Author Interviews, Health Care Systems, Hospital Readmissions, Yale / 09.07.2016

MedicalResearch.com Interview with: Kumar Dharmarajan, MD, MBA Assistant Professor of Medicine (Cardiology) Cardiovascular Medicine: Center for Outcomes Research & Evaluation (CORE) Yale School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Programs from the Centers for Medicare and Medicaid Services simultaneously promote strategies to lower hospital admissions and readmissions. However, there is concern that hospitals in communities that successfully reduce admissions may be penalized, as patients that are ultimately hospitalized may be sicker and at higher risk of readmission. We therefore examined the relationship between changes from 2010 to 2013 in admission rates and thirty-day readmission rates for elderly Medicare beneficiaries. We found that communities with the greatest decline in admission rates also had the greatest decline in thirty-day readmission rates, even though hospitalized patients did grow sicker as admission rates declined. The relationship between changing admission and readmission rates persisted in models that measured observed readmission rates, risk-standardized readmission rates, and the combined rate of readmission and death. (more…)
Author Interviews, Fertility, Herpes Viruses, Infections, PLoS / 09.07.2016

MedicalResearch.com Interview with: Roberta Rizzo PhD Department of Medical Sciences Section of Microbiology University of Ferrara Ferrara, Italy MedicalResearch.com: What is the background for this study? Response: Infertility affects approximately 6% of 15-44 year old women or 1.5 million women in the US, according to the CDC. Approximately 25% of female infertility cases are unexplained, leaving women with few options other than expensive fertility treatments. Researchers are trying to identify factors and mechanisms at the basis of this condition. (more…)
Author Interviews, Blood Pressure - Hypertension, Vitamin D / 08.07.2016

MedicalResearch.com Interview with: Dr. Nicola Veronese University of Padova Department of Medicine - DIMED, Geriatrics Division Padova, Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the last 5 years, some studies investigated the possible association between hypovitaminosis D and orthostatic hypotension. However, all these studies were cross-sectional,  not disentangling if hypovitaminosis D precedes or follows orthostatic hypotension. In our work, we reported that low vitamin D at baseline predict the onset of orthostatic hypotension at follow-up in older people. This association was stronger in women than in men. (more…)
Author Interviews, Science / 08.07.2016

MedicalResearch.com Interview with: Dr. Michelle L. Holland The Blizard Institute, Barts and The London School of Medicine and Dentistry Queen Mary University of London London MedicalResearch.com: What is the background for this study? Response: There is strong evidence that the early life environment can influence lifelong health-a phenomenon termed ‘developmental programming.’ However, the mechanisms by which this occurs are poorly understood. Here, we set out to explore whether epigenetic marks-modifications to DNA that influence whether a gene is ‘on’ or ‘off,’ are altered in response to the early life environment and whether this relates to later life health. (more…)
Author Interviews / 07.07.2016

MedicalResearch.com Interview with: Sofiya Milman, MD, MS Assistant Professor of Medicine Divisions of Endocrinology and Geriatrics Albert Einstein College of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Aging is a major risk factor for most chronic diseases, including cancer, cardiovascular disease, diabetes, hypertension, stroke and osteoporosis. However, many very long-lived individuals delay the onset or never develop age-related diseases. This study compared groups of individuals with exceptional longevity (age ≥95 years) of different genetic and ethnic backgrounds to younger referent groups without familial longevity (age 49-93 years). Long-lived individuals from different groups similarly delayed the age of onset of cancer, cardiovascular disease, hypertension, osteoporosis, and stroke. For example, cancer onset was delayed by 30 years and cardiovascular disease by 24 years. The risk of developing any age-related disease was on average 80% lower in individuals with exceptional longevity compared to referents. (more…)
AHA Journals, Author Interviews, Heart Disease, Lipids / 07.07.2016

