Author Interviews, HIV, PLoS / 26.01.2016

MedicalResearch.com Interview with: Julian Falutz, MD Director, HIV Metabolic Clinic MUHC, Coordinator of Chronic Viral Illness Service, HIV and Aging Clinic McGill University Health Center Medical Research: What is the background for this study? What are the main findings? Dr. Falutz: The long-term use of antiretroviral therapy (ART) in HIV-infected patients is associated with body composition changes, including visceral adipose tissue (VAT) accumulation. HIV-infected patients with excess VAT may be at increased risk of type 2 diabetes, cardiovascular diseases, and mortality. Tesamorelin is a synthetic analog of human growth hormone-releasing factor, also known as growth hormone-releasing hormone (GHRH), which is indicated for the treatment of excess abdominal fat in HIV-infected patients with lipodystrophy. The objectives of our paper were to 1) evaluate the utility of patient characteristics and validated disease-risk scores, including indicator variables for the metabolic syndrome and the Framingham Risk Score (FRS), as predictors of  visceral adipose tissue reduction during tesamorelin therapy, and 2) to explore the characteristics of patients who reached a threshold of VAT <140 cm2, a level associated with lower risk of adverse health outcomes, after 6 months of treatment with tesamorelin. The basis of the report was a pooled analysis of the two pivotal, randomized Phase 3 trials of tesamorelin in 806 HIV-infected patients with excess abdominal fat. Our results indicate that presence of metabolic syndrome, high triglycerides, and white race are associated with a greater likelihood of responding to 6 months of tesamorelin treatment. The most robust response appears to be in subjects with VAT above 140 cm2, as well as those in the overweight range for body mass index (BMI) measures. (more…)
Author Interviews, Emergency Care, Hepatitis - Liver Disease, NYU / 26.01.2016

Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016MedicalResearch.com Interview with: Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Allison: It was found that among 383 baby boomers presenting to a large urban emergency department in New York City the prevalence of HCV antibody reactivity was 7.3%. Only four patients were successfully linked to care and only one patient was started on HCV treatment. The study highlights the possibility that there may be problems in linking patients to care from the ED compared to other clinical settings such as primary care and inpatient settings. It was concluded that only with strategies to improve linkage to care could a screening program for baby boomers be recommended in the ED where the study was carried out. The study additionally had a qualitative component and, via structured interviews, evaluated knowledge about HCV infection amongst baby boomers presenting to the ED. Overall knowledge was good but some misconceptions about transmission persisted and many patients mistakenly believed that there is a vaccine for hepatitis C. (more…)
Asthma, Author Interviews, Brigham & Women's - Harvard, JAMA, Vitamin D / 26.01.2016

MedicalResearch.com Interview with: Augusto A. Litonjua, MD, MPH Associate Professor Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 USA  Medical Research: What is the background for this study? What are the main findings? Response: Vitamin D deficiency has been hypothesized to contribute to the asthma and allergy epidemic.  Vitamin D has been shown to affect lung development in utero. However, observational studies have shown mixed results when studying asthma development in young children. Since most asthma cases start out as wheezing illnesses in very young children, we hypothesized that vitamin D supplementation in pregnant mothers might prevent the development of asthma and wheezing illnesses in their offspring.  We randomly assigned 881 pregnant women at 10 to 18 weeks' gestation and at high risk of having children with asthma to receive daily 4,000 IU vitamin D plus a prenatal vitamin containing 400 IU vitamin D (n = 440), or a placebo plus a prenatal vitamin containing 400 IU vitamin D (n = 436). Eight hundred ten infants were born during the study period, and 806 were included in the analyses for the 3-year outcomes. The children born to mothers in the 4,400 IU group had a 20% reduction in the development of asthma or recurrent wheeze compared to the children born to mothers in the 400 IU group (24% vs 30%, respectively; an absolute reduction of 6%).  However, this reduction did not reach statistical significance (p=0.051). (more…)
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Memory / 26.01.2016

