Author Interviews, Flu - Influenza, Pediatrics, Science, UCLA / 28.11.2016

MedicalResearch.com Interview with: Katelyn M. Gostic and Monique Ambrose Department of Ecology and Evolutionary Biology University of California Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Monique Ambrose: Influenza pandemics pose a serious, recurrent threat to human public health. One of the most probable sources of future pandemic influenza viruses is the pool of influenza A virus (IAV) subtypes that currently circulate in non-human animals. It has traditionally been thought that the human population is immunologically naïve and unprotected against these unfamiliar subtypes. However, our work suggests that an individual ‘imprints’ to the influenza A virus (IAV) encountered in early childhood in such a way that they retain protection against severe disease if they later encounter a novel IAV subtype that belongs to the same genetic group as their first exposure. Our research looked at human cases of H5N1 and H7N9, two avian IAV subtypes of global concern, to investigate what factors most strongly predicted risk of severe disease. The most striking explanatory factor was childhood IAV imprinting: our results suggest that individuals who had childhood imprinting on an IAV in the same genetic group as the avian IAV they encountered later in life experienced 75% protection against severe disease and 80% protection against death. (more…)
Author Interviews, Lancet, Outcomes & Safety, Thromboembolism, Transfusions / 28.11.2016

MedicalResearch.com Interview with: Mary A.M. Rogers, PhD, MS Research Associate Professor Research Director, Patient Safety Enhancement Program Department of Internal Medicine University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: Peripherally inserted central catheters (PICCs) are commonly used for vascular access in hospitalized patients. Previous studies have shown that PICCs of larger gauge (diameter) increase the risk of developing venous thromboembolism (blood clots in the deep veins that sometimes travel to the lung). Red blood cell transfusion is also known to increase the risk of venous thromboembolism. Because PICCs are often used to transfuse blood, we designed a study to investigate whether the method of transfusion delivery influences the risk of developing venous thromboembolism. (more…)
Author Interviews, Kidney Disease, Lancet, Transplantation / 28.11.2016

MedicalResearch.com Interview with: Prof. Dr. med. Christian Hugo Head, Division of Nephrology Medical Clinic III Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Dresden MedicalResearch.com: What is the background for this study? Response: At the end of 2007, the harmony trial was designed predominantly based on the one year results of the ELITE-Symphony trial, demonstrating that low dose tacrolimus, mycophenolate mofetile, and steroids together with monoclonal interleukin-2-receptor (CD 25 antigen) antibody induction therapy has superior efficacy in renal transplant patients compared to all other regimens (low or normal dose cyclosporine or sirolimus) tested. While these advantages of the low dose tacrolimus protocol were so convincing to become the new gold standard of immunosuppressive therapy within the next few years (see KDIGO guide lines for renal transplantation in 2009), the low dose tacrolimus treatment arm also demonstrated increased incidence rates regarding post-transplantation diabetes mellitus (PTDM, at that time called new onset of diabetes after transplantation - NODAT) compared to the low cyclosporine treatment arm. Previous studies had also demonstrated a detrimental association between NODAT and cardiovascular events and mortality, the leading cause of death in renal transplant recipients. Corticosteroid-free or rapid withdrawal regimens were relatively encouraging regarding influencing NODAT rates but only at the price of an increased rate of T cell mediated acute rejections. (more…)
Author Interviews, MRI, Technology / 28.11.2016

MedicalResearch.com Interview with: Dr. Heron Werner Junior Clínica de Diagnóstico por Imagem – CDPI Rio de Janeiro - Brazil MedicalResearch.com: What is the background for this study? Response: A growing number of technological advancements in obtaining and viewing images through noninvasive techniques have brought major breakthroughs in fetal medicine. In general, two main technologies are used to obtain images within the uterus during pregnancy i.e. ultrasound (US) and magnetic resonance imaging (MRI). (more…)
Artificial Sweeteners, Author Interviews, Brigham & Women's - Harvard, Metabolic Syndrome, Weight Research / 28.11.2016

