for this study? Response: Exposure-based Cognitive Behavior Therapy (CBT) is the treatment of choice for patients with anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorders. Some patients do not respond sufficiently to such treatment. This has led researchers to find ways to augment (enhance) CBT with pharmacological agents, such as D-cycloserine (DCS). Because CBT is such a powerful treatment for most patients, we suspected that the effects of DCS would probably be small. This means that very large samples of patients are needed to show statistically significant differences between groups. Previous studies and meta-analyses were underpowered to detect such small effects. Combining the raw data from all available studies to date gave us the power we needed to address the question of whether DCS is an efficacious augmenting strategy, over and above CBT. We also had a second research question. Previous research from our group had suggested that there may be undesirable interactions between DCS and antidepressants, whereby patients taking both types of drugs would have significantly worse outcomes (see Andersson et al JAMA Psychiatry. 2015 Jul;72(7):659-67. doi: 10.1001/jamapsychiatry.2015.0546). (more…)
Author Interviews, JAMA, Obstructive Sleep Apnea, Sleep Disorders / 27.01.2017

MedicalResearch.com Interview with: Dr. Alex Krist, MD MPH Task Force member Associate Professor Fairfax Family Medicine Residency Co-director, Ambulatory Care Outcomes Research Network Virginia Commonwealth University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Obstructive sleep apnea (OSA) has been found to be associated with serious health conditions, including heart disease and diabetes. Additionally, OSA can cause excessive daytime sleepiness, which can significantly impact a person’s quality of life, increase involvement in motor vehicle crashes, and lead to an increased risk of death. Estimates show that OSA affected between 10 and 15% of the U.S. population in the 1990s, and rates may have increased over the past 20 years, so the Task Force wanted to examine the evidence on screening adults without symptoms or symptoms for obstructive sleep apnea. (more…)
Author Interviews, Autism, Brigham & Women's - Harvard, Gastrointestinal Disease, Microbiome / 26.01.2017

MedicalResearch.com Interview with: Maria Rosaria Fiorentino, PhD Assistant Professor at Harvard Medical School Molecular Biologist at Mucosal Immunology and Biology Research Center Massachusetts General Hospital East Charlestown, MA 02129-4404 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Autism Spectrum Disorders (ASD) refers to complex neurodevelopmental disorders arising from the interaction of genes and environmental factors. There are no defined mechanisms explaining how environmental triggers can lead to these conditions. One hypothesis based on the gut-brain axis connection suggests that inappropriate antigens trafficking through an impaired intestinal barrier, followed by passage of these antigens through a permissive blood-brain barrier (BBB), can be part of the chain of events leading to the disease. Many Autism Spectrum Disorders children experience co-morbid medical conditions, including gastrointestinal (GI) dysfunctions whose underlying nature is poorly understood. Several clinical observations describe increased intestinal permeability in ASD with often conflicting findings. Permeability to neuroactive food antigens derived from the partial digestion of wheat (gliadorphins) and cow’s milk (casomorphins) has been reported in ASD. However, while evidence of a permeable gut barrier in ASD is increasingly reported, no information is available concerning a similar breach for the BBB. The BBB is a critical line of defense in the Central Nervous System, limiting the access of circulating solutes, macromolecules, and cells that could negatively impact neuronal activity. Dysfunctions of the BBB have been associated with numerous inflammatory neurologic disorders, such as stroke, epilepsy, multiple sclerosis, Parkinson’s and Alzheimer’s disease. (more…)
Author Interviews, Eating Disorders, PLoS, Weight Research / 26.01.2017

MedicalResearch.com Interview with: Dr Maria Kekic PhD Research Worker | The TIARA study: Transcranial magnetic stimulation and imaging in anorexia nervosa Section of Eating Disorders | Department of Psychological Medicine Institute of Psychiatry, Psychology & Neuroscience | King’s College London MedicalResearch.com: What is the background for this study?  What are the main findings? Response: Bulimia nervosa is an eating disorder characterised by repeated episodes of binge-eating and inappropriate compensatory behaviours. It is associated with multiple medical complications and with an increased risk of mortality. Although existing treatments for bulimia are effective for many patients, a sizeable proportion remain symptomatic following therapy and some do not respond at all. Evidence shows that bulimia is underpinned by functional alterations in certain brain pathways, including those that underlie self-control processes. Neuroscience-based techniques with the ability to normalise these pathways may therefore hold promise as treatments for the disorder. One such technique is called transcranial direct current stimulation (tDCS) – a form of non-invasive brain stimulation that delivers weak electrical currents to the brain through two electrodes placed on the head. It is safe and painless, and the most common side effect is a slight itching or tingling on the scalp. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, University of Pittsburgh / 26.01.2017