MedicalResearch.com Interview with: Dr. Brian K. Lebowitz, PhD ABPP-CN DIRECTOR OF NEUROPSYCHOLOGY TRAINING Clinical Neuropsychologist Clinical Assistant Professor, Neurology Stony Brook University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Lebowitz: As a lifespan neuropsychologist, my clinical work involves evaluating cognitive concerns in both children and adults.  We know that children with learning disorders, such as dyslexia, often demonstrate difficulties on neuropsychological tests that are seemingly unrelated to reading.  For example, children with dyslexia may have difficulty with auditory processing and short-term memory.  We also know that, for many individuals, learning disorders remain present throughout the lifespan.  Despite awareness of the relationship between reading disorder and other areas of cognitive weakness, many clinicians who work with older adults do not routinely ask about academic/neurodevelopmental history.  Further, little research has assessed the potential impact of lifelong learning disorder on later life neuropsychological test performance. Our study attempted to assess whether or not a history of possible reading disorder increased the likelihood that an individual's performance would fall at a level suggestive of possible Mild Cognitive Impairment MCI), a diagnosis associated with increased risk for Alzheimer’s disease.  Individuals with MCI continue to function normally in everyday life but experience subjective memory problems and identified weaknesses on neuropsychological tests.  Our study found a strong relationship between poor reading ability and low memory test scores on two tests commonly used to evaluate memory complaints in older adults.  Depending on the test, individuals with a suspected reading disorder were two to three-and-one-half times more likely than their peers to score at a level indicative of Mild Cognitive Impairment. (more…)
Author Interviews, Brigham & Women's - Harvard, Multiple Sclerosis, Neurological Disorders, Stem Cells / 26.01.2016

MedicalResearch.com Interview with: Zhigang He, PhD, BM Professor of Neurology  and Michela Fagiolini, PhD Assistant Professor of Neurology F.M. Kirby Neurobiology Center, Department of Neurology Children’s Hospital, Harvard Medical School Boston, MA 02115, USA

Medical Research: What is the background for this study? Drs. Fagiolini and He: Brain or spinal cord injury is still a major medical problem and there is no effective treatment of promoting functional recovery. A key issue is the nerve fibers, or axons, connecting different brain regions are damaged and cannot be repaired. For example, the axons in the optic nerve are the only channels transmitting visual signals from eye to brain. If damaged, our brain will not be able to receive visual signals and be blinded. Thus, a logical therapy should be to stimulate damaged axons to regrow to the targets and reconnect the eyes and brain. Studies in the past from us and others revealed several approaches of promoting the regrowth of injured axons, but it was unknown whether these regenerated axons could form functional connections and mediate functional recovery. Medical Research: What are the main findings? Drs. Fagiolini and He:  What we discovered in this study is that these regenerated axons could form functional connections, synapses, in the brain targets, but surprisingly fail to mediate behavioral visual function recovery. In mammals, many long projecting axons are insulated by lipid-enriched myelin sheets which could significantly speed up nerve conduction and facilitate the functional coordination of different brain regions during behavior. Interestingly, we found that different from intact optic nerves, these regenerated axons fail to be myelinated and thus possess poor conductance. When we treat these mice with compounds that can improve nerve conduction, we do observe partial yet significant functional recovery. Thus, there are at least two pieces of information from this study:
  • First, axon regrowth might not enough for functional recovery, nerve conduction could be another hurdle;
  • Second, the combination of these manipulations could serve a proof-of-principle example for achieving functional recovery.
(more…)
Author Interviews, Hand Washing, Hospital Acquired, Nursing / 26.01.2016