MedicalResearch.com Interview with: Amanda M. Perak, MD Division of Cardiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, and Department of Preventive Medicine Northwestern University Feinberg School of Medicine Donald M Lloyd-Jones, MD/ScM (senior author) Senior Associate Dean for Clinical and Translational Research; Chair, Department of Preventive Medicine Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) and Eileen M. Foell Professor Professor in Preventive Medicine-Epidemiology and Medicine-Cardiology MedicalResearch.com: What is the background for this study? Response: Heterozygous familial hypercholesterolemia, or FH, affects up to 1 in 200 individuals in the United States. FH is a genetic disorder that should be suspected in individuals with very high levels of low-density lipoprotein cholesterol (LDL-C; at least 190 mg/dL) plus a first-degree relative with similar degree of high cholesterol or with premature coronary heart disease. Individuals with FH are exposed to high levels of "bad" cholesterol from birth, so if they are not treated with cholesterol-lowering therapy, they are at elevated risk for atherosclerotic cardiovascular disease (ASCVD; diseases related to hardening of the arteries, including heart attack and stroke). However, these risks previously had not been well quantified in untreated individuals with familial hypercholesterolemia in the general US population. (more…)
Author Interviews, Flu - Influenza, JAMA, Pediatrics, Vaccine Studies / 07.07.2016

MedicalResearch.com Interview with: Marta C. Nunes, PhD DST/NRF:Vaccine Preventable Diseases Respiratory and Meningeal Pathogens Research Unit University of Witwatersrand Chris Hani Baragwanath Academic Hospital Soweto, South Africa MedicalResearch.com: What is the background for this study? Response: Young infants are at increased risk for influenza infection and hospitalizations associated with influenza infection. While active annual influenza vaccination is the most efficient mode for the prevention of influenza infection, current vaccines are poorly immunogenic and not licensed for use in infants (more…)
AHRQ, Author Interviews, Cost of Health Care / 07.07.2016

MedicalResearch.com Interview with: Jessica Vistnes, Ph.D. Senior Economist, Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medical Expenditure Panel Survey – Household Component (MEPS-HC), sponsored by the Agency for Healthcare Research and Quality (AHRQ), is one of the few sources of nationally representative data that can assess changes in the percentage of Americans gaining and losing health insurance coverage between 2013 and 2014, the first year that many provisions of the Affordable Care Act (ACA) were implemented. The MEPS-HC is also one of the few data sources that can be used to assess changes in the rates at which Americans are uninsured for a full calendar year. Three new AHRQ studies use data from the MEPS-HC and show large declines from 2013 to 2014 in the percentage of non-elderly adults who were uninsured throughout the calendar year. They also show large increases in the likelihood of gaining health care coverage from 2013-2014 compared to 2012-2013 across demographic groups defined by age, race/ethnicity and education. (more…)
Author Interviews, JAMA, MRI, Parkinson's / 06.07.2016

MedicalResearch.com Interview with: Blayne Welk, MD, MSc,FRCSC Assistant Professor of Surgery Western University London, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior research has demonstrated that gadolinium, which may be used during MRI scans to help visualise the body organs, can be deposited in the body, and remain there for years. The US FDA released a notice last year stating that further research was needed to evaluate the clinical implications of these brain deposits. One of the areas that gadolinium is deposited is the brain, specifically in two regions which control voluntary movement (the globus pallidus and dentate nucleus). Damage to these areas could cause symptoms of Parkinsonism. We used administrative data from Ontario, Canada to evaluate whether people who underwent MRI scans with gadolinium had a higher risk of developing Parkinsonism in the future. In this study, we did not demonstrate an increased risk of Parkinsonism in patients exposed to gadolinium. (more…)
Author Interviews, Cannabis, JAMA, Mental Health Research / 06.07.2016

MedicalResearch.com Interview with: Mary P. Heitzeg, PhD Assistant Professor Department of Psychiatry University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: We wanted to find out if marijuana use changed the way the brain’s reward system responded to natural rewards. To probe response to natural reward, we used the chance to win some money and we observed brain response using functional magnetic resonance imaging (fMRI). We looked at brain activity when participants were 20 years old on average, and then again 2 years later and 4 years later. We found that over time marijuana use was associated with a decrease in the brain’s reward response to the chance to win money. This finding is consistent with current theories of addiction that suggest that repeated use of a substance may dampen the brain’s reward response to things normally perceived as pleasurable and this alteration may drive the individual to continue substance use. (more…)
Author Interviews, Bipolar Disorder, JAMA, Schizophrenia / 06.07.2016

