Author Interviews, Chemotherapy, Lancet, Leukemia / 13.04.2016

MedicalResearch.com Interview with: Prof Jeffrey H Lipton, PhD, MD, FRCPC Princess Margaret Cancer Centre Toronto, ON Canada MedicalResearch.com: What is the background and purpose for this study? Dr. Lipton: Ponatinib is a third generation tyrosine kinase inhibitor that has been shown to be extremely effective in treating patients with chronic myeloid leukemia resistant to other drugs.  Because of this, it was decided to look at it in newly diagnosed patients in a randomized study against imatinib.  The study was terminated prematurely because of evidence of vascular toxicity that became evident in the phase 1 and 2 studies of ponatinib in previously treated patients with resistant disease.   (more…)
Author Interviews, Herpes Viruses, Ophthalmology / 13.04.2016

MedicalResearch.com Interview with: Kimberly D Tran, MD Bascom Palmer Eye Institute MedicalResearch.com: What is the background and purpose for this study?  Dr. Tran: Approximately 30% of the population will suffer from herpes zoster (also known as shingles) at some point in their lifetime, with an estimated 1 million cases in the U.S. each year (1).  The most common long term complication of  herpes zoster is postherpetic neuralgia (PHN), or persistent neuropathic pain lasting beyond three months after initial presentation of  herpes zoster. PHN can negatively affect quality of life to a degree similar to congestive heart failure, depression, acute myocardial infarction,diabetes. Postherpetic neuralgia is a leading cause of suicide in patients over 70 with chronic pain.(3,4) Of all the cases of herpes zoster, an estimated 10-20% will have herpes zoster ophthalmicus (HZO), which is defined as shingles in the area of the face near the eye, and sometimes the eye itself becomes involved.  Approximately 50% of individuals with HZO will develop ocular complications without antiviral treatment, while antiviral induction within the first 72 hours of rash onset reduces this number to 20-30% (2). Randomized control trial has demonstrated the efficacy antiviral therapy in the treatment of herpes zoster on first presentation.(6) What is less understood is the course of HZ after its initial presentation. Traditionally studied and treated in the acute phase,(5-7) recent data suggest that some patients experience a chronic or recurrent disease course. Based on this data, it is clear that more information is needed on the long term clinical course of herpes zoster ophthalmicus. The purpose of this study was to characterize the epidemiology of recurrent and chronic HZO in a unique South Florida population, with an ethnically and racially mixed, predominately male population. (more…)
Author Interviews, Hepatitis - Liver Disease, HIV, JAMA, Vaccine Studies / 13.04.2016

MedicalResearch.com Interview with: Odile Launay MD, PhD Paris Descartes University Assistance Publique Hôpitaux de Paris, Cochin Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Launay: In patients with HIV infection, responses to standard HBV vaccination regimens remain suboptimal compared with responses in HIV seonegative individuals. We previously reported that alternative regimens (a 4 injection IMdouble dose regimen and a 4 injection intradermal low dose regimen) improve antibody response compared with the standard HBV vaccination regimen (ANRS HB03 VIHVAC-B study). Further precision on the duration of response achieved with alternative HBV vaccination regimes was needed. We report in this paper the results from the follow-up of the study. The results of this study show that the 4 dose IM regimen induces higher seroconversion rate but also higher long term seroprotection in HIV infected patients (more…)
Author Interviews, Brain Injury, Neurological Disorders / 13.04.2016

MedicalResearch.com Interview with: Thomas A. Buckley Ed.D Assistant Professor Kinesiology & Applied Physiology 144 Human Performance Lab College of Health Sciences University of Delaware MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Buckley: The most recent international consensus statement recommends 24 - 48 hours of cognitive and physical rest in the immediate aftermath of a concussion; however, our clinical experience was that patients who were "shut down" for a few days did worse than patients who were allowed to be out and about as tolerated by symptoms.  This was a retrospective study (chart review) comparing symptom reporting among patients who were shut down for 24 hours and those who were not. The main finding of the study was the addition of a day of cognitive and physical rest (i.e., 'shut down") did not improve symptom recovery recovery.  In fact, we were surprised to see that the non-rest group was symptom free 1.3 days sooner than the rest group and this was statistically significant. (more…)
Author Interviews, Nature / 12.04.2016