MedicalResearch.com Interview with: Richard Hodin, MD Gastrointestinal and Endocrine Surgery Professor of Surgery, Harvard Medical School Chief of Academic Affairs, Department of Surgery, Massachusetts General Hospital Boston, Mass 02114 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Sugar substitutes like Aspartame are widely used and supposed to make people lose weight and have less diabetes, heart disease, etc. However, a number of studies indicate that theses substitutes don’t work very well. The reasons for them not working have not been clear. Our study found that the most common sugar substitute (aspartame) blocks an enzyme in our gut called Intestinal Alkaline Phosphatase (IAP). By blocking IAP, Aspartame prevents the beneficial effects of IAP which normally works to prevent obesity, diabetes, and other aspects of the metabolic syndrome. So, we now have an explanation for why Aspartame may make obesity and the metabolic syndrome worse, rather than better. (more…)
Author Interviews, HIV, Pharmacology / 28.11.2016

MedicalResearch.com Interview with: Arkaitz Imaz Vacas HIV and STD Unit, Department of Infectious Diseases Hospital Universitari de Bellvitge MedicalResearch.com: What is the background for this study? Response: Sexual transmission is the most common route of human immunodeficiency virus (HIV) acquisition in most regions of the world. The male genital tract is a separate reservoir for HIV and may contribute to HIV shedding in seminal fluid even in individuals receiving antiretroviral (ARV) therapy (ART). Treatment of HIV-infected patients with currently available combined ART suppresses HIV in blood and also in genital fluids and reduces the risk of HIV acquisition by their sexual partners. However, sexual HIV transmission is possible even in patients on ART, especially if treatment was initiated recently. Thus, the ability of ARV drugs to penetrate into the male genital tract is a key factor for achieving HIV suppression in seminal fluid and preventing sexual transmission of the virus. Dolutegravir (DTG) is a new integrase inhibitor (INI) with high antiviral potency and a high genetic barrier to resistance. In large phase III-a randomized clinical trials, DTG in combination with 2 nucleos(t)ide reverse-transcriptase inhibitors (NRTIs) has shown noninferiority compared with raltegravir and superiority to efavirenz or ritonavir-boosted darunavir as first-line therapy in treatment-naive HIV-1 infected patients. A study in healthy volunteers showed that DTG penetration in seminal fluid was <7% of DTG exposure in blood plasma (BP), and the median seminal concentration at the end of the dosing interval (C24h) was lower than the in vitro protein-adjusted (PA) 90% inhibitory concentration (IC90) for wild-type HIV-1. However, information about protein unbound DTG fraction in seminal fluid is lacking and there is no information regarding DTG concentrations in the semen of HIV-1–infected patients or the antiviral activity of a DTG-based ARV combination in this compartment. The aim of this study was to compare viral decay kinetics and DTG concentrations (total drug and unbound fraction) in the seminal plasma (SP) and BP in a group of treatment-naive HIV-1 infected patients starting DTG plus abacavir (ABC) and lamivudine (3TC) once daily. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Outcomes & Safety, Sleep Disorders / 28.11.2016

MedicalResearch.com Interview with: Luc Schlangen PhD Principal Scientist at Philips Lighting Research Eindhoven the Netherlands MedicalResearch.com: What is the background for this study? What are the main finding Response: Everyone knows that sleep is critical to one’s overall health and well-being. Yet one-third of the general adult population report difficulties sleeping. Ongoing social commitments and work routines make it difficult to make sleep a priority, also in hospitals. People increasingly recognize that the usage of light emitting electronic devices before bedtime is compromising sleep. Consequently, many people started to use these devices in a more sleep-permissive mode during the evening, using algorithms that automatically dim down the intensity and blue content of their tablet and smart phone screens as the evening progresses. Moreover, there is increasing evidence that brighter daytime light conditions help to improve mood and nighttime sleep quality. These observations inspired us to undertake a joint study with the Maastricht University Medical Center. In the study we explored whether a tunable lighting system with extra daytime brightness and lower light intensities and warmer tones of light in the evening and night, can improve sleep and wellbeing in hospital patients. We found that the system was well appreciated and helped hospital patients to fall asleep more rapidly. Moreover, after 5 days in a room with such a dynamic lighting system patients slept longer by almost 30 minutes as compared to a standardly lit room. (more…)
Alcohol, Author Interviews, Biomarkers, Genetic Research / 28.11.2016