MedicalResearch.com Interview with: Thomas M. Lancaster, PhD Neuroscience and Mental Health Research Institute Cardiff University Brain Imaging Research Centre Cardiff University, Cardiff, United Kingdom   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Psychotic disorders such as schizophrenia and bipolar disorders are heritable. Part of this genetic risk may be conferred by the combined effects of common risk alleles identified via genome wide association studies. Individuals with psychosis are also more likely to experience alterations in the ventral striatum (VS); a key node in the brain’s reward processing network. We hypothesized that common genetic risk for psychosis may confer risk via alterations in the VS. Using functional magnetic resonance imaging (fMRI) data from an adolescent sample (the IMAGEN cohort), we showed that increased psychosis risk was associated with increased BOLD (blood oxygen level dependency) in the VS, during reward processing. (more…)
Author Interviews, Colon Cancer, Cost of Health Care, Gastrointestinal Disease, Vanderbilt / 06.07.2016

MedicalResearch.com Interview with: Erica R. H. Sutton, MD Assistant Professor Department of Surgery, General Vanderbilt MedicalResearch.com: What is the background for this study? What are the main findings? Response: Colorectal cancer is one of the most preventable diseases that we face; however, despite the great strides that we have made in the realm of early detection, many people still do not undergo screenings. We sought to increase the availability of screenings to those in our community who are at high risk for colorectal cancer and uninsured by providing free colonoscopies to them and to examine the cost-effectiveness of this intervention. Over a 12-month period, 682 uninsured people underwent screening colonoscopies, and 9 cancers were detected. Compared to the Surveillance, Epidemiology, and End Results (SEER) registry, our patient population included more early-stage cancers, and our program was found to be cost-neutral. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Lipids, Nutrition, Omega-3 Fatty Acids / 06.07.2016

MedicalResearch.com Interview with: Daniel (Dong) Wang, MD, ScD, Research Fellow Department of Nutrition | Harvard T.H. Chan School of Public Health Boston, MA 02115 MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been widespread confusion in the biomedical community and the general public about the health effects of specific types of fat in the diet. In particular, the role of unsaturated fats vs. saturated fat in cardiovascular disease prevention remains controversial. Our study is by far the most detailed and powerful examination of this very important research topic, i.e., health effects of specific types of dietary fats, because of very large sample size (more than 120,000 men and women), repeated and validated measurements of diet and lifestyle over an extended follow-up (up to 32 years). In addition, our study is able to examine a much broader range of outcomes, including total mortality and mortality due to cardiovascular disease, cancer, neurodegenerative disease and respiratory disease. We found that different types of dietary fat had different associations with mortality. Consuming higher amounts of unsaturated fats- mainly from plant-based foods like olive oil, canola oil, soybean oil and nuts - was associated with lower mortality, while higher consumption of saturated-found in red meat, butter, cheese, and ice cream- and trans fats- predominantly from hydrogenated oils- was linked with higher mortality compared with the same number of calories from carbohydrates. Most importantly, replacing saturated fats with unsaturated fats conferred substantial health benefits, including lowering risk of all-cause premature death and premature death due to cardiovascular disease, cancer, neurodegenerative disease and respiratory disease. (more…)
Author Interviews, BMJ / 06.07.2016