MedicalResearch.com Interview with: Dr. Michael V. Sofroniew, MD PhD Professor of Neurobiology David Geffen School of Medicine UCLA MedicalResearch.com: What is the background for this study? Dr. Sofroniew: For over seventy-five years, it has been thought that scars formed by cells called astrocytes actively prevent the regeneration of damaged nerve fibers (also known as axons) across injury sites in the brain and spinal cord. This view was based largely on two forms of circumstantial evidence: (1) after injury, damaged nerve fibers do not regrow past astrocyte scars and appear to be ‘stalled’ within them; (2) astrocytes (along with other cells) can produce molecules that inhibit nerve fiber growth in cell culture experiments. We also initially subscribed to this inhibitory view of astrocyte scars and about twenty years ago my lab began to develop experimental tools that allowed us to prevent astrocyte scar formation in mice. The hope was that preventing astrocyte scar formation would lead to nerve fiber regeneration across brain or spinal cord injuries. Unfortunately, although we were successful in preventing scar formation, we never saw any regrowth of nerve fibers in spite of multiple different attempts over many years of work. We were disappointed and held back from publishing those results, but kept thinking about the problem and looking for new ways to study it. Over the last five years, new tools and information became available that allowed us to return to this question and probe further. We kept getting similar kinds of results and eventually we collected enough different types of evidence to convince ourselves that the original view that astrocyte scars prevent nerve fiber regrowth was incorrect. MedicalResearch.com: What are the main findings? Dr. Sofroniew: We found that after preventing astrocyte scar formation, or after removing chronic astrocyte scars, there was no spontaneous regrowth of damaged nerve fibers and that instead, the nerve fibers retracted further back away from spinal cord injury sites. We found that both astrocytes and other cells in the injury sites produced numerous molecules that could support nerve fiber regrowth along with molecules that might repel or inhibit it. This suggested a complex molecular environment that needs to be studied more. We also found that when appropriate growth factors were applied locally into the injury site, nerve fibers could be stimulated to regrow in spite of astrocyte scar formation, and that this stimulated regrowth was significantly reduced, and not improved, when scar formation was prevented. Together, these findings show that rather than being major inhibitors of nerve fiber regrowth, scar-forming astrocytes can be supportive of such growth.  (more…)
Author Interviews, CMAJ, Fertility, OBGYNE / 12.04.2016

MedicalResearch.com Interview with: Marcelo L. Urquia PhD PhD, MSc, Mg Public Health, BA Scientist, Li Ka Shing Knowledge Institute St. Michael’s Hospital Assistant Professor, Dalla Lana School of Public Health, University of Toronto  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Urquia: In most populations the sex ratio at birth, that is, ratio of male newborns to female newborns, is about 103 to 107 males per 100 females. This is well established and does not substantially vary according to whether a woman had one or two previous children of the same sex, as each pregnancy is an independent event. However, it is known that several parts of Asia characterize for having son-biased sex ratios at birth. As countries from Asia, such as India and China are the top contributors of births to immigrant women in Canada, we wanted to verify whether son-biased sex ratios were present in Canada. Since induced abortion following prenatal sex determination using ultrasonography has been hypothesized to be a major mechanism that may explain the distorted sex ratios observed in Asia, we also studied the connection between the probability of having boys after induced abortions. In our first study entitled “Sex ratios after induced abortion” published in CMAJ (http://www.cmaj.ca/lookup/doi/10.1503/cmaj.151074), which used Ontario health care records, we found that sex ratios among Canadian-born women in Ontario were within the expected, irrespective of birth order. The sex ratio among immigrant women from India with two prior girls was 196 males per 100 females for the third live birth. Among Indian immigrant women with two prior daughters the sex ratio increased to 326 males per 100 females if they have had induced abortions preceding the third birth, to 409 males per 100 females if they have had more than one induced abortion since the last newborn child, and to 663 males per 100 females if they have had at least one preceding abortion after 14 weeks of gestation (when the sex of the fetus can be accurately estimated by ultrasonography). These findings suggest that among Indian immigrants to Ontario induced abortions of female fetuses are much more common than induced abortions of male fetuses, which helps explain the deficit in the expected number of female newborns. In our companion paper entitled “Variations in male-female infant ratios among births toCanadian- and Indian-born mothers, 1990-2011: a population-based register study” and published in CMAJ Open (insert URL), we used national birth certificate data and verified that the patterns observed in Ontario are very likely to apply to all Canadian provinces. Moreover, son-biased sex ratios at birth among Indian immigrants have existed in Canada since the early 1990’s. The deficit in the expected number of girls to Indian immigrants over the last two decades in Canada is in between 3211 to 5921. (more…)
Antibiotic Resistance, Author Interviews, Nature / 12.04.2016