MedicalResearch.com Interview with: Sachin Yende, M.D., M.S., Associate professor University of Pittsburgh School of Medicine’s departments of Critical Care Medicine and Clinical and Translational and Vice president of Critical Care at the VA Pittsburgh. Florian B. Mayr, M.D., M.P.H. Faculty member in University of Pittsburgh Department of Critical Care Medicine and the Center for Health Equity Research and Promotion MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Centers for Medicare and Medicaid Services and the Veteran Health Administration currently track readmission rates for pneumonia, acute heart attacks, heart failure and chronic obstructive lung disease for quality purposes and pay for performance. In our study, we were able to demonstrate that unplanned readmissions after sepsis (defined as life threatening organ failure due to the body's response to an overwhelming infection) are more common than readmission for these other conditions stated above and associated with significant excess costs. (more…)
Author Interviews, Brain Injury, Cost of Health Care, CT Scanning, Electronic Records, Emergency Care, Kaiser Permanente / 25.01.2017

MedicalResearch.com Interview with: Adam L. Sharp MD MS Research Scientist/Emergency Physician Kaiser Permanente Southern California Kaiser Permanente Research Department of Research & Evaluation Pasadena, CA 91101 MedicalResearch.com: What is the background for this study? Response: Millions of head computed tomography (CT) scans are ordered annually in U.S. emergency Departments (EDs), but the extent of avoidable imaging is poorly defined. Ensuring appropriate use is important to ensure patient outcomes and limited resources are optimized. A large number of stake holders have highlighted the need to reduce “unnecessary” CT scanning as part of their recommendations for the Choosing Wisely campaign. However, despite calls for improved stewardship, the extent of avoidable CT use among adults with minor trauma in community EDs is not known. The Canadian CT Head Rule (CCHR) is perhaps the most studied of many validated decision instruments designed to assist providers in evaluating patients with minor head trauma. This study aims to describe the scope of overuse of CT imaging by ED providers in cases where application of the CCHR could have avoided imaging. Secondarily, we sought to describe the extent to which avoidable CTs, if averted, would have resulted in “missed” intracranial hemorrhages requiring a neurosurgical intervention. (more…)
Author Interviews, Electronic Records, Endocrinology, Thyroid, Thyroid Disease / 25.01.2017

MedicalResearch.com Interview with: Ilya Likhterov, MD Assistant Professor, Otolaryngology Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: As our understanding of thyroid cancer improves, the way these patients are diagnosed and treated is changing. It is difficult for clinicians to incorporate every individual scientific study into their practice. These studies are numerous and the results can be conflicting. To address this difficulty, organizations such as the American Thyroid Association (ATA) create summary recommendations that account for the latest research and translate it into a format that is easily usable for physicians. Such clinical practice guidelines are available not just for thyroid cancer care, but in many other fields. The difficulty however, is how to ensure that clinicians have access to the guidelines and incorporate the recommendations into their practice. There are a number of barriers to actually using the guidelines in practice, and we attempt to identify strategies on how to overcome these. (more…)
Author Interviews, Baylor College of Medicine Houston, OBGYNE, Outcomes & Safety / 25.01.2017

MedicalResearch.com Interview with; Dr. Amirhossein Moaddab Postdoctoral Research Fellow at Baylor College of Medicine Houston, Texas MedicalResearch.com: What is the background for this study? Response: Based on data from the Centers for Disease Control and Prevention, the United States maternal mortality ratio is three to four times higher than that of most other developed nations. Previous studies from the demonstrated a possible association between weekend hospital admissions and higher rates of mortality and poor health outcomes. We investigated differences in maternal and fetal death ratios on weekends compared to weekdays and during different months of the year. In addition we investigated the presence of any medical and obstetrics complications in women who gave birth to a live child and in their offspring by day of delivery. (more…)
Author Interviews, Cancer Research, Colon Cancer, JAMA, Surgical Research / 25.01.2017