MedicalResearch.com Interview with: Professor Tom Bourne Ph.D., FRCOG, FAIUM (hon). Adjunct Professor, Imperial College, London Visiting Professor, KU Leuven, Belgium Consultant Gynaecologist Queen Charlotte's and Chelsea Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies had suggested that complaint investigations might be associated with psychiatric morbidity – including depression and suicide. For example in the United States, malpractice litigation has been reported to be associated with burnout, depression and suicidal ideation. We had also witnessed in our daily practice both the burden that complaints investigations have on colleagues, but also that doctors were often practicing defensive medicine to “protect themselves”. Against this background we embarked on a large survey study on doctors in the UK – with almost 8000 physicians replying to the survey. This survey contained questions relating to validated psychological instruments for depression and anxiety, new metrics for defensive practice (hedging and avoidance) as well as single item questions. We published these data in 20151. We found that recent or current complaints were associated with significant levels or anxiety, depression and suicidal ideation, this was irrespective of the complaints procedure – although this was highest when it involved the main UK regulator the general medical council (GMC). Many doctors reported practising defensive medicine due to a fear of complaints – with over 80% reporting hedging and over 40% reporting avoidance. A number of recommendations were made to improve how complaints procedures might work. In the final part of the questionnaire we asked three open questions, how the complaints procedure made the doctor feel, what was the most stressful aspects of the procedure and what could be done to improve things. It is the analysis of this qualitative data that is presented in the current paper. (more…)
Author Interviews, Infections, Microbiome, Pulmonary Disease / 06.07.2016

MedicalResearch.com Interview with: Genevieve Marchand Ph.D., RMCCM SCCM(Env) Microbiologiste agréée & Biochimiste Chercheure, Prévention des risques chimiques et biologiques IRSST MedicalResearch.com: What is the background for this study? Response: It is well known that Health Care Workers (HCWs) are at risk of occupationally acquired infections. Some procedures, such as bronchoscopies, are recognized to be high-risk tasks. Most researches that have linked infectious risk to specific task in healthcare settings did not measure the real bioaerosol exposure. Those link where mostly made from epidemiology observations. The aim of this study was to qualify and quantify the real bioaerosol concentrations found during bronchoscopy procedures in order to estimate the true occupational risk. (more…)
Author Interviews, Beth Israel Deaconess, JAMA, Neurological Disorders / 06.07.2016

MedicalResearch.com Interview with: Samuel Frank, MD Director of the Huntington’s Disease Society of America Center of Excellence Beth Israel Deaconess Medical Center Boston, MA 02215 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Huntington Disease is a hereditary, progressive neurodegenerative disease characterized by involuntary movements (chorea and dystonia), cognitive dysfunction and psychiatric symptoms. Deutetrabenazine is a novel molecule containing deuterium, which attenuates CYP2D6 metabolism, increases active metabolite half-lives leading to stable systemic exposure. We found that deutetrabenazine significantly reduces chorea. There was also an overall improvement in participants' condition based on patient and clinician measures and improvement in a quality of life measure. There was no worsening, but also no improvement in balance. The improvements in Huntington Disease were seen with a remarkably good safety and tolerability profile. (more…)
Author Interviews, Heart Disease, JAMA, Omega-3 Fatty Acids / 06.07.2016

MedicalResearch.com Interview with: Dr. Marcus E. Kleber Fifth Department of Medicine (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology), Medical Faculty of Mannheim University of Heidelberg Mannheim, Germany MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many epidemiological studies found inverse associations between the concentration of omega-3 fatty acids, especially EPA and DHA, and cardiovascular disease and mortality. On the other hand, most clinical trials that investigated the effect of omega-3 supplementation on cardiovascular risk failed to show a benefit. Therefore, the role of omega-3 fatty acids is still debated controversially. One problem with clinical trials is that they usually do not screen their participants for their initial omega-3 status. In our study we measured the omega-3 status of our participants using a very reliable and validated method and found an inverse association of EPA and DHA with all-cause and cardiovascular mortality. (more…)
Author Interviews, Blood Pressure - Hypertension, Mineral Metabolism, UT Southwestern / 06.07.2016