MedicalResearch.com Interview with: Dr. Lingchong You PhD Paul Ruffin Scarborough Associate Professor of Engineering Duke University MedicalResearch.com: What is the background for this study? What are the main findings? Dr. You: Horizontal gene transfer (HGT) refers to the transfer of genes between organisms of the same or different species other than reproduction. In bacteria, ​Horizontal gene transfer can occur through conjugation (bacterial mating), transduction mediated by phage, or transformation. During conjugation, a donor cell makes a copy of a conjugal plasmid and passes it to a recipient cell, turning it into a transconjugant. It is well appreciated that HGT (particularly through conjugation) is the major mechanism underlying the wide spread of genes encoding antibiotic resistance.  Given this notion, it is tempting to assume that the use of antibiotics could increase the efficiency of horizontal gene transfer, creating a vicious cycle. Indeed, this has been speculated in the literature even though precise experimental measurements have been lacking. In our study, we find that antibiotics covering all major classes do not promote the probability of conjugation between donor and recipient cells. Instead, antibiotics modulate the final outcome of conjugation dynamics by imposing different degrees of selection on the donor cells, recipient cells, and the transconjugants. Depending on the antibiotic doses and how the antibiotic affects the three populations, the selection dynamics could lead to an increase or the decrease in the frequency of transconjugants. (more…)
Author Interviews, Hand Washing, Hospital Acquired / 12.04.2016

MedicalResearch.com Interview with: Professor Jacqui Reilly PhD Institute for Applied Health Research Glasgow Caledonian University Glasgow MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Reilly: Hand hygiene is the single most important intervention to reduce avoidable illness and prevent infections. Two techniques have been reported for hand hygiene use with alcohol-based hand rub (ABHR) in international guidance:  6 step by the WHO and 3 step by the Center for Disease Control. Neither of these techniques have an evidence base to support their effectiveness. The study provides the first evidence in a RCT that the 6 step technique is superior in reducing residual bacterial load on the hands. The reduction was not related to coverage, type of organism or staff group. The 6 step technique was microbiologically more effective at reducing the median log10 bacterial count (3.28  to 2.58)than the 3 step (3.08  to 2.88), (p=0.02), but did not increase the total hand coverage area (98.8% versus 99.0%, p=0.15) and required 25% (95% CI: 6%-24%) more time (42.50 seconds  vs 35.0 seconds, p=0.002). Total hand coverage was not related to the reduction in bacterial count. (more…)
Author Interviews, Diabetes, Exercise - Fitness, UCSD / 12.04.2016

MedicalResearch.com Interview with: Britta Larsen, Ph.D. Assistant Professor Family Medicine & Public Health University of California, San Diego Medical Teaching Facility La Jolla, CA 92093-0628  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Larsen: We know that muscle is important for metabolic processes, but there has been very little research on the role muscle may play in the development of metabolic diseases like type 2 diabetes. While excess fat can increase the risk of metabolic disease, there are people who are normal weight who still develop diabetes, and it’s possible that this could be due to low muscle mass. Our main findings were that, in normal weight women, women with more abdominal, thigh, and overall muscle were less likely to develop diabetes over a 13-year period.  (more…)
Author Interviews, Hospital Acquired, JAMA, Outcomes & Safety, Surgical Research / 12.04.2016

MedicalResearch.com Interview with: Christina A. Minami, MD Surgical Outcomes and Quality Improvement Center Department of Surgery, Feinberg School of Medicine, Center for Healthcare Studies, Feinberg School of Medicine Northwestern University, Chicago, Illinois MedicalResearch.com: What is the background for this study? Dr. Minami: An earlier study by our group demonstrated a seemingly paradoxical relationship between hospital quality and hospital penalization in the Hospital-Acquired Condition, or HAC, Reduction Program. Basically, of those hospitals that were penalized more frequently were those that were major teaching hospitals, had more quality accreditations, and had better performance on process and outcome measures. When CMS released that surgical-site infections were going to be added to the HAC scoring, we decided to see if these additional measures might exhibit the same paradoxical association between quality and penalization. MedicalResearch.com: What are the main findings? Dr. Minami: The SSI measures follow the same trend as was previously illustrated. Basically, the hospitals who were in the bottom 25% (that is, those who were the worst performers) were more often those that were major teaching hospitals, with more quality accreditations, and offered more advanced services. It’s possible that this is due in part to surveillance bias, or “the more you look, the more you find” phenomenon. Also, what do we really call an infection? The National Healthcare Safety Network has specific definitions and guidelines, but there are still different data collections used by different hospitals. (more…)
Author Interviews, Diabetes, Pharmacology / 12.04.2016