MedicalResearch.com Interview with: Donna Powers, DNP, RN Kransoff Quality Management Institute North Shore Long Island Jewish Health System New York, NY  Medical Research: What is the background for this study? What are the main findings? Dr. Powers: Despite widely published, accessible guidelines on infection control and negative health consequences of noncompliance with the guidelines, significant issues remain around the use of Standard Precautions to protect nurses  from bloodborne infectious diseases. Only 17.4% of ambulatory nurses reported compliance with all nine standards. The nurses represented medicine, cardiology, dialysis, oncology, pre - surgical testing, radiation and urology practices. Compliance rates varied considerably and were highest for wearing gloves (92%) when exposure of hands to bodily fluids was anticipated, however only 63% reported washing hands after glove removal.  68% provided nursing care considering all patients as potentially contagious. Overall, the ambulatory care nurses chose to implement some behaviors and not others, and this behavior puts them at risk for acquiring a bloodborne infection.” The study also found knowledge of HCV was variable. Although HCV is not efficiently transmitted by sexual activity, more than one in four nurses (26 %) believed that sexual transmission is a common way that HCV is spread.  14 percent believed incorrectly that most people with HCV will die prematurely because of the infection, 12 percent did not know that HCV antibodies can be present without an infection, and 11 percent did not know there are multiple HCV genotypes. A statistically significant relationship was found between compliance and perception of susceptibility to HCV illness (P = .05) and between compliance and perception of barriers to use of Standard precautions (P=.005). (more…)
Author Interviews, OBGYNE, Pediatrics / 25.01.2016

MedicalResearch.com Interview with: Jonathan Muraskas M.D. Professor of Pediatrics and OB/Gyne Neonatal and Maternal Fetal Medicine Director Neonatal-Perinatal Research Loyola University Stritch School of Medicine Loyola University Medical Center Medical Research: What is the background for this study? What are the main findings?  Dr. Muraskas: Multiple studies over the years have demonstrated that only 15% of cerebral palsy is due to the birthing process. In other words, a normal pregnancy is 7000 hours and lawyers frequently only focus on the last 2 hours. (more…)
Author Interviews, Hip Fractures, Medical Imaging, Osteoporosis / 25.01.2016

MedicalResearch.com Interview with: Margaret L. Gourlay, MD, MPH Assistant Professor UNC Department of Family Medicine Chapel Hill, NC 27599-7595 Medical Research: What is the background for this study? What are the main findings? Dr. Gourlay: While clinical practice guidelines universally recommend bone density screening for fracture prevention in women aged 65 years and older, minimal data exist to guide bone density screening in older men. We studied how often bone density screening tests should be ordered in men, using data from the Osteoporotic Fractures in Men (MrOS) Study. MrOS is the largest and longest-running (since 2000) US study of bone density and fracture in men aged 65 and older. After peak bone mass is reached in young adulthood, both men and women lose bone density as they get older. Based on our earlier findings in older women, we expected that men aged 65 and older with higher bone density T-score measurements (T-score >-1.50) on a first (baseline) bone density test would have a substantially longer estimated time to develop the lowest level of bone density (osteoporosis) than men with better baseline measurements. Clinicians want to know the time to osteoporosis because they prescribe osteoporosis treatments to prevent future fractures in elderly patients. As expected, we found that the men with higher baseline bone density had a much slower transition to osteoporosis compared to men with lower bone density. In fact, only nine out of 4203 (0.2%) of men with higher baseline bone density developed osteoporosis after an average of 8.7 years of bone density follow-up. That was much lower than we expected and is good news for men who have favorable scores on their first bone density test. Men who had lower baseline bone density measurements developed osteoporosis faster. Unfortunately, maintaining bone density above the osteoporosis range did not guarantee that men remained fracture-free.   Most of the major osteoporotic fractures (broken hip, spine, wrist or upper arm/shoulder) occurred in men who did not have osteoporosis. This might be because they had accidents or injuries that broke their bones despite their bone density being above the thinnest range. (more…)
Aging, Author Interviews, Autism, Mental Health Research, PLoS, Schizophrenia / 25.01.2016

MedicalResearch.com Interview with: Dr. Richard Deth PhD Professor of Pharmacology Department of Pharmaceutical Sciences Nova Southeastern University Medical Research: What is the background for this study? Dr. Deth: Vitamin B12 plays a crucial role in regulating and promoting methylation reactions (the attachment of a carbon atom to molecules), including DNA methylation. Recent research has identified methylation of DNA and consequential changes in gene expression as crucial factors in brain development, as well as in memory formation and maintenance of brain function during aging. More specifically, the cause(s) of neurodevelopmental disorders such as autism remain obscure, although numerous studies have demonstrated oxidative stress and low plasma levels of the antioxidant glutathione (GSH) in autism.  Medical Research: What are the main findings? Dr. Deth: We found that brain levels of vitamin B12, especially the methylation-regulating form known as methylB12, decrease significantly with age, even though blood levels don’t show a similar decrease. Importantly, much lower levels of methylB12 were found in subjects with autism and schizophrenia compared to normal subjects of a similar age. Animal studies showed that impaired GSH formation is associated with decreased brain B12 levels. (more…)
Author Interviews, Tobacco / 25.01.2016