MedicalResearch.com Interview with: Chunyu Liu, PhD The Population Sciences Branch, Division of Intramural Research The Framingham Heart Study, National Heart, Lung and Blood Institute Framingham, MA Department of Biostatistics Boston University School of Public Health Boston, MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Excessive alcohol consumption contributes to many diseases as well as to injuries and deaths. The lack of reliable measures of alcohol intake is a major obstacle to the diagnosis and treatment of alcohol-related diseases. Our study has identified a group of DNA markers in blood that could provide the basis for a reliable blood test to detect heavy alcohol use. (more…)
Author Interviews, JAMA, Neurological Disorders, Radiology, UCLA / 28.11.2016

MedicalResearch.com Interview with: Joseph O’Neill, PhD Division of Child and Adolescent Psychiatry University of California–Los Angeles Semel Institute for Neuroscience Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Stuttering seriously diminishes quality of life. While many children who stutter eventually grow out of it, stuttering does persist into adulthood in many others, despite treatment. Like earlier investigators, we are using neuroimaging to explore possible brain bases of stuttering, aiming, eventually, to improve prognosis. What's novel is that our study deploy neuroimaging modalities-- arterial spin labelling and, in this paper, magnetic resonance spectroscopy (MRS)-- not previously employed in stuttering. MRS offers prospects of detecting possible neurochemical disturbances in stuttering. The MRS results showed differences in neurometabolite-- brain chemicals-- levels between people who stutter (adults and children) and those who don't in many brain regions where other neuroimaging has also observed effects of stuttering. In particular, MRS effects were apparent in brain circuits where our recent fMRI work detected signs of stuttering, circuits subserving self-regulation of speech production, attention and emotion. This reinforces the idea that stuttering has to do with how the brain manages its own activity along multiple dimensions: motivation, allocation of resources, and behavioral output. (more…)
Author Interviews, Cancer Research, JAMA, Lung Cancer / 27.11.2016

MedicalResearch.com Interview with: Paul W. Sperduto, MD, MPP, FASTRO Minneapolis Radiation Oncology University of Minnesota Gamma Knife Center, Minneapolis, Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Response: Analysis of past randomized clinical trials involving patients with brain metastases, an extremely heterogeneous population, suggested that the stratification tools of the past were inadequate to ensure those trials were comparing similar patients which made the results of those trials difficult to interpret or misleading. So, in 2008, a new prognostic index, the Graded Prognostic Assessment (GPA) was designed and published to more accurately predict survival. In 2010, the GPA was refined when we learned survival and the factors that predict survival varied by diagnosis (i.e. lung, breast, melanoma, kidney cancer patients with brain metastases had different survival). Now we have learned survival also varies by gene mutations and the diagnosis-specific GPA for lung cancer is further refined in this article with this new information, specifically EGFR and ALK gene alterations. 27 co-authors from 12 academic medical centers contributed patients to this database which represents the largest study of lung cancer patients with brain metastases ever reported. (more…)
Author Interviews, CMAJ, Heart Disease, Stroke / 27.11.2016

MedicalResearch.com Interview with: Dr. Tony Antoniou, PhD Research Scholar Department of Family and Community Medicine and a Scientist Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital Assistant Professor in the Department of Family and Community Medicine and Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, Ontario MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate. (more…)
Author Interviews, Erectile Dysfunction, Gout / 27.11.2016