MedicalResearch.com Interview with: Christopher Sorli, MD SUSTAIN 1 investigator and Chair of the Department of Diabetes, Endocrinology and Metabolism Billings Clinic, Billings, Montana MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sorli: GLP-1 receptor agonists (GLP-1 RAs) have been found to be useful in the treatment of Type 2 diabetes with potent effects on blood glucose lowering while minimizing the risk of hypoglycemia and weight gain often seen with other classes of hypoglycemic agents. Semaglutide is a novel GLP-1RA that is currently in clinical development. The molecule shares 94% amino acid homology with native GLP-1 and has a half-life of approximately one week allowing for once weekly dosing. SUSTAIN 1 was designed to demonstrate superiority of semaglutide 0.5 mg and 1.0 mg once weekly over placebo in lowering HbA1c after 30 weeks of treatment. Additional secondary endpoints included weight loss versus placebo, percent of patients achieving HbA1c goals, percent of patients achieving 5% and 10% weight loss, and safety and tolerability. (more…)
Author Interviews, End of Life Care, JAMA / 12.04.2016

MedicalResearch.com Interview with: Nancy L. Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine Nancy L. Schoenborn, MD Assistant Professor Division of Geriatric Medicine and Gerontology Johns Hopkins University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Schoenborn: A growing body of research recommend that clinicians should consider patients’ life expectancy in a number of clinical decisions, but it is not clear how primary care clinicians approach these recommendations. We interviewed primary care clinicians to understand their perspectives on this topic. We found that clinicians describe a number of barriers and ambiguities in using long-term life expectancy to inform medical decisions; they also varied widely in their approaches to assess and to discuss life expectancy. (more…)
Author Interviews, Multiple Sclerosis, PNAS / 12.04.2016

MedicalResearch.com Interview with: Dr. Christian W. Gruber PhD Assistant Professor tenure-track and ARC Future Fellow The University of Queensland, School of Biomedical Sciences, Australia Medical University of Vienna, Center for Physiology and Pharmacology, Vienna, Austria  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Gruber: We initially discovered that particular circular peptides (called cyclotides) isolated from an African traditional herbal medicine have promising immunosuppressive properties (Gründemann et al., 2012, J Nat Prod, 75(2):167-74). Cyclotides are considered a pharmacological ‘treasure trove’ (Koehbach et al., 2013, PNAS, 110(52):21183-8). Hence we aimed at testing the efficacy of these peptides to treat and ameliorate multiple sclerosis, and found that the new plant-derived drug (‘T20K’), in an animal model, can block the progression of the disease. We demonstrated in an animal model that T20K stopped progression of the normal clinical symptoms of multiple sclerosis (Thell et al., PNAS, doi: 10.1073/pnas.1519960113). (more…)
Alzheimer's - Dementia, Author Interviews / 12.04.2016

MedicalResearch.com Interview with: Dr. Sven Joubert, PhD Département de psychologie, Université de Montréal Centre de recherche Institut universitaire de gériatrie de Montréal (CRIUGM) Montréal, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Joubert: Difficulties in recognizing familiar people in Alzheimer's disease have typically been attributed to the underlying memory impairment. There is evidence however that people with Alzheimer's disease also have difficulties in visual perception. The aim of this study was to determine if people with Alzheimer's were specifically impaired at face perception. In the current study, people with Alzheimer's along with healthy seniors were asked to process pictures of faces and cars at both upright and inverted orientation. Results showed that persons with Alzheimer's disease had a reduced face inversion effect, in other words they had a disproportionate impairment in processing upright relative to inverted faces. This reduced inversion effect in Alzheimer's disease, which was specific to faces, may reflect a reduced ability in "holistic" processing of faces, in other words the ability to form intergrated and individualized representations of faces based on their local features. (more…)
Author Interviews, OBGYNE, Weight Research / 12.04.2016

MedicalResearch.com Interview with: Laura Mullaney School of Biological Sciences Dublin Institute of Technology Dublin Ireland. MedicalResearch.com: What is the background for this study? What are the main findings? Response:  There are gaps in our knowledge regarding postpartum changes in weight. There continues to be a dramatic increase in adult obesity and the postpartum period is a vulnerable life-stage for weight gain in women. Maternal obesity matters because it is associated with an increase in both fetal and maternal complications, it is technically challenging, it is economically costly and it carries potential lifelong health consequences for the woman and her offspring. Thus, our aim was to compare trajectories in maternal weight and BMI between early pregnancy and four months postpartum and nine months postpartum, and to analyse these trajectories by BMI category. Of the 328 women who attended all appointments, mean weight at the first antenatal visit was 69.3 ±14.3 kg, mean Body Mass Index (BMI) was 25.3 ±5.0 kg/m2 and 14.4% were obese. At four months postpartum, the mean change in weight from the first antenatal visit was +1.6 ±4.2 kg, the mean change in BMI was +0.6 ±1.5 kg/m2 and 19.2% were obese. At nine months postpartum, the mean change in weight was +0.2 ±4.7 kg, the mean BMI change was -0.06 ±1.8 kg/m2 and 16.8% were obese. Of women who had an ideal BMI in early pregnancy, 16.6% and 11.1% were overweight at four and nine months postpartum respectively. Of women who were overweight in early pregnancy, 20.3%and 14.3% had become obese at four and nine months postpartum respectively. Ninety percent of women who were obese in early pregnancy remained obese at four and nine months postpartum. Women who had gained weight between early pregnancy and four months postpartum had a lower early pregnancy BMI and were less likely to be obese in early pregnancy. However women who gained weight between four and nine months postpartum were more likely to be obese in early pregnancy. (more…)
Author Interviews, Urology / 11.04.2016