MedicalResearch.com Interview with: Terry Gordon, PhD Professor, Department of Environmental Medicine at NYU Langone Medical Center and at New York University's College of Global Public Health  Medical Research: What is the background for this study? What are the main findings? Dr. Gordon:I t is well established that the intentional inhalation of tobacco combustion products causes severe respiratory and cardiovascular health effects and, in fact, active smoking is the leading preventable cause of death in the US and worldwide.  Importantly, secondhand smoke exposure also causes a range of serious health problems in adults, adolescents, and children exposed in the home or at work. Secondhand smoke exposure can be as harmful as active smoking and is a major cause of both cancer and cardiovascular disease itself, as well as having countless other harmful effects. It was the scientific findings of these effects that led to many clean air regulations across the nation and enabled the FDA to regulate a number of tobacco products.  A growing number of studies in the U.S. and abroad have demonstrated poor indoor air quality in hookah bars, but none have looked at the effect of this on those who work in such establishments. We, therefore, studied whether workplace exposure to secondhand hookah smoke affects the pulmonary and cardiovascular systems.  One of our main findings was that occupational exposure to secondhand hookah smoke produces systemic effects as seen by increases in inflammatory cytokines in the blood after a 10 to 12 hour work shift. This is very worrisome as more and more diseases are being linked to chronic inflammation.  Changes in heart rate suggested that the cardiovascular system was also altered during a single work shift.  The most dramatic effect, however, appeared to be an increase in exhaled carbon monoxide after the work shift.  The low temperature burning of charcoal used to heat the shisha in a water pipe produces large amounts of carbon monoxide, and we observed exhaled carbon monoxide levels as high as 90 ppm, which suggests significant exposure of workers to secondhand hookah smoke and the potential for impairment of hemoglobin to efficiently carry oxygen to the tissues. (more…)
AACR, Author Interviews, Melanoma, NYU, Personalized Medicine / 25.01.2016

MedicalResearch.com Interview with: Tomas Kirchhoff, PhD Assistant Professor, Departments of Population Health and Environmental Medicine NYU Langone Medical Center Member, Laura and Isaac Perlmutter Cancer Center NYU Langone  Medical Research: What is the background for this study? Dr. Kirchhoff: Melanoma is the deadliest form of skin cancer, and the cause of approximately 80% of all skin cancer patients annually. One factor that can help reverse this negative trend is efficient prediction of which patients at early melanoma stage will likely progress to more advanced metastatic disease. Current clinical predictors of patient survival, based on tumor characteristics, are important, but are relatively non-specific to inform melanoma prognosis to an individual patient level. It is critical to identify other factors that can serve as more personalized markers of predicting the course of melanoma. Medical Research: What are the main findings? Dr. Kirchhoff: In our study, we found that inherited genetic markers that impact activity of certain immune genes correlate with melanoma survival. More specifically, our findings show that patients with more frequent forms of these genetic markers (genotypes) have, on average, a five-year shorter survival than patients with less common genotypes. We suggest that these genetic markers are independent of the current tumor surrogates and, as such, can serve as novel personalized markers of melanoma prognosis. (more…)
Author Interviews, Menopause, Pain Research / 25.01.2016