MedicalResearch.com Interview with: Kangmin Zhu, PhD, MD John P. Murtha Cancer Center, Walter Reed National Military Medical Center Professor at the Uniformed Services University of the Health Sciences in the Department of Preventive Medicine and Biostatistics Bethesda, Maryland MedicalResearch.com: What is the background for this study? Response: An article published on JAMA Surgery in 2015 showed more utilization of chemotherapy among young colon cancer patients.  To demonstrate the study findings, we analyzed the data from the Department of Defense healthcare system, in which all members have the same level of access to medical care and therefore the potential effects of insurance status and types on research results can be reduced. MedicalResearch.com: What are the main findings? Response: The main findings were that young and middle-aged colon cancer patients were 2 to 8 times more likely to receive postoperative chemotherapy and 2.5 times more likely to receive multiagent regimens, compared with their counterparts aged 65 to 75 years.  However, no matched survival benefits were observed for the young and middle-aged among patients who received surgery and postoperative chemotherapy. (more…)
Author Interviews, Kidney Stones, Urology / 25.01.2017

MedicalResearch.com Interview with: Li Hao Richie Xu MD Division of Mineral Metabolism University of Texas Southwestern Medical Center Dallas, Texas, United States MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the past three decades, the prevalence of the kidney stones has escalated in the United States. Changes in dietary patterns, increasing body weight and obesity likely contributed to this significantly higher prevalence of kidney stone. In this study, we explored temporal changes in stone composition, demographic characteristics, and in serum and urinary kidney stone risk profile in kidney stone forming population for the last 35 years. The proportion of uric acid stones has been almost doubled during this period. Although age and body mass index (BMI) increased over time in both uric acid and calcium stone formers, uric acid stone formers were consistently older, had higher BMI, and lower urinary pH than calcium stone formers. In addition, over time, the proportion of female vs. male increased in calcium stone formers, but not in uric acid stone formers. The most significant urinary parameter differentiating uric acid stone formers from calcium stone formers is 24-hour urinary pH. (more…)
Author Interviews / 25.01.2017

MedicalResearch.com Interview with: Dr. Michael Agus MD Pediatric critical care specialist and endocrinologist Boston Children’s Hospital and Harvard Medical School and Dr. Vinay Nadkarni, MD Pediatric critical care specialist Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Controlling the blood sugar of a critically ill child while sick in the ICU has been the matter of much debate since the first trial appeared in 2001 suggesting there was substantial benefit in certain adult populations. Retrospective data in adults and children consistently and convincingly associate hyperglycemia with poor outcomes across a wide range endpoints, however, the question remains whether normalizing glucose levels changes those outcomes. As the data emerged from prospective trials specifically in children, the answer became less clear. We performed a large study of glucose control in critically ill children who had not had cardiac surgery, as this was group in which questions about best practice lingered. Our study showed that critically ill infants and children do not gain additional benefit from controlling their elevated blood sugars down to a lower target range of 80-110 mg/dL compared to a higher target range of 150-180 mg/dL. Patients treated in both target ranges had similar outcomes in virtually every parameter studied, including the primary outcome of ICU-free days up to day 28 (mortality-adjusted length of ICU stay), where both groups had the same number at 19.4 days. There were differences in severe hypoglycemia (<40 mg/dL) related to the protocol where those with the lower target range had a rate of 3.7% compared to 0.3% in the higher target range, and an increased rate of catheter-associated bloodstream infections (CABSI’s) was noted in the lower target range with 1.94 infections per 1,000 catheter days compared with none in the higher target range. On the other hand, empiric antibiotic use was significantly higher in the higher target range, at 96.8%, compared with 93.4% in the lower target range. No other intergroup differences were detected in mortality, severity of illness, seizures, or the need for CPR, ECMO, renal replacement therapy or transfusion. (more…)
Author Interviews, OBGYNE, Weight Research / 25.01.2017