MedicalResearch.com Interview with: Wanpen Vongpatanasin, MD Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Research Director, Hypertension Section Cardiology Division UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Inorganic phosphate has been added to our processed food at an enormous amount as food preservatives and flavor enhancer such that typical American diet contains twice as much as the recommended daily allowance. A high phosphate (Pi) diet was recently shown to trigger blood pressure (BP) elevation in otherwise normal rats but the mechanisms are still unknown.We found that rats treated with high phosphate diet that mimics the excess Pi consumed by the general American population developed high BP related to increased sympathetic nerve activity (SNA), resulting in excessive peripheral vasoconstriction. This exaggerated increase in SNA and BP is evident particularly during exercise. This study is conducted in collaboration with Drs. Masaki Mizuno and Scott Smith, the two leading experts in neural control of circulation at UT Southwestern in the Department of Health Care Sciences. (more…)
Author Interviews, Endocrinology, NIH / 05.07.2016

MedicalResearch.com Interview with: Dr. Evgenia Gourgari MD Section on Endocrinology and Genetics, Program on Developmental Endocrinology & Genetics (PDEGEN) & Pediatric Endocrinology Inter-institute Training Program Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD) Bethesda, MD 20892 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Polycystic ovary syndrome (PCOS) is the most common cause of infertility among women of reproductive age ,yet the etiology of this syndrome remains unknown. Women with PCOS can have high androgens, irregular periods, cysts in their ovaries, acne, excessive facial hair. Women with PCOS are also at high risk to develop diabetes. Androgens and cortisol are hormones that produced from the adrenal glands. We wanted to investigate whether a group of women with PCOS have an adrenal disorder as underlying etiology of PCOS. We found a group of women with PCOS produced more adrenal hormones compared to healthy women and these women also had some characteristics of micronodualr adrenal hyperplasia in their adrenals. Our findings suggest that a problem in the adrenal glands mostly involved in their steroid hormone secretion and how this is regulated may be the underlying cause of PCOS in a subgroup of women with this syndrome. MedicalResearch.com: What should readers take away from your report? Response: Some women with PCOS might have a problem with their adrenal gland, but more research is needed to better understand the role of adrenal glands in the development of PCOS syndrome. (more…)
Author Interviews, Diabetes, UT Southwestern / 05.07.2016

MedicalResearch.com Interview with: Dr. Eunhee Choi Research scientist in the Yu laboratory and lead author of the study UT SouthWestern Dr. Hongtao Yu, Professor of Pharmacology at UT Southwestern and Investigator with the Howard Hughes Medical Institute (HHMI). MedicalResearch.com: What is the background for this study? What are the main findings? Response: Diabetes is a metabolic disease. High blood sugar is a common symptom of diabetes, and over time it can lead to serious damage to multiple organs. Insulin, a hormone made by the pancreas, regulates blood sugar. Diabetes can occur either when the pancreas does not produce enough insulin (type 1 diabetes) or when the cells in our body cannot efficiently respond to insulin (type 2 diabetes). Diabetes is now a major global epidemic. The World Health Organization (WHO) estimates that more than 400 million people worldwide have diabetes. Insulin binds the insulin receptor (IR) at the cell surface. The insulin-bound IR can send signals inside the cell and instruct the cell to take up sugar from the blood, thus maintaining healthy blood sugar levels. After insulin has done its job, insulin-bound IR is packaged into small vesicles with a protein coat and dragged into the cell, thus terminating the signals. An adequate level of IR on the cell surface is crucial for insulin signaling and blood sugar metabolism. We have found a new mechanism that keeps IR at the cell surface. Without such a mechanism, IR is prematurely dragged inside the cell before it encounters insulin. Our discovery is quite unexpected. A main interest of our lab is to study the molecular control of cell division. During each cell division, the duplicated sister chromosomes are evenly separated into two daughter cells. A cellular surveillance system called the spindle checkpoint ensures the accuracy of sister-chromosome separation. Three checkpoint proteins, p31comet, MAD2 and BUBR1, are critical for accurate chromosome segregation. In the process of studying this checkpoint, we have unexpectedly discovered that mice lacking p31comet in the liver develop diabetes. Liver cells lacking p31comet do not have IR on the cell surface, and thus cannot respond to insulin. We have further shown that MAD2 directly binds to IR, and along with BUBR1, helps to drag IR inside the cell. p31comet prevents BUBR1 from interacting with IR-bound MAD2, thus keeping IR at the cell surface. In cells lacking p31comet, MAD2 and BUBR1 gain the upper hand and remove IR from the cell surface. Thus, the dynamic tug-of-war between p31comet and MAD2-BUBR1 determines the status of IR at the cell surface. (more…)
Author Interviews, Surgical Research / 05.07.2016