MedicalResearch.com Interview with: Dr. Vincent Martin, MD Professor of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH Medical Research: What is the background for this study? What are the main findings? Dr. Martin: Past studies have found that the perimenopause is associated with an increased prevalence of migraine headache, but there have been no studies to determine if the frequency of migraine attacks is increased during this time period.  In our study we reported that high frequency headache (≥10 days per month with headache) was increased by 62% during perimenopause (irregular menstrual cycles) as compared to premenopause (regular menstrual cycles).  We later divided the perimenopause into early and late stages.  During the early perimenopause women experience irregular menstrual bleeding while during the late perimenopause women begin skipping menstrual periods for 2-11 months.  Of the two stages the late perimenopause in particular had the greatest likelihood for high frequency headache increasing its risk by 86%.  This could suggest that low estrogen and progesterone levels, which occur when menstrual periods are skipped, might account for the increased probability of headache attacks in women with migraine. The common belief in the medical field is that migraine attacks improve in women during menopause.  To the contrary we found that high frequency migraine increased by 76% during menopause compared to premenopause.  This indicates that a subgroup of women with frequent headaches tend to worsen with menopause.  The increased probability of high frequency headache appeared to be secondary to an increased intake of pain medications occurring during this time period, which could result in “rebound headaches”.  Rebound headaches occur from overuse of pain medications. (more…)
Author Interviews, Duke, Genetic Research, Infections / 24.01.2016

MedicalResearch.com Interview with: Ephraim L. Tsalik, MD MHS PhD Assistant Professor of Medicine Division of Infectious Diseases Center for Applied Genomics & Precision Medicine Duke University Medical Center Emergency Department Service Line Durham VA Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Tsalik: This study was motivated by the convergence of two research interests.  The first was spearheaded by Dr. Sack, leading our collaboration at Johns Hopkins.  Dr. Sack and his colleagues have a long history and expertise in studying enteric infections such as E. coli.  The second is our group here at Duke’s Center for Applied Genomics & Precision Medicine as well as the Durham VA Medical Center.  Specifically, we have an interest in studying the host response to infectious disease.  One of the ways we’ve done that historically is through challenge studies where healthy volunteers are exposed to a pathogen in a controlled setting.  Despite everyone getting the same exposure, not everyone gets sick.  That observation gives us a unique opportunity to study the host biology of symptomatic individuals, asymptomatic individuals, and what distinguishes the two from each other.  That is precisely what we did here. Volunteers ingested Enterotoxigenic E. coli (ETEC), which is a common cause of traveler’s diarrhea.  Some subjects became ill with diarrhea while others remained well.  In this study, we focused on gene expression patterns, which is a snapshot of how genes in the body are being used in response to this infection.  Some genes are more active, some are less.  The pattern of those changes that occur in response to infection is what we call a “signature”. This approach allowed us to generate some key findings.  First of all, we were able to define the genes involved in the body’s response to this type of E. coli infection.  Second, we discovered genes that were differentially expressed at baseline that could distinguish people who would go on to become ill from those that would remain healthy.  Although this study was not designed to identify the mechanism for that resilience to infection, it does focus our attention on where to look.  We suspect the genes we identified are likely to play a role in infectious disease resilience and susceptibility based on their known immune function roles.  We also have data, which wasn’t published in this study, that implicates some of these genes in the resilience to other infections such as influenza. The last major finding was something called Drug Repositioning Analysis.  This is a tool that allowed us to identify drugs and drug classes that could be used to mitigate infections caused by ETEC.  That analysis highlighted some compounds already known to be effective such as Zinc.  But it also identified several other drug classes that have not previously been investigated and could be important tools to combat such infections especially as antibiotic resistance looms. (more…)
Author Interviews, BMJ, Cancer Research, Heart Disease, Pharmacology / 24.01.2016

More on Heart Disease on MedicalResearch.com MedicalResearch.com Interview with: Professor Ian C K Wong Fellow of Royal Pharmaceutical Society Fellow of Royal College of Paediatrics and Child Health (Honorary) Fellow of the Higher Education Academy Chair in Pharmacy Practice Head of Research Department of Practice and Policy UCL School of Pharmacy London  Medical Research: What is the background for this study? What are the main findings? Dr. Wong: Previous studies had showed an increased cardiovascular risk associated with clarithromycin (a widely used antibiotic) but the duration of effect remained unclear. Therefore, we conducted this study to investigate the duration of cardiovascular adverse effect provided that the risk exists after patients receiving clarithromycin in Hong Kong. We used three study designs to examine the  association (temporal relationship) between clarithromycin and cardiovascular adverse outcomes such as myocardial infarction, arrhythmia, stroke, cardiac mortality at different time points.