MedicalResearch.com Interview with: Alan Peaceman, MD Professor and Chief of Maternal Fetal Department of Obstetrics and Gynecology Northwestern Feinberg School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Excess maternal weight gain during pregnancy is very common in the United States, and has been associated with a number of pregnancy complications, including gestational diabetes, maternal hypertension, excess fetal size, and cesarean delivery. Children born to mothers who gained excessively during pregnancy are at much higher risk of developing obesity themselves. We performed a randomized trial where half of the women received an intensive intervention of diet and exercise counseling in an effort to limit their weight gain. Compared to the control group, those in the intervention gained on average 4 pounds less and were more likely to gain within recommended guidelines. Despite this improvement, however, we did not see any improvement in any of the pregnancy complications. (more…)
Author Interviews, Blood Pressure - Hypertension, OBGYNE / 24.01.2017

MedicalResearch.com Interview with: Dr. Lauren Theilen, MD Obstetrics/Gynecology specialist Salt Lake City, Utah. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Women with a history of hypertensive disease of pregnancy are known to have increased risk of mortality from cardiovascular and other causes. Our study shows that hypertensive disease of pregnancy is strongly associated with deaths due to diabetes, heart disease, and stroke. The association is strongest for early mortality – deaths occurring before age 50 – and life expectancy decreases with increasing number of affected pregnancies. (more…)
Author Interviews, Gastrointestinal Disease, Surgical Research / 24.01.2017

MedicalResearch.com Interview with: Dr. Mark Noar Director of The Heartburn and Reflux Study Center Towson, MD  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study was developed out of a need to know whether the Stretta procedure was effective in both the short and long-term in all forms of reflux. This included standard refluxing patients who had never had surgery but also in the subpopulation of patients who had recurring reflux after having had reflux corrective surgery. The question to be answered was whether the Stretta procedure would be less effective, more effective, or just as effective in the patient who had had prior surgery compared to patients who did not have surgery. The main findings were that independent of whether a patient had had surgery for the correction of reflux or just had standard reflux without prior surgery, the Stretta procedure was equally effective in all patient subgroups both in the short-term and the long-term. (more…)
Author Interviews, OBGYNE / 24.01.2017

MedicalResearch.com Interview with: Dr Josianne Paré MD, FRCSC Département d'obstétrique-gynécologie Faculté de médecine et des sciences de la santé de l'université de Sherbrooke 3001 12e avenue Nord, Sherbrooke (Québec), J1H 5N4 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prolonged labor is a significant cause of maternal and fetal morbidity and very few interventions are known to shorten labor course. Skeletal muscle physiology suggests that glucose supplementation might improve muscle performance in case of prolonged exercise and this situation is analogous to the gravid uterus during delivery. Therefore, it seemed imperative to evaluate the impact of adding carbohydrate supplements on the course of labor. Accordingly, we conducted a single centre prospective double-blind randomized-controlled trial comparing the use of parental IV of dextrose 5% with normal saline to normal saline in induced-nulliparous women. A total of 193 patients (96 in the dextrose with normal saline [NS+D] group and 97 in the normal saline group [NS] were analysed in the study. The median total duration of labor was 76 minutes shorter in the NS+D group (499 versus 423 minutes, p = 0.024) than in the NS group. There was no difference in the rate of caesarean section, instrumented delivery, APGAR score or arterial cord pH. (more…)
Author Interviews, Dermatology / 24.01.2017

MedicalResearch.com Interview with: Hao Ou-Yang, PhD Johnson & Johnson Consumer Inc Skillman, New Jersey MedicalResearch.com: What is the background for this study? What are the main findings? Response: This is the first-ever published study to evaluate UV protection value of shade in a real-world setting. Eighty-one subjects with Fitzpatrick skin type I to III were divided into two groups: one using only a commercially available beach umbrella (round-shaped, 80” diameter, 75” high) and the other using only Neutrogena® Ultra Sheer® SPF 100+ sunscreen. Sunscreen subjects were monitored applying the product to all exposed areas following the label directions 15 minutes before beach exposure and were instructed to re-apply at least every 2 hours or as needed. Subjects were instructed to stay at the beach for 3.5 hours but could leave or stay under a shade for up to 30 minutes for cooling or rest. Shade subjects were instructed to stay under the umbrella without wearing clothes that could block the evaluated areas during the study duration. They were allowed to leave the umbrella after covering up for up to 30 minutes. There were significant differences between the two groups in clinically evaluated sunburn protection for all seven body sites measured. The Ultra Sheer SPF 100+ sunscreen provided excellent sunburn protection for all the body sites, as demonstrated by no significant changes in sunburn grading before and after UV exposure in any sites except for face. Of the subjects in the shade group, there were a total of 142 sunburn areas across all parts of the body in 78% of the umbrella group (vs. 17 areas among 10 people in the sunscreen group – 25%). Sunburn incidence within the sunscreen group may be due to uneven application (missed spots), failure to re-apply after sweating, and under-application. Most subjects in the sunscreen group applied roughl yhalf of the amount of sunscreen recommended to achieve the SPF value on the label. High SPF products provide a margin of safety for consumers who under-apply, as shown here and in other studies. (more…)
Author Interviews, Hospital Acquired, Infections, Surgical Research / 24.01.2017