MedicalResearch.com Interview with: Dr. H. Bob Smouse MD Interventional Radiology, Radiology OSF Saint Francis Medical Center Peoria, IL MedicalResearch.com: What is the background for this study? Dr. Smouse: For more than twenty years I've seen my patients with severe blockages of the ureter undergo two separate invasive procedures to implant one ureteral stent. Even though these procedures are done with interventional techniques, they require sedation, radiation, time off work, and occasionally have some level of pain and discomfort. Being able to potentially eliminate an entire invasive procedure for these patients has been a goal of mine for years. MedicalResearch.com: What are the main findings? Dr. Smouse: All devices tested showed 100% success in implantation and 100% success in converting from an internal-external nephroureteral catheter into an internal nephroureteral stent without the need for a second invasive procedure. (more…)
Author Interviews, Autism, Brigham & Women's - Harvard, PLoS / 09.04.2016

MedicalResearch.com Interview with: Ya Wen PhD TRANSCEND Research, Neurology Department Massachusetts General Hospital, Charlestown, Massachusetts, Harvard Medical School, Harvard University, Boston, Massachusetts Higher Synthesis Foundation, Cambridge, Massachusetts MedicalResearch.com: What is the background for this study? Dr. Ya Wen: At the time of this study (December 2014), the SFARI (Simons Foundation Autism Research Initiative) Gene-Human Gene Module recorded 667 human genes implicated as relevant to Autism spectrum disorders (ASDs). Now the number is close to 800. We sought to address the challenge of making sense of this large list of genes by identifying coherent underlying biological mechanisms that link groups of these genes together. To do this, we used information from several existing and well established databases and created a “demographics” of autism genes and pathways. MedicalResearch.com: What are the main findings? Dr. Ya Wen: From these hundreds of autism genes, we first found the relatively most important pathways, and then we generated a pathway network by mapping the pathway-pathway interactions into an Autism Pathway Network. Our systems analyses of this network converged upon an important role in autism pathophysiology for two pathways: MAPK signaling and calcium signaling, and specifically the process where they overlap, “calcium-protein kinase C-Ras-Raf-MAPK/ERK”. Our study also illuminated genetic relationships between autism and several other kinds of illness, including cancer, metabolic and heart diseases. Many of the significant genes and pathways were associated with vulnerability in the processing of challenging environmental influences. (more…)
Author Interviews, NYU, Radiology, Surgical Research / 09.04.2016

MedicalResearch.com Interview with: Eric T. Aaltonen MD, MPH Interventional Radiologist Assistant Professor, Department of Radiology Radiology  NYU Langone Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Aaltonen: A few years ago we started placing Denali  inferior vena cava (IVC) filters and noticed that these filters tended to not tilt and were subsequently more straight forward to remove when patients returned for filter retrieval.  Subsequently, a retrospective study was performed comparing these Denali filters with ALN and Option filters that have also been placed and removed at our hospitals.  The results demonstrate that Option filters have an increased rate of tilt at retrieval and increased retrieval time compared to Denali filters.  No significant difference in tilt or retrieval time was found with ALN filters.  Additionally, the presence of tilt correlates with more equipment use and increased fluoroscopy time during retrieval. (more…)
Author Interviews, Infections / 09.04.2016

MedicalResearch.com Interview with: Dr Ramiz Boulos PhD School of Chemical and Physical Sciences Flinders University, Bedford Park Chief Executive Officer Boulos & Cooper Pharmaceuticals Pty Ltd Port Adelaide, SA, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Boulos: Zolav® is a first generation antibiotic belonging to a novel class of small molecule synthetic antibiotics that was developed using in-silico modelling. It targets the mechanosensitive ion channel of large conductance, a highly conserved ion channel in bacteria not found in the human genome, making it a well sought after target. The channels have evolved to rescue bacteria from a high osmotic environment by acting as an emergency valve, opening up, and preventing bacteria from lysis. Our antibiotics reduce the threshold at which the channels open and elongate their opening times, in essence causing bacteria to "vomit". Acne affects about 650 million people worldwide making it one of the top ten most common diseases.  Isotretinoin, a vitamin A derivative, is currently the standard of care for treatment. However, it has a number of side effects among which a well-established teratogenic activity is the most serious, a reason for the development of novel and low-risk treatment options for acne. Zolav®,like other antibiotics in this new class, have low cytotoxicity, antioxidant properties and high chemical stability. The very low concentrations needed to yield a therapeutic effect and reduce inflammation in the mouse intradermal acne infection model, and the low risk nature of a topical administration of the drug, makes Zolav® a potentially very attractive option for the treatment of acne. (more…)
AHA Journals, Author Interviews, Heart Disease / 08.04.2016