MedicalResearch.com Interview with: Stephen Ferzoco, MD, FACS Chief of General Surgery Atrius Health in Boston MedicalResearch.com Editor's Note:  Dr. Stephen Ferzoco, a prominent active, academic surgeon, discusses the complexities of surgery for hernia repair. MedicalResearch.com: What is the background for this surgery? How many patients are affected by clinically significant hernias? Response: A hernia is a common condition where soft tissue breaches a weak spot in the abdominal wall. Hernias can affect the abdomen (ventral) or the groin (inguinal). In the U.S. there are about 350,000 ventral hernia procedures each year; these hernia patients present a range of complexity to the surgeon, with some of these procedures being among the most difficult cases for surgeons to manage. Inguinal hernias are even more common, with about 750,000 total procedures performed in the U.S. each year. (more…)
Annals Internal Medicine, Author Interviews, Infections / 05.07.2016

MedicalResearch.com Interview with: Louise Bruun Østergaard MD. Ph.D student Faculty of Medicine and Faculty of Engineering and Science Aalborg University Department of Cardiology, Gentofte Hospital Hellerup MedicalResearch.com: What is the background for this study? What are the main findings? Response: Staphylococcus aureus bacteremia strikes people of all ages resulting in devastating consequence even in young and healthy individuals. Animal studies have shown that the susceptibility to Staphylococcus aureus differs among different genetic strains in mice, suggesting that genetic differences could influence the susceptibility to Staphylococcus aureus in other spices. As a first step in determining whether genetics influence risk of Staphylococcus aureus infections we aimed to study whether a family history of Staphylococcus aureus bacteremia in first-degree relatives was associated with risk of the disease. (more…)
Author Interviews, Diabetes, Diabetologia, Technology / 05.07.2016

MedicalResearch.com Interview with: Dr Hood Thabit and Co-author: Dr Roman Hovorka University of Cambridge Metabolic Research Laboratories Wellcome Trust-MRC Institute of Metabolic Science Cambridge UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Type 1 diabetes is an insulin-deficient condition, therefore people with type 1 diabetes need to be on life-long insulin therapy to maintain normal blood glucose levels. Currently insulin is delivered either by injections (with an insulin pen) or by infusion (with an insulin pump). In addition, they have to monitor their blood glucose regularly by performing fingerprick measurements several times a day, to avoid over- or under-dosing with insulin. Hypoglycaemia, or low blood glucose, can occur as a result of giving too much insulin; if severe or prolonged can lead to the patient being unconscious and in some cases sudden death. Hyperglycaemia, or high blood glucose, can occur as a result of giving too little insulin, and chronic hyperglycaemia can lead to diabetes related complications such as blindness, kidney failure and heart disease. Maintaining blood glucose within a normal range poses a daily challenge and struggle for many people with type 1 diabetes, who have to juggle with the variability and unpredictability of their glucose levels and insulin requirements due to meals, physical activity and stress. People with type 1 diabetes have on average 3 episodes of severe hypoglycaemia per year which requires third party assistance and sometimes hospitalisation. In the UK, the average HbA1c for people with type 1 diabetes is around 8.5% (69mmol/mol), which puts them at risk of diabetes complications and developing significant disability affecting their lives. There is therefore an unmet need of a novel therapeutic approach to be able to automatically modulate and change the amount of insulin delivered, based on real-time glucose levels. The artificial pancreas, or closed-loop insulin delivery, is an emerging technology which couples real-time sensor glucose levels with insulin delivery under the direction of a control algorithm, and automatically steps-up insulin delivery when glucose levels are going up, and reduces or suspends insulin delivery when glucose levels are going down. The longest home study to date was recently performed by researchers at the University of Cambridge and showed that compared to best available therapy, the artificial pancreas significantly improved long-term glucose control (HbA1c) and reduces the risk of hypoglycaemia. (more…)
Author Interviews, Nutrition / 05.07.2016