MedicalResearch.com Interview with: Kristen A. Ban, MD Loyola University American College Surgery Clinical Scholar MedicalResearch.com: What is the background for this study? What are the main findings? Response: The American College of Surgeons previously released surgical site infections (SSI) guidelines, and we wanted to update them with the most recent literature to give surgeons a concise, comprehensive document of recommended practices to reduce SSI. We were very fortunate to partner with our colleagues and content experts at the Surgical Infection Society for this update. There are a few areas where we had additional literature to support new or different guidelines. Blood glucose control is now recommended for all patients regardless of diabetic status. SSI reduction bundles have become very popular, and we emphasize that compliance must be high with all parts of these bundles to obtain the maximum benefit. Finally, we recommend cessation of prophylactic antibiotics at incision closure with some exceptions (mainly in regard to implanted material/hardware). (more…)
Author Interviews, Cancer Research, Nature / 24.01.2017

MedicalResearch.com Interview with: Dr. Hua Lu MS PhD Department of Biochemistry & Molecular Biology Reynolds and Ryan Families Chair in Translation Cancer Tulane Cancer Center Tulane University School of Medicine New Orleans, Louisiana 70112 MedicalResearch.com: What is the background for this study? What are the main findings? Response: It has been well appreciated and acknowledged that p53 is the most important tumor suppressor in human body. However, approximately 50% of human cancers still sustain the wild type form of its gene, and also oddly, some cancers, such as breast cancer, which contain wild type p53, are often less sensitive to chemotherapy than those harbor mutated p53. Although a number of oncoproteins, including MDM2 and MDMX (MDM4), have been shown to be highly expressed and to inactivate p53 in those wild type p53-containing cancers, more molecules need to be discovered to keep p53 in control in order to let cancer cells to proliferate and growth. Our study as described in our recent publication in Nature Communications unveils a new p53 target gene that encodes pleckstrin homology domain-containing protein (PHLDB3) as another p53 inhibitor in a negative feedback fashion. Interestingly and mechanistically, PHLDB3 can work with MDM2 by boosting its E3 ubiquitin ligase activity, consequently leading to degradation of p53. Biologically, PHLDB3 can promote cancer cell proliferation and growth in culture and in xenograft tumor models by in part inactivating p53 activity. More interestingly, PHLDB3 is highly amplified and expressed in a number of human cancers, such as pancreatic, prostate, colon and breast cancers. High expression of PHLDB3 is well correlated with the wild type status of p53 in certain portion of breast cancer. These findings uncover PHLDB3 as another oncoprotein that can promote cancer growth by partially inactivate p53, and thus might serve as a potential target for future development of anti-cancer therapy. Our study also suggests that PHLDB3 has a p53-independent function important for cancer growth. (more…)
Author Interviews, BMJ, Cost of Health Care, Kidney Disease / 23.01.2017

MedicalResearch.com Interview with: Talar W. Markossian PhD MPH Assistant Professor of Health Policy Loyola University Chicago 2160 S. First Ave, CTRE 554 Maywood, IL 60153 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Approximately 10% of U.S. adults currently have non-dialysis dependent chronic kidney disease (CKD), while dialysis dependent CKD accounts for only 0.5% of the U.S. population. The escalation in healthcare expenditures associated with CKD starts prior to requirement for dialysis, and treatment costs escalate as non-dialysis dependent CKD progresses. We examined the total healthcare expenditures including out-of-pocket costs for non-dialysis dependent chronic kidney disease and compared these expenditures with those incurred for cancer and stroke in the U.S. adult population. After adjusting for demographics and comorbidities, the adjusted difference in total direct healthcare expenditures was $4746 (95% CI $1775-$7718) for CKD, $8608 (95% CI $6167-$11,049) for cancer and $5992 (95% CI $4208-$7775) for stroke vs. group without CKD, cancer or stroke. Adjusted difference in out-of-pocket healthcare expenditures was highest for adults with CKD ($760; 95% CI 0-$1745) and was larger than difference noted for cancer ($419; 95% CI 158–679) or stroke ($246; 95% CI 87–406) relative to group without CKD, cancer or stroke. (more…)
Author Interviews, Colon Cancer, Cost of Health Care, Medicare / 23.01.2017