MedicalResearch.com Interview with: Luigi Di Biase, MD, PhD, FACC, FHRS Section Head Electrophysiology Director of Arrhythmia Services Associate Professor of Medicine, Department of Medicine (Cardiology) Albert Einstein College of Medicine at Montefiore Hospital Moses and Weiler Campuses Montefiore-Einstein Center for Heart & Vascular Care Bronx, NY 10467 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Di Biase: The superiority of catheter ablation of atrial fibrillation (AF) over antiarrhythmic drugs (AADS) has been tested and demonstrated in several randomized clinical trial in patients with normal ejection fraction and paroxysmal AF. Only a few studies are available for patients with heart failure and persistent AF. In this multicenter randomized trial we compared the most utilized AAD for heart failure patients to achieve a rhythm control strategy (Amiodarone) vs ablation of atrial fibrillation in patients with heart failure, persistent AF and ICD. Catheter ablation was superior to Amiodarone to achieve long term freedom from AF. In addition patients undergoing ablation had a lower re-hospitalization rate and importantly a lower mortality. (more…)
Aging, Author Interviews, Melanoma, Nature, Wistar / 08.04.2016

MedicalResearch.com Interview with: Ashani T. Weeraratna, Ph.D. Associate Professor Melanoma Research Center The Wistar Institute Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Weeraratna: The background for this study is the fact that advancing age remains the greatest risk factor for the development of many cancers, and melanoma is no exception. We found that age-related changes in normal skin, specifically dermal fibroblasts, increase both the metastatic potential and therapeutic resistance of melanoma cells. The most fascinating thing is that even targeted therapy, which should depend solely on the interaction between the drug and the target within the tumor cell is affected by the age of the microenvironment. (more…)
Author Interviews, BMJ, Cancer Research, Education / 08.04.2016

MedicalResearch.com Interview with: Dr Alex Ghanouni Research Associate UCL Research Department of Epidemiology and Public Health Health Behaviour Research Centre London MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ghanouni: This study comes out of growing concern among academics, doctors, and policymakers about the unintended harms of healthcare interventions. One prominent issue in the ongoing debate is ‘overdiagnosis’, that is detection of disease that would not have caused symptoms or death if it had remained undetected. There are many contexts in which overdiagnosis can occur but one of the most prominent is cancer screening, in which asymptomatic individuals undergoing testing may have slow-growing cancers detected that would never have otherwise come to light. However, because it is impossible to be sure which cancers are slow-growing and which are aggressive, most are treated. This means that overdiagnosis can lead to harm through the anxiety caused by a disease label and the negative effects of treatment (e.g. surgery) that is actually unnecessary. Despite professional concern about overdiagnosis, previous research has found that the public is mostly unaware that it exists. One study that was particularly relevant to our research was an Australian survey in which members of the public were asked whether they had encountered the term before and what they thought it meant. Although around half the sample stated that they had heard or seen the term before, only 41% were able to provide a definition that was approximately correct. We tested the extent to which this was true as part of an online survey of adults aged 50-70 years in the UK. We found that recognition of the term was very low (only 30%) and almost no-one (3%) gave an answer that was strictly accurate. Responses often indicated misconceptions (e.g. “misdiagnosis”, “false positive diagnosis”, or being “overly health conscious”). (more…)
Allergies, Author Interviews, JAMA, Pediatrics / 08.04.2016

MedicalResearch.com Interview with: Moshe Ben-Shoshan, MD, M.Sc. Assistant Professor Division of Pediatric Allergy and Clinical Immunology Department of Pediatrics McGill University Health Center Montreal, Quebec, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ben-Shoshan: Given that up to 10% of children treated with amoxicillin are tagged as allergic usually with no confirmatory tests (given high waiting times to see an allergist and controversy regarding confirmatory tests) we aimed to assess the accuracy of the graded provocation challenge (PC) . Unlike previous studies we challenged ALL 818 children presenting with rashes on amoxicillin treatment . We were able to show that almost 95% tolerated the challenge while 17 had immediate reactions (within 1 hour ) and 31 had non immediate reactions . We found that although it is suggested to do skin tests ( with PrePen and pen G ) to diagnose immediate amoxicillin allergy only 1 of 17 had a positive skin test indicating poor sensitivity of this test. In addition among all those with negative challenge that we followed over 3 years 10% had mild skin reactions when they received subsequent full treatment . (more…)
Author Interviews, Biomarkers, Columbia, JAMA, Lung Cancer / 08.04.2016