MedicalResearch.com Interview with: Dr Edward Roddy Clinical Senior Lecturer in Rheumatology and Honorary Consultant Rheumatologist Arthritis Research UK Primary Care Centre Research Institute for Primary Care & Health Sciences Keele University Staffordshire UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Both gout and erectile dysfunction (ED) are prevalent in the general population, and share some common risk factors such as obesity, alcohol consumption and comorbidity (vascular disease, renal disease etc). We undertook a retrospective cohort study in UK Clinical Practice Research Database, a large longitudinal UK database of UK computerised primary care records, to quantify the risk of incident ED in men with gout. We found that men with gout had 30% greater risk of developing erectile dysfunction than men without gout, after adjusting for confounding variables such as lifestyle factors and comorbidity, although the absolute increased risk was small (0.6%). We did a further analyses including men who already had ED when they were diagnosed with gout, finding that they were also at increased risk of being diagnosed with ED in the year before they developed gout, suggesting that hyperuricaemia, which people can have for decades before developing gout, may be a key reason to explain the increased risk of erectile dysfunction in people with gout. Apparently, some people who make use of content on websites similar to sex-hd.xxx to aid in alleviating their ED. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Surgical Research / 27.11.2016

MedicalResearch.com Interview with: Dr. Stefano Savonitto  Director, Division of Cardiology Manzoni Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the last 15 years, there has been a shift from fibrinolytic therapy for STEMI to primary angioplasty, which required a re-organization of the whole STEMI treatment network. Besides the higher reperfusion efficiency of primary angioplasty, as compared to lytic therapy, it has been a global upgrade of the STEMI care system that has reduced the rate of no reperfusion. Elderly patients and women (who are, on average, also older than men) had theoretically the most to gain from this shift, but little data were available to assess this benefit. In the present paper, we have shown that “lack of reperfusion” was reduced dramatically across all age groups and in both sexes, with a progressive and uniform increase in primary angioplasty, and a significant reduction in mortality. Almost as expected, elderly women were the category with the most relevant mortality benefit. Nevertheless, after adjustment for age and other confounders, women continue to experience a higher mortality as compared to men. In the discussion of the paper, we propose some hypotheses for this persistently higher mortality in women. (more…)
Author Interviews, Cancer Research, Chemotherapy / 27.11.2016

MedicalResearch.com Interview with: Kelvin K. Tsai, MD, PhD Associate Investigator and Attending Physician Laboratories for Tumor Aggressiveness and Stemness National Institute of Cancer Research, National Health Research Institutes Associate Professor and Principal Investigator Laboratories of Advanced Molecular Therapeutics Graduate Institute of Clinical Medicine College of Medicine, Taipei Medical University, Taiwan MedicalResearch.com: What is the background for this study? Response: Human cancer is a complex organ consisting of a heterogenous collection of cancer cells and stroma cells. Many solid tumors such as breast cancer and pancreatic cancer are characterized by a pronounced stromal fibrosis termed desmoplasia. Studies showed that systemic chemotherapy can target not only cancer cells but also the stromal fibroblasts, which may have significant impacts on the treatment response in desmoplastic cancers. We set out to study whether and how traditional “maximum tolerated dose (MTD)” chemotherapy affects the tumor fibroblasts and thereby modulates the treatment response, and if so how this therapy-induced stroma perturbation can be avoided or attenuated. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Heart Disease, Nutrition / 25.11.2016

MedicalResearch.com Interview with: Dr. Qi Sun Sc.D, M.D., M.M.S. Assistant Professor in the Department of Nutrition Harvard T.H. Chan School of Public Heath Boston MedicalResearch.com: What is the background for this study? What are the main findings? Response: Interpretation of existing human study data regarding saturated fat intake in relation to heart disease risk is quite confusing and distorted in certain publications. It is a fact that, depending on data analysis strategies, the effects of saturated fats may depend on which macronutrients they replace. For example, substituting saturated fats for refined carbohydrates will not lead to an elevated risk of heart disease because both nutrients are harmful whereas replacing saturated fats with good polyunsaturated fats results in risk reduction. In our current analysis, we clearly demonstrated that when total saturated fatty acids were replaced by polyunsaturated fatty acids, monounsaturated fatty acids, whole grain carbohydrates, and plant-based proteins, the diabetes risk would decrease. Furthermore, we showed that major individual saturated fatty acids were all associated with an elevated heart disease risk. (more…)
Author Interviews, Biomarkers, BMJ, Heart Disease / 25.11.2016