We found that there was an increased short-term risk of myocardial infarction, arrhythmia and cardiac mortality associated with clarithromycin in all study designs. However, no long-term risk was observed. In every 1000 patients, there was 1.90 extra myocardial infarction events in current use of CLARITHROMYCIN when compared with the use of amoxicillin.

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Author Interviews, Cancer Research, Genetic Research, Personalized Medicine, UCLA / 24.01.2016

MedicalResearch.com Interview with: Dr. Chirag Patil, MD American Board Certified Neurosurgeon Brain & Spine Tumor Program Lead Investigator, Precision Medicine Initiative Against Brain Cancer Program Director, Neurosurgical Residence training program Director, Center for Neurosurgical Outcomes Research Cedars-Sinai Medical Center, Los Angeles, California MedicalResearch.com Editor’s note: Dr. Patil’s research is focused on developing a method of personalized cancer treatment through the harnessing of genome wide mutational analysis of a specific patient’s cancer. MedicalResearch.com: Would you tell us a little about yourself and your research interests? Dr. Patil: I am a Stanford-trained, Board Certified Neurosurgeon and cancer researcher at Cedars-Sinai Medical Center in Los Angeles, California. I primarily focus on the care of patients with malignant brain tumors, particularly glioblastomas. I received my undergraduate degree from Cornell, followed by a medical degree from the University of California, San Francisco (UCSF), where I was a Regent’s scholar. I completed a residency in neurosurgery and a fellowship in stereotactic radiology at Stanford University. I also have a master’s degree in epidemiology with a focus on clinical trial design and mathematical modeling from Stanford. MedicalResearch.com: Can you tell us about some of your research interests? Dr. Patil: I am keenly interested in and focused on developing precision science-powered novel brain tumor therapies, immuno-therapies, and patient-centered “big data” outcomes research. I lead the recently-funded Cedars-Sinai Precision Medicine Initiative Against Brain Cancer, which utilizes tumor genomics to build a mathematical computer model, i.e., a virtual cancer cell of each patient’s unique tumor. The White House and several other stakeholders have taken keep interest in this research initiative as an example of a leading precision medicine program. (more…)
Author Interviews, Breast Cancer, Cancer Research, JAMA, Prostate Cancer / 23.01.2016

More on Cancer Research on MedicalResearch.com MedicalResearch.com Interview with: Firas Abdollah, M.D., F.E.B.U. (Fellow of European Board of Urology) Urology Fellow with the Center for Outcomes Research, Analytics and Evaluation Vattikuti Urology Institute at Henry Ford Hospital in Detroit  MedicalResearch: What is the background for this study? What are the main findings? Dr. Abdollah: Cancer screening aims to detect tumors early, before they become symptomatic. Evidence suggests that detection and treatment of early-stage tumors may reduce cancer mortality among screened individuals. Despite this potential benefit, screening programs may also cause harm. Notably, screening may identify low-risk indolent tumors that would never become clinically evident in the absence of screening (overdiagnosis), subjecting patients to the harms of unnecessary treatment. Such considerations are central to screening for prostate and breast cancers, the most prevalent solid tumors in men and women, respectively. These tumors are often slow growing, and guidelines recommend against screening (non-recommended screening) for these tumors in individuals with limited life expectancy, i.e. those with a life expectancy less than 10 years. Unfortunately, our study found that this practice is not uncommon in the US. Using a nationwide representative survey conducted in 2012, we found that among 149,514 individuals 65 years or older, 76,419 (51.1%) received any prostate/breast screening. Among these, 23,532 (30.8%) individuals had a life expectancy of less than 10 years. These numbers imply that among the screened population over 65 years old, almost one in three individuals received a non-recommended screening. This corresponds to an overall rate of non-recommended screening of 15.7% (23,532 of 149,514 individuals). Another important finding of our study was that there were important variations in the rate of non-recommended screening from state to state; i.e. the chance of an individual older than 65 to receive a non-recommended screening varies based on his/her geographical location in United States. Finally, on a state-by-state level, there was a correlation (40%) between non-recommended screening for prostate and breast cancer, i.e. states that are more likely to offer non-recommended screening for prostate cancer are also more likely to offer non-recommended screening for breast cancer, and vice versa. (more…)
Author Interviews, Heart Disease, JACC / 23.01.2016