MedicalResearch.com Interview with: Dr. David Hughes Honorary Lecturer, Centre for Systems Medicine RCSI Physiology & Medical Physics Dept Royal College of Surgeons in Ireland Ireland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Liver cancer is the second most common cause of death from cancer worldwide, and the seventh most common cause of death from cancer in Europe (1). “The incidence of liver cancers is increasing in developed countries, likely due to Western lifestyle and dietary habits. Liver cancers are often diagnosed at late stages and have limited treatment options,” says IARC scientist Dr Mazda Jenab, one of the study’s authors. “Further research is needed into the modifiable determinants of these cancers and effective prevention strategies.” A growing body of evidence suggests that suboptimal intakes of the micronutrient selenium contribute to the development of several cancers (2). Selenium is a trace mineral micronutrient that is found in foods like shellfish, salmon, Brazil nuts, meat, eggs, grains, and onions. However, selenium levels in foods depend largely on the levels of selenium in the soil where the food is grown and animals graze. Soil levels tend to be low in many regions in Europe, contributing to lower body levels of selenium in those populations compared with people living in regions with higher soil selenium concentrations, such as North America. In humans, selenium is essential, particularly for the effective functioning of the immune system and in controlling oxidative processes linked to cancer development. This new study shows that the highest levels of blood selenium or of selenoprotein P, the protein that distributes selenium from the liver around the body, are associated with a decreased risk of developing liver cancer (particularly hepatocellular carcinoma), even when all other major liver cancer risk factors are taken into account. The study also shows that selenium level is not associated with the development of gall bladder or biliary tract tumours (3). The study was based on the European Prospective Investigation of Cancer and Nutrition (EPIC) cohort, headed by the International Agency for Research on Cancer (IARC) in Lyon, France,  and composed of more than half a million participants across 10 European countries. We used a case–control design of 121 liver cancers and 140 gall bladder and biliary tract cancers matched to equal numbers of individuals free of cancer within the cohort. (more…)
Author Interviews, JAMA, Pediatrics / 04.07.2016

MedicalResearch.com Interview with: Dr. Kirsten Herrick Ph.D. Division of Health and Nutrition Examination Surveys National Center for Health Statistics Centers for Disease Control and Prevention Hyattsville, Maryland MedicalResearch.com: What is the background for this study? What are the main findings? Response: The benefits of breastfeeding are well established: for children, it offers protection against infections and increases in intelligence; for nursing women, it protects against breast cancer and improves birth spacing. But there is no nationally representative information about whether there are differences in breastfeeding by birth weight (BW). Using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014, we estimated the proportion of infants ever breastfed (initiated), and those reporting any breastfeeding at 1 month, 4 months, and 6 months by birth weight categories and birth year cohorts. Our sample size was 13,859. (more…)
Author Interviews, Heart Disease, Pharmacology / 04.07.2016