MedicalResearch.com Interview with: Adrian G. Sacher, M.D. Assistant Professor of Medicine Thoracic Oncology & Phase I Drug Development Columbia University/New York-Presbyterian Hospital  MedicalResearch.com: What is the background for this study? Dr. Sacher: The aim of this prospective study was to determine the accuracy, turnaround time and robustness of ddPCR-based liquid biopsy for the detection of EGFR and KRAS mutations in patients with advanced non-small cell lung cancer (NSCLC). The detection of these mutations is key to selecting optimal therapy for patients with this disease. Currently, the standard of care is to perform tissue biopsies on patients in order to obtain material to detect these mutations and make decisions about treatment. Frequently, patients undergo multiple tissue biopsies during the course of their treatment. We sought to determine if liquid biopsy could quickly and accurately detect these mutations with the ultimate goal of understanding how to use these tests to select treatment for patients. (more…)
Author Interviews, Breast Cancer, Endocrinology, Journal Clinical Oncology, Menopause / 08.04.2016

MedicalResearch.com Interview with: Karin Ribi, PhD, MPH Head of Quality of Life Office IBCSG International Breast Cancer Study Group Bern Switzerland  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ribi: This study investigated the quality of life (QoL) outcomes for women in the Suppression of Ovarian Function (SOFT) trial. SOFT investigated the value of adding ovarian suppression (OFS) to tamoxifen and to determine the role of the aromatase inhibitor exemestane+OFS as adjuvant (post-surgery) therapies for hormone-sensitive early breast cancer. SOFT was conducted by the International Breast Cancer Study Group (IBCSG) in over 3000 premenopausal women from more than 500 centers worldwide. The primary analysis of SOFT compared tamoxifen alone with tamoxifen+OFS in over 2000 women, and showed that adding OFS to tamoxifen did not provide a significant benefit in the overall population of premenopausal women. However, for women who were at sufficient risk for recurrence to warrant adjuvant chemotherapy and who remained premenopausal, the addition of OFS improved disease outcomes.[1] With regard to the QoL main findings, patients on tamoxifen+OFS were more affected than patients on tamoxifen alone by hot flushes at 6 and 24 months, by loss of sexual interest and sleep disturbance at 6 months, and by vaginal dryness up to 60 months. Without prior chemotherapy, patients on tamoxifen alone reported more vaginal discharge over the 5 years than patients on tamoxifen+OFS. Symptom-specific treatment differences at 6 months were less pronounced in patients with prior chemotherapy. Changes in global QoL indicators from baseline were small and similar between treatments over the whole treatment period. (more…)
Author Interviews, Bone Density, Endocrinology, Hip Fractures, Pharmacology / 08.04.2016

MedicalResearch.com Interview with: Bente Langdahl Professor, Consultant, PhD, DMSc Department of Endocrinology and Internal Medicine THG Aarhus University Hospital Aarhus Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Romosozumab is a humanised antibody against sclerostin currently in development for the treatment of osteoporosis. Romosozumab has a dual effect on bone; it stimulates bone formation and inhibits bone resorption. If this new treatment obtains regulatory approval and becomes available for the treatment of osteoporosis, some of the patients who will be candidates for this new treatment will already have been treated with other available treatments, for example, bisphosphonates. This study compared the effects of romosozumab and teriparatide, a currently available bone forming treatment, on bone mass, bone structure and bone strength. The results showed that the percent change from baseline in BMD at the total hip through month 12 (the primary endpoint) was significantly greater with romosozumab compared with teriparatide: 2.6 percent versus –0.6 percent, respectively (p<0.0001). For the secondary endpoints; lumbar spine BMD by DXA, total hip and femoral neck BMD by DXA and QCT and bone strength estimated by finite element analysis patients treated with romosozumab had significantly larger increases from baseline compared with those taking teriparatide, with mean differences ranging from 3.1 percent to 4.6 percent (all p-values <0.0001). (more…)
Accidents & Violence, Author Interviews, CDC, Pediatrics, Sleep Disorders / 07.04.2016