MedicalResearch.com Interview with: Frank J. Rybicki, MD, PhD Professor, Chair and Chief, Department of Radiology The University of Ottawa, Faculty of Medicine and The Ottawa Hospital Editor-in-Chief, 3D Printing in Medicine Medical Research: What is the background for this document? Dr. Rybicki: This document represents a conglomeration of the approach to appropriateness of three large medical professional groups. The American College of Radiology Appropriateness Criteria® are evidence based guidelines to assist referring physicians to order the most appropriate imaging test for a wide range of clinical scenarios. The Appropriateness Criteria are divided by organ section, and while they include emergent imaging studies, there is not a single publication to provide imaging guidance for patients who present to the emergency room with chest pain. The American College of Cardiology Appropriate Use Criteria provides evidence based data for a very large gamut of cardiovascular conditions. These guidelines include emergent cardiovascular imaging; however the Appropriate Use Criteria are divided by modality and like the ACR have not specially addressed this important, high risk patient population. The American College of Emergency Physicians, a key stakeholder group that represents referring physicians, has developed a large number of guidelines but also has not organized this group of imaging recommendations. Thus, the background of this document was a joint effort among all three societies to update, harmonize, and publish contemporary guidelines that can be readily incorporated into clinical practice but also provide standards for a large fraction of patients who come to the emergency room with chest pain who require imaging to evaluate for a life threatening diagnosis. Medical Research: What types of chest pain conditions are covered by these guidelines? Dr. Rybicki: Based on the background as noted above, the Writing Group for this important document included cardiologists, emergency physicians, and radiologists. Since the group was charged with describing common clinical scenarios seen in contemporary practice, there are four entry points for chest pain conditions. They are as follows:
  1. Suspected Non-ST Segment Elevation Acute Coronary Syndrome
  2. Suspected Pulmonary Embolism
  3. Suspected Acute Syndrome of the Aorta
  4. Patients for Whom a Leading Diagnosis is Problematic or not Possible 
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Annals Internal Medicine, Author Interviews, Menopause, Pain Research / 23.01.2016

MedicalResearch.com Interview with: Carolyn Ee, MBBS Department of General Practice University of Melbourne Carlton, Victoria, Australia Medical Research: What is the background for this study? What are the main findings? Response: Hot flushes affect up to 90% of women during the menopause and beyond, and women are turning to complementary therapies. Our randomised sham-controlled trial found no difference between real and sham acupuncture (given with a blunt needle) for hot flushes, with both groups improving by around 40% at the end of treatment. (more…)
Author Interviews, OBGYNE, Ovarian Cancer, Radiology / 22.01.2016

More on Ovarian Cancer on MedicalResearch.com MedicalResearch.com Interview with: Dirk Timmerman, MD PhD Department of Development and Regeneration Department of Obstetrics and Gynecology University Hospitals Leuven Leuven, Belgium Medical Research: What is the background for this study? What are the main findings? Dr. Timmerman: Ovarian cancer is the most aggressive and lethal gynecological malignant neoplasm. The prognosis of ovarian cancer is poor, with only about 40% of patients still alive five years after being diagnosed. The preoperative characterization of an adnexal tumor is fundamental for selecting the optimal management strategy. An accurate differentiation between benign and malignant masses can lead to optimal referral of patients with malignant diseases to gynecological oncology centers for further diagnostics and treatment, which positively influences the prognosis. On the other hand, it may help in safely selecting patients with benign ovarian masses for minimally invasive or fertility sparing surgery, and in some cases maybe even conservative follow-up. The International Ovarian Tumor Analysis (IOTA) study is the largest diagnostic accuracy study of its kind. Transvaginal ultrasound is a cheap and very accessible imaging technique. Using ultrasound features, which are easy to assess by a trained examiner, we proposed a model to define the individual risk of malignancy for each patient presenting with an adnexal tumor. This could considerably impact on the morbidity and mortality associated with adnexal pathology. (more…)
Author Interviews, Depression / 22.01.2016