MedicalResearch.com Interview with: Archana Singh-Manoux, PhD Research Professor (Directeur de Recherche) Epidemiology of ageing & age-related diseases INSERM,France MedicalResearch.com: What is the background for this study? What are the main findings? Response: A recent metabolomics study examined 106 biomarkers and found alpha-1-acid glycoprotein (AGP), an acute phase protein, to be the strongest predictor of five-year mortality. It is also unknown how well AGP compares with other sensitive, dynamic, and commonly measured markers of systemic inflammation, such as CRP and IL-6, as a predictor of mortality. We examined the association of these three inflammatory markers with short- and long-term mortality in a large sample of middle-aged adults, followed for 17 years. Our analysis of all-cause, cancer and cardiovascular mortality suggests that for all these outcomes IL-6 may be a better prognostic marker, both in the short and the long-term. (more…)
Author Interviews, Autism, Emory, Pediatrics / 25.11.2016

MedicalResearch.com Interview with: Warren Jones, PhD Director of Research, Marcus Autism Center Children's Healthcare of Atlanta CHOA Distinguished Chair in Autism Asst. Professor, Dept. of Pediatrics Emory University School of Medicine Atlanta, Georgia 30329 MedicalResearch.com: What is the background for this study? What are the main findings? Response: These results help clarify an important and longstanding question in autism: why do children with autism look less at other people’s eyes? Two ideas for reduced eye contact in autism have been proposed: - One idea is that children with autism avoid eye contact because they find it stressful and negative. - The other idea is that children with autism look less at other people’s eyes because the social cues from the eyes are not perceived as particularly meaningful or important. This study is important because each idea reflects a very different understanding of what autism is. And maybe even more importantly, each idea reflects a very different view about the right treatment approach to autism and to reduced eye contact in autism. To answer this question, we used eye-tracking technology to study how 86 children with and without autism paid attention to other people’s eyes. Children were tested when they were just two years old, at their time of initial diagnosis. (more…)
Author Interviews, HIV, NEJM, University of Pennsylvania / 24.11.2016

MedicalResearch.com Interview with: Katharine J Bar, MD Assistant Professor of Medicine Attending Physician, Infectious Diseases, Hospital of the University of Pennsylvania Physician, International Travel Medicine, Perelman Center for Advanced Medicine Director, Penn CFAR Viral and Molecular Core MedicalResearch.com: What is the background for this study? What are the main findings? Response: The passive administration of monoclonal antibodies has revolutionized many fields of medicine. Anti-HIV monoclonal antibodies are being explored as components of novel therapeutic and curative strategies, as they can both neutralize free virus and kill virus-infected cells. We sought to determine whether passive administration of an anti-HIV monoclonal antibody, VRC01, to chronically HIV-infected individuals on antiretroviral medications (ART) would be safe and well tolerated and could delay virus rebound after discontinuation of their ART. (more…)
Author Interviews, Gastrointestinal Disease, Genetic Research / 23.11.2016

MedicalResearch.com Interview with: Mauro D’Amato Ikerbasque Research Professor Head, Unit of Gastrointestinal Genetics, Department of Gastrointestinal and Liver Diseases BioDonostia Health Research Institute San Sebastian, Spain MedicalResearch.com: What is the background for this study? What are the main findings? Response: Irritable bowel syndrome (IBS) is a very common condition, whose underlying pathophysiology is poorly understood. People with IBS often complain certain foods trigger their symptoms and, at least in some patients, incomplete breakdown of carbohydrates may result in malabsorption with diarrhoea, bloating and abdominal pain. At the extreme of the spectrum of such clinical manifestations, this is what happens in a hereditary form of sucrose intolerance, the congenital sucrase-isomaltase deficiency (CSID) due to mutations in the Si gene that lead to defective enzymatic disaccharidase activity in the gut. Because IBS shows genetic predisposition, we tested the hypothesis that mutations and DNA variants affecting SI enzyme function may confer increased risk of IBS. We studied almost 2000 individuals from several clinics from Europe and USA, and found out that rare SI mutations and other more common defective DNA variants are indeed more frequent in patients than healthy controls. (more…)
Author Interviews, Breast Cancer, Geriatrics, Radiation Therapy / 23.11.2016