MedicalResearch.com Interview with: Anne G. Wheaton, Ph.D. Epidemiologist Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Division of Population Health Epidemiology and Surveillance Branch Atlanta, GA  30341-3717  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Wheaton: Unintentional injury, mostly from motor vehicle crashes, is the leading cause of death for adolescents. Adolescents who do not get enough sleep are at an increased risk for motor vehicle crashes and other unintentional injury, such as sports injuries and occupational injuries. We evaluated the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among more than 50 thousand US high school students. The likelihood of each of five injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) was significantly higher for students sleeping ≤7 hours on an average school night compared with 9 hours. Infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students sleeping ≥10 hours compared to 9 hours on an average school night. Although short and long sleep may simply be associated with other adolescent risk behaviors, insufficient sleep may cause individuals to take more risks and disregard the possibility of negative consequences. However, the study was cross-sectional, meaning the students were asked questions at one time point, so it is not possible to determine if there is a cause and effect association between sleep and these risk behaviors. Insufficient sleep may contribute to injury risk directly by slowing reaction time, impairing ability to pay attention, or causing a driver to fall asleep, but these results provide evidence that some of the increased risk associated with insufficient sleep might be due to engaging in injury-related risk behaviors. (more…)
Author Interviews, CDC, HPV, Pediatrics, Vaccine Studies / 07.04.2016

MedicalResearch.com Interview with: Natalie L. McCarthy, MPH Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recently, deaths immediately following 4vHPV vaccination have garnered intense media attention.  Often, these media stories do not take into account the background rates of death in older children and young adults or disclose the potential for non-vaccine related causes of death.  The publicity surrounding deaths temporally associated with HPV and the paucity of studies examining deaths in adolescents following vaccination, was the basis for our evaluation of deaths following vaccines administered to individuals 9 through 26 years of age in the Vaccine Safety Datalink (VSD). The VSD is a collaborative project between the Centers for Disease Control and Prevention and several integrated healthcare systems, which monitors the safety of vaccines in the U.S. This study assessed the risk of death in the first 30 days following vaccination, described the causes of death, and included an evaluation of the potential association of vaccination and death among older children and young adults. The risk of death was not increased during the 30 days following vaccination, and no deaths were found to be causally associated with vaccination. The causes of death were consistent with what would be expected for this age group. (more…)
Author Interviews, Hearing Loss, JAMA / 07.04.2016

MedicalResearch.com Interview with: Prof. dr. Wilko Grolman MD, PhD Department of Otolaryngology Head and Neck Surgery Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands. Linkedin: https://www.linkedin.com/in/wilko-grolman-73a4927   MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Grolman: The importance of healthy hearing is extremely important for us humans. Decline in hearing will potentially affect not only our functional status but also our emotional and social health but also our economic status. It is impossible to imagine what the impact of losing one’s hearing ability is while still having a healthy hearing. Although many of us will eventually suffer from reduced hearing as part of the physiological effect of getting older, scientists are alarmed by the fact that hearing loss is on the rise and especially the number of youngsters that are affected is increasing. The WHO in their report of March 2015 reveal some alarming statistics; 360 million people have disabling hearing loss. In the acquired hearing loss group, excessive noise from personal audio devices and concert and festival visits has gained importance. Occupational noise has long been recognized as a source of acquired hearing loss. The WHO recognizes that half of the hearing loss cases can be prevented by primary prevention. For the noise induced hearing loss category, it is important to reduce exposure to loud sounds by raising awareness about the risks, implement relevant legislation and to encourage the use of personal protective devices such as earplugs, noise-canceling earphones and headphones. Our previous systematic review of the effectiveness of wearing earplugs to music venues showed that there were only two studies on this subject of which only one was a randomized clinical trial but had a major different set-up. (more…)
Author Interviews, Baylor College of Medicine Houston, Heart Disease, JACC / 07.04.2016

MedicalResearch.com Interview with: Dr. William Frank Peacock MD, FACEP Baylor College of Medicine, Houston MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Peacock: ​Patients with atrial fibrillation get strokes but can take anticoagulation which is very effective at preventing strokes. Patients on anticoagulation bleed, to the point that a very few die. The higher the CHADSVASC score, the more likely you are to have a stroke.​ ​Also the more likely ​you are to bleed. But the risk of stroke ALWAYS exceeds the risk of bleeding. We studied diabetics with atrial fibrillation as a subset, because diabetes is significant predictor for both stroke and bleeding and we wanted to determine if our understanding of the risks and benefits were maintained in real world trial. What we found was the risk of a fatal major bleed for a diabetic with atrial fibrillation who was taking rivaroxaban was 0.09/100 patient years of treatment. We know that the risk of having a stroke in a patient with a CHADS score of 2 is about 3% per year (that is 3/100 patients will stroke). Put in a similar denominator as our study, failing to treat an Afib diabetic will results 300 strokes for every 100 patient years, which compares to the effect of treatment, which will significantly prevent stroke, at the cost of 0.1 major bleed fatality per 100 patient years. Even if the effect of treatment was as low as 50% (which it is not), that is still preventing 150 strokes. 0.1 dead, to prevent 150 strokes seems like easy math to me.  ​ (more…)