MedicalResearch.com Interview with: Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting. We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent. (more…)
Author Interviews, Diabetes, Pediatrics, Weight Research / 23.01.2017

MedicalResearch.com Interview with: Robin Gelburd, JD President FAIR Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: For more than 20 years, an epidemic of obesity has been contributing to increasing rates of type 2 diabetes in the United States. During at least part of that period, both conditions have been found to be rising in young people as well as adults. Using our FAIR Health database of billions of privately billed healthcare claims, we sought to ascertain recent trends in obesity and obesity-related conditions (including type 2 diabetes) in the national, privately insured, pediatric population, which we defined as spanning the ages from 0 to 22 years. Our study period was the years 2011 to 2015. We found that claim lines with a diagnosis of obesity increased across the pediatric population during the study period. The largest increase among pediatric patients was 154 percent, in the age group 19 to 22 years. Claim lines with a type 2 diabetes diagnosis more than doubled in the pediatric population, increasing 109 percent. In most pediatric age groups, claim lines with an obesity diagnosis occurred more often in females than in males; by contrast, claim lines with a type 2 diabetes diagnosis were more common for males than females in most pediatric age groups. Other conditions associated with obesity also increased in claim lines among young people. The conditions included obstructive sleep apnea and hypertension, both of which were more common in claim lines for males than females. We also compared the percent of claim lines for pediatric type 2 diabetes diagnoses to the percent of claim lines for all pediatric medical claims by state. Using that standard, pediatric type 2 diabetes was most prevalent in Ohio, Pennsylvania, North Dakota, Utah and South Dakota. It was least prevalent in New Hampshire, Vermont, Delaware, Hawaii and Rhode Island. (more…)
Author Interviews, Diabetes, JAMA, Technology / 23.01.2017

MedicalResearch.com Interview with: Dr Marcus Lind Associate Professor of Diabetology at the University of Gothenburg Gothenburg, Sweden Chief Physician of Diabetology, Uddevalla Hospital Uddevalla, Sweden MedicalResearch.com: What is the background for this study? Response: This was a randomized trial over 16 months (cross-over study with 26 weeks of each treatment and a between wash-out period of 17 weeks) of 161 persons with type 1 diabetes. The main purpose was to evaluate whether a “diabetes tool”, denoted continuous glucose monitoring improves the glycaemic control, known to be essential to lower risks for diabetic complications such as injuries on eyes, kidneys, nerves and the cardiovascular system. The study also evaluated whether the glucose could be stabalised, i.e. having less fluctutations (beside the average level per se) and whether well-being, treatment satisfaction and feeling more confident in the daily living to avoid low glucose values which lead influence the cognitive function and can lead to unconciousness. Earlier trials exist of this therapy in connection to insulin pumps. But it has not been tested in randomized trials with persons only using multiple daily insulin injections to administer insulin which is the most common therapy among adults with type 1 diabetes. Another novelty is that the current CGM-system (DexCom G4) has earlier shown a high accuracy and positive treatment experience among persons with type 1 diabetes, but it has not been tested in long-term randomized trials. Of note this trial was performed among adults with type 1 diabetes. Continuous glucose monitoring (CGM) is a system where the patient has a sensor subcutaneously that he/she easily can change every week. It estimates the glucose level every minute and shows values on a hand-held small monitor (size of a small cell-phone) and whether the glucose levels are rising or declining. The hypothesis with the study is that if the patient has continuous information of the glucose level and trends it will improve treatment variables. The comparison group was that patients got information of their glucose control via capillary finger sticks which has been the general treatment for a long time period but can only be made at certain occasions since a procedure where blood must be taken from the finger tips. (more…)
Author Interviews, Nutrition, Sugar, Weight Research / 23.01.2017