MedicalResearch.com Interview with: Emily C. Daugherty, MD Upstate Medical University Radiation Oncology Resident, PGY-4 MedicalResearch.com: What is the background for this study? Response: Adjuvant radiation following breast conserving surgery has been well established in the management of early-stage breast cancer as it has been shown to decrease the incidence of ipsilateral breast tumor recurrences and also reduce breast cancer mortality. Large prospective trials have shown for elderly patients with favorable, ER positive pathology, omission of radiation after lumpectomy can be considered. However, women with ER negative disease were typically not included in these trials and given their higher risk for relapse as well as lack of effective endocrine therapy, we hypothesized that adjuvant radiation would benefit women over 70 years with early-stage, ER negative tumors. (more…)
Author Interviews, Neurological Disorders, Ophthalmology, Pediatrics / 23.11.2016

MedicalResearch.com Interview with: Marius George Linguraru, DPhil, MA, MB Principal Investigator Associate Professor of Pediatrics and Radiology George Washington University School of Medicine and Health Sciences Children’s National Health System Washington, DC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Neurofibromatosis type 1 (NF1) is the most common cancer predisposition syndrome affecting the central nervous with an incidence of one in 3,000 births. Nearly one in five children with NF1 develops an optic pathway glioma (OPG), a low-grade tumor of the anterior visual pathway (i.e., optic nerves, chiasm and tracts). These tumors are not amenable to surgical resection and can cause permanent vision loss ranging from a mild decline in visual acuity to complete blindness. Only half of children with NF1-OPGs will experience vision loss, typically between 1 to 6 years of age. The other half will never lose vision or require treatment. All previous studies have consistently demonstrated that the change in NF1-OPG size is not related to the clinical outcome. For example, the optic pathway glioma size may be stable or even decrease, yet the vision will decline. Alternatively, the OPG size may increase, yet the clinical outcome remains stable or even improves. As no imaging or clinical features can identify which children with NF1-OPGs will ultimately lose vision, clinicians struggle to follow these children and decide when to intervene. We used quantitative imaging technology to accurately assess in magnetic resonance imaging (MRI) the total volume of OPGs in NF1. We also determined the retinal nerve fiber layer thickness in these children, a measure of axonal degeneration and an established biomarker of visual impairment. The results were outstanding, as we showed for the first time that the volume of an optic pathway glioma is indeed correlated with the likelihood of vision loss in children with Neurofibromatosis type 1. (more…)
Author Interviews, Dermatology, Genetic Research / 22.11.2016

MedicalResearch.com Interview with: Prof. Dr. Regina Betz and Dr. Buket Basmanav Ünalan (first author) Institute of Human Genetics University of Bonn Bonn, Germany MedicalResearch.com: What is the background for this study? What are the main findings? Response: Up to know, the cause for uncombable hair was totally unknown. We identified now mutations in three genes, all being responsible for uncombable hair syndrome. Of interest, the corresponding proteins, namely, PADI3, TGM3 and TCHH, are all in the same cascade that is responsible for the formation and mechanical strengthening of the hair shaft. (more…)
Author Interviews, Heart Disease, JAMA / 22.11.2016