MedicalResearch.com Interview with: Robert Sheldon, MD, PhD Division of Cardiology, Department of Cardiac Sciences University of Calgary, Calgary, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: Vasovagal syncope is very common and more debilitating than most people appreciate. Probably up to 50% of people faint from this in their lives, making it the most common cardiovascular symptom. Around 15-20 years ago we had learned that the recurrence rates for vasovagal syncope were quite high, and that quality of life was correspondingly low. From the results of our earlier Vasovagal Pacemaker Study II and Prevention of Syncope Trial I (POST I) we knew that neither pacemakers nor beta blockers helped most patients with vasovagal syncope. However there was ample evidence that a reduction in venous return and cardiac preload were important early steps in the vasovagal cascade. Florinef is a salt-retaining mineralocorticoid that is successful in treating orthostatic hypotension with tantalizing early evidence that it might prevent vasovagal syncope induced by tilt tests. We therefore set out to test whether it prevented vasovagal syncope in a randomized placebo-controlled clinical trial. One important early part of designing a clinical trial is estimating the event rate in the untreated and treated arms. Based on our earlier work we could predict the untreated event rate but there were no data on which we could estimate the treated outcome rate. We therefore surveyed numerous colleagues for what they considered a Minimal Clinically Important Difference, and the answer was a 40% relative risk reduction. That is, to make fludrocortisone appealing to clinicians it should cause a relative risk reduction of 40%. We used this estimate to design the study. There are two main conclusions.
  • First, we studied the right population, people who would clearly be considered for active biomedical treatment. They had fainted 15-20 times in their lives and 3-4 times in the preceding year.
  • Second, we found that fludrocortisone reduced syncope by 31%, and this narrowly missed conventional statistical significance. However when we adjusted for the first two weeks that were allotted for dose adjustment we found that fludrocortisone reduced syncope by up to 50% in people who were taking 0.2 mg daily. This is quite a low dose, deliberately picked to be safe in this young and predominantly female population.
(more…)
Author Interviews, Blood Pressure - Hypertension, Mineral Metabolism, Nutrition, UT Southwestern / 04.07.2016

MedicalResearch.com Interview with: Dr. Wanpen Vongpatanasin MD The Norman and Audrey Kaplan Chair in Hypertension UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Diet rich in fruits, vegetables, and dairy products, known as the DASH diet, is known to reduce blood pressure in hypertensive patients. More recently, the DASH diet was shown to reduce oxidative stress in people with and without high blood pressure . However, the main nutritional ingredient responsible for these beneficial effects of the DASH diet remain unknown. Because the DASH diet is rich in potassium (K), magnesium (Mg), and alkali, we performed a randomized, double-blinded, placebo-controlled study to compare effects of KMg Citrate (KMgCit), K Chloride (KCl), and K Citrate (KCit) to allow dissociation of the three in hypertensive and prehypertensive individuals. This study was conducted in collaboration with Drs. Charles Pak and Orson Moe at UT Southwestern, the two leading experts in the field of Mineral Metabolism. We found that oxidative stress was markedly reduced by KMgCit powder compared to placebo, K Chloride, and K Citrate. On the hand, KMgCit has no significant effects on blood pressure . MedicalResearch.com Editor's note:  DO NOT Take Potassium supplements unless under the direction of your health care provider. (more…)
Author Interviews, Heart Disease, JAMA, Radiology / 04.07.2016

MedicalResearch.com Interview with: Venkatesh Locharla Murthy MD, PhD, FACC, FASNC Assistant Professor, Internal Medicine Frankel Cardiovascular Center University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Technetium-99m, which is very commonly used for cardiac stress testing, has had multiple supply disruptions due to aging nuclear reactors where it is produced coupled with changing regulations to minimize the risk of nuclear proliferation. The most severe of these disruptions occurred over six months in 2010. We asked whether this disruption lead to changes in patterns of care among Medicare beneficiaries. We found that during this time, use of technetium-99m in nuclear stress testing fell from 64% to 49%, reflecting a shift towards thallium-201, which has higher radiation exposure and lower diagnostic specificity. This was reflected in a 9% increase in the rate of cardiac catheterization after a nuclear stress test during the study period, implying nearly 6,000 additional, possibly unnecessary, catheterizations during that time. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Endocrinology, JAMA / 04.07.2016

MedicalResearch.com Interview with: Aditya Bardia, MD, MPH Massachusetts General Hospital Cancer Center Harvard Medical School Boston, MA  MedicalResearch.com: What is the background for this study? What are the main findings? Response: While endocrine therapy is the recommended therapy for Estrogen Receptor positive (ER+) breast cancer, the role of endocrine therapy in neoadjuvant (pre-surgical) setting is unclear. We performed this systematic review and meta-analysis to comprehensively evaluate the efficacy of neoadjuvant endocrine therapy, both alone and in combination with other therapies, compared to neoadjuvant chemotherapy for localized ER+ breast cancer. We found no statistically significant differences between the two treatments in regards to clinical response, imaging response, rates of breast conservation therapy, and achievement of pathologic complete response. (more…)