MedicalResearch.com Interview with: Dr. Marta Alegret Department of Pharmacology, Toxicology and Therapeutic Chemistry Pharmacology Section School of Pharmacy and Food Sciences University of Barcelona MedicalResearch.com: What is the background for this study? Response: In humans, an excessive intake of sugars has been linked to the development of metabolic disturbances, and therefore to an increase in the risk for cardiovascular diseases. Specifically, increased consumption of simple sugars in liquid form, as beverages sweetened with high fructose corn syrup or sucrose, has been linked to obesity, insulin resistance and type 2 diabetes. However, two questions remain unresolved: what is/are the underlying molecular mechanism(s) linking these metabolic alterations to cardiovascular diseases? Are the adverse cardiovascular and metabolic effects of sugar-sweetened beverages merely the consequence of the increase in caloric intake caused by their consumption? To answer to these questions, we performed a study in female rats, which were randomly assigned to three groups: a control group, without any supplementary sugar; a fructose-supplemented group, which received a supplement of 20% weight/volume fructose in drinking water; and a glucose-supplemented group, supplemented with 20% weight/volume glucose in drinking water. (more…)
Author Interviews, Lancet, Lipids, Thromboembolism / 21.01.2017

MedicalResearch.com Interview with: Setor Kunutsor BSc MD MPhil(cantab) PhD(cantab) Research Fellow/Epidemiologist Musculoskeletal Research Unit University of Bristol School of Clinical Sciences Southmead Hospital MedicalResearch.com: What is the background for this study? Response: Statins are well established for the prevention of cardiovascular disease and this is based on their ability to lower levels of circulating lipids in the blood. However, statins are also known to have pleotropic effects and these include potential protective effects on multiple disease conditions. Based on their anti-inflammatory and antithrombotic properties, there have been suggestions that statins may prevent venous thromboembolism (VTE) (which comprises of pulmonary embolism and deep vein thrombosis). The evidence is however uncertain. Several studies utilizing both observational cohort and randomized controlled designs have been conducted to evaluate whether statin therapy or use is associated with a reduction in the incidence of VTE, but the results have been inconclusive. In a recent review that was published in 2012, Rahimi and colleagues pooled the results of several randomized controlled trials (RCTs), but found no significant reduction in the risk of VTE with statin therapy [REF]. Given the publication of new studies since this study was published and the existing uncertain evidence on the effect of statins on VTE, we decided it was time to bring all the evidence together and evaluate if statin therapy really did have a protective effect on the risk of venous thromboembolism. (more…)
Author Interviews, BMJ, End of Life Care, Opiods, Pain Research / 21.01.2017

MedicalResearch.com Interview with: Dr. Katherine Irene Pettus, PhD, OSB Advocacy Officer International Association for Hospice and Palliative Care Vice Chair, Vienna NGO Committee on Drugs Secretary NGO Committee on Ageing, Geneva MedicalResearch.com: What is the background for this study? Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries. (more…)
Author Interviews, Heart Disease, Lipids, Omega-3 Fatty Acids / 21.01.2017

MedicalResearch.com Interview with: Dominik D Alexander, PhD, MSPH Principal Epidemiologist EpidStat Institute Ann Arbor, MI Seattle, WA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In recent years, the body of scientific literature on n-3 LCPUFA (EPA/DHA) intake and coronary heart disease (CHD) risk has exploded with mixed results. It was only logical to conduct a comprehensive meta-analysis of randomized controlled trials (RCTs) to estimate the effect of EPA+DHA on CHD, and to conduct a comprehensive meta-analysis of prospective cohort studies to estimate the association between EPA+DHA intake and CHD risk. Among RCTs, there was a nonstatistically significant reduction in CHD risk with EPA+DHA provision (SRRE=0.94; 95% CI, 0.85-1.05). Subgroup analyses of data from RCTs indicated a statistically significant CHD risk reduction with EPA+DHA provision among higher-risk populations, including participants with elevated triglyceride levels (SRRE=0.84; 95% CI, 0.72-0.98) and elevated low-density lipoprotein cholesterol (SRRE=0.86; 95% CI, 0.76-0.98). Meta-analysis of data from prospective cohort studies resulted in a statistically significant SRRE of 0.82 (95% CI, 0.74-0.92) for higher intakes of EPA+DHA and risk of any CHD event. (more…)