MedicalResearch.com Interview with: Vinay Kini, MD, MS Division of Cardiovascular Medicine Hospital of the University of Pennsylvania The Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent studies have shown that use of cardiac stress tests has declined by about 25% among Medicare beneficiaries and by about 50% in Kaiser Permanente over the last several years. However, the reasons for these declines is not well understood. Decreases in the use of stress testing could be due to dissemination of appropriate use criteria and other clinical practice guidelines, advances in preventive care, reductions in reimbursement for testing, or other health system organizational characteristics. Therefore, our goal was to determine whether similar declines in testing are observed among a nationally representative cohort of commercially insured patients. We identified over 2 million stress tests performed among 33 million members of the commercial insurance company, and found that there was a 3% increase in the overall use of stress testing in this cohort between 2005 and 2012. Declines in the use of nuclear SPECT tests were offset by increases in the use of stress echocardiography, exercise electrocardiography, and newer stress test modalities such as coronary computed tomography angiography. The largest increase in use of testing was seen among younger individuals - there was a 60% increase in use of testing among patients aged 25-34, and a 30% increase among individuals aged 35-44. (more…)
Author Interviews, BMJ, Pediatrics, Social Issues / 22.11.2016

MedicalResearch.com Interview with: Charles Opondo, BPharm MSc PhD. Researcher in Statistics and Epidemiology National Perinatal Epidemiology Unit Nuffield Department of Population Health University of Oxford Oxford MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study measured fathers’ involvement in their child’s upbringing in infancy by looking at their emotional response to their child (e.g. feeling confident with the child, making a strong bond with the child), how involved they were in childcare (e.g. changing nappies, playing, night feeding, and also general care tasks around the house such as meal preparation) and their feelings of being a secure in their role as a parent (e.g. feeling included by mother in childcare, not feeling inexperienced with children). We found that the children of fathers who scored highly in terms of their emotional response and feeling like a secure parent were less likely to have symptoms of behavioural problems when they were 9 or 11 years. However, fathers being more involved in direct childcare did not seem to affect the child’s risk of having later behavioural problems. (more…)
Author Interviews, Cancer Research, Dermatology, JAMA, UCLA / 22.11.2016

MedicalResearch.com Interview with: Albert Yoon-Kyu Han, PhD Class of 2017 Medical Scientist Training Program David Geffen School of Medicine at UCLA MedicalResearch.com: What is the background for this study? What are the main findings? Response: Squamous cell carcinoma (SCC) of the lip makes up a large portion of oral cancers (25%). Most of the demographic and prognostic indicators for lip SCC are only available through retrospective case series. Thus, we used the national cancer database (Surveillance, Epidemiology, and End Results, or SEER) to examine the incidence, treatment, and survival of patients with lip SCC. The main findings of this study were that lip Squamous cell carcinoma predominantly affects white men in their mid-60s. We also found that the determinants of survival for lip SCC include age at diagnosis, primary site, T stage, and N stage. More specifically, on the primary site, SCC of the upper and lower lip had similar survival, whereas SCC of the oral commissure was associated with decreased survival. (more…)
Author Interviews, NEJM, Outcomes & Safety, Surgical Research / 22.11.2016

MedicalResearch.com Interview with: Alan Karthikesalingam MD PhD, NIHR Academic Clinical Lecturer in Vascular Surgery St George's Vascular Institute London, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study was that the typical diameter at abdominal aortic aneurysm (AAA)  repair, and the population incidence of AAA repair, have been known to vary considerably between different countries. This study aimed to observe whether a discrepancy in the population incidence rate of AAA repair between England and the USA was seen alongside a discrepancy in population rates of AAA-related mortality or AAA rupture in those countries. (more…)
Author Interviews, Cancer Research, Education, Surgical Research / 22.11.2016

MedicalResearch.com Interview with: Dr. Dmitri Alden MD, FACS Surgical Oncologist, specializes in liver cancer, bile duct cancer, metastatic ovarian cancer and pancreatic cancer at Lenox Hill Hospital, NY Dr. Alden is an advocate of the role of empathy in medicine and discusses his passion for compassionate care in this interview. Please see his bio and website at http://www.liversurgeryny.com. MedicalResearch.com: Why do you feel that empathy is a vital part of treating a patient? Response: Over the last decade many physicians, patients and other professionals began to recognize that medical care is much more than treatment with medications or an act of surgery. Healing involves pain and suffering and dealing with psychological issues connected to the stress of being taken out of one’s normal life routine. Pain is now considered a “vital sign” and only recently it became mandatory to address it properly and document it in a medical record. Empathy in my opinion is a “vital sign” of any relationship that forms between a patient and a medical professional. When expressed genuinely, it makes a tremendous impact on patient’s overall experience and recovery. MedicalResearch.com: How do you define empathy in regards to medical treatment? Response: Empathy is understanding and true genuine caring. Patients and doctors create a unique and very personal relationship built on trust and “chemistry”. The doctor’s ability to express empathy, step in the patient’s shoes, get to know their life, loves, personal problems and to structure care around this unique individual enhances the patient’s belief in the route of treatment chosen and the doctor’s ability to provide a cure. MedicalResearch.com: Do you feel that the medical system doesn't emphasize empathy enough? Response: Doctors are trained without an emphasis on empathy. They focus on acquiring immense amounts of information that need to be learned during medical school and residency. Emotions are currently left to the side in order to succeed. The end product is often a machine that knows what to do in any medical situation but has difficulty to connect on an emotional level. I feel that empathy is also a very important step towards achieving successful outcomes because a patient will feel more invested in following the doctor's advice if he feels there is compassion and understanding. (more…)
ADHD, Author Interviews, JAMA, Neurological Disorders, NIH / 22.11.2016

MedicalResearch.com Interview with: Gustavo Sudre, PhD Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch National Human Genome Research Institute Bethesda, Maryland MedicalResearch.com: What is the background for this study? What are the main findings? Response: ADHD is the most common childhood neuropsychiatric disorder, affecting 7-9% of school age children. It is highly heritable (h2=0.7), but few risk genes have been identified. In this study, we aimed to provide quantitative brain-based phenotypes to accelerate gene discovery and understanding. ADHD is increasingly viewed as resulting from anomalies of the brain’s connectome. The connectome is comprised of the structural connectome (white matter tracts joining different brain regions) and the functional connectome (networks of synchronized functional activity supporting cognition). Here, we identified features of the connectome that are both heritable and associated with ADHD symptoms. (more…)
Author Interviews, Dermatology, Infections / 22.11.2016

MedicalResearch.com Interview with: Adam Friedman, MD, FAAD Associate Professor of Dermatology Residency Program Director Director of Translational Research Department of Dermatology George Washington School of Medicine and Health Sciences MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study was developed out of a session I and my colleague, Neal Bhatia, held at the 2016 Orlando Dermatology Aesthetic and Clinical Conference. As an interactive session which had the audience answer whether they clinically thought an image was representative of a fungal skin infection or not, we collected audience responses and were impressed by how even dermatologists struggle with making this diagnosis clinically. This is not so surprising given the protean nature and diverse presentations of these infections, not to mention the many mimics which are not due to infection. Only one of the thirteen images shown was appropriately diagnosed by 90% of the audience. This highlights that the importance of using bedside diagnostic techniques such as KOH preps and culture to identify underlying cause in order to appropriately use the right therapy for the right condition. (more…)
Author Interviews, Blood Pressure - Hypertension, Bone Density, JAMA, Kaiser Permanente, Osteoporosis, Pharmacology / 22.11.2016

MedicalResearch.com Interview with: Joshua I. Barzilay, MD Kaiser Permanente of Georgia Duluth, GA 30096 MedicalResearch.com: What is the background for this study? Response: Hypertension (HTN) and osteoporosis (OP) are age-related disorders. Both increase rapidly in prevalence after age 65 years. Prior retrospective, post hoc studies have suggested that thiazide diuretics may decrease the risk of osteoporosis. These studies, by their nature, are open to bias. Moreover, these studies have not examined the effects of other anti HTN medications on osteoporosis. Here we used a prospective blood pressure study of ~5 years duration to examine the effects of a thiazide diuretic, a calcium channel blocker and an ACE inhibitor on hip and pelvic fractures. We chose these fractures since they are almost always associated with hospitalization and thus their occurrence can be verified. After the conclusion of the study we added another several years of follow up by querying medicare data sets for hip and pelvic fractures in those participants with medicare coverage after the study conclusion. (more…)