More on Depression on MedicalResearch.com MedicalResearch.com Interview with: Prof. Steven LoBello, Professor of Psychology Auburn University at Montgomery Study co-authors: Megan Traffanstedt (graduate student) and Dr. Sheila Mehta Medical Research: What is the background for this study? What are the main findings? Response: Looking at a large sample of the U.S. population who completed the PHQ-8 depression scale we found that there is no relation between different seasons and prevalence of depression. Sunlight exposure is supposed to be the key variable at work here, so we also obtained sunlight data from the US Naval Observatory about sunlight exposure time in the communities of survey respondents on the date of their interviews.  We found no relationship between amount of available sunlight and prevalence of depression. Finally we also evaluated prevalence of depression in 3 different latitude bands, latitude being an often-used proxy for sunlight exposure. Again, we found no relationship between prevalence and latitude of residence.  Our findings pertain to the DSM 5 diagnostic category of major depression with seasonal variation. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Nutrition / 22.01.2016

MedicalResearch.com Interview with: Dr. Refaat Hegazi, MD, PhD MS MPH Abbott medical director and study author MedicalResearch: What is the background for this study? What are the main findings? Dr. Hegazi: The NOURISH study that was recently published in Clinical Nutrition showed that a specialized oral nutrition supplement (with high protein, HMB and Vitamin D) was associated with a 50 percent lower death rate in older, malnourished patients with a heart or lung disease, 90 days after leaving the hospital. The study was conducted with the utmost scientific rigor and is one of the largest nutrition clinical studies of its kind. In the study, we evaluated the effects of this specialized nutrition supplement compared to a placebo supplement on the incidence of hospital readmission or death through 90-days after leaving the hospital. The population studied has never been evaluated before in this way. Results showed no significant differences between the two groups for the primary composite (i.e. combined) endpoint of hospital readmissions or death. However, the study individual components and additional analyses showed:
  • A significantly lower (50 percent) death rate for those who received the specialized nutrition supplement. This lower incidence of death began at 30 days after participants left the hospital, and continued for 90 days.
  • Similar rates of hospital readmissions between the two groups.
  • Improvements in other health outcomes including body weight, nutritional status and Vitamin D levels at 30 and 60 days after leaving the hospital, and continued body weight and nutritional status improvements at 90 days for the group taking the specialized nutrition supplement. 
(more…)
Author Interviews, Endocrinology / 22.01.2016

MedicalResearch.com Interview with: Marita Teng, MD Associate Professor of Otolaryngology Head and Neck Institute Icahn School of Medicine at Mount Sinai MedicalResearch.com Editor's note: January is Thyroid Awareness Month. In recognition, Dr. Teng discusses the thyroid gland's important role in the production of  hormones that help the body regulate its metabolism.  Dr. Teng also discusses the recognition of thyroid nodules and cancer. MedicalResearch: What does the thyroid gland do?  Why is it important for health? Dr. Teng: The thyroid gland produces thyroid hormone, which is carried through the circulation to the other organs in the body.  Thyroid hormone is responsible for the body’s metabolism, and therefore maintains functions such as keeping the body warm, and properly use the energy we derive from food. MedicalResearch: What is are some signs or symptoms of an underactive or overactive thyroid? Dr. Teng: Thyroid overactivity (hyperactivity) results in heat intolerance, weight loss, rapid heartbeat, nervousness, increased appetite, difficulty sleeping, skin thinning, and hair loss, among other symptoms.  Thyroid underactivity (hypothyroidism) causes fatigue, weight gain, cold sensitivity, slowed heart rate, depression, memory impairment, and weakness, among other symptoms.  It should be noted that these symptoms are all nonspecific and can certainly be caused by other medical conditions as well. (more…)
Accidents & Violence, Author Interviews, JAMA, Surgical Research, UCSF / 22.01.2016

MedicalResearch.com Interview with: Dr. Rachael Callcut M.D., M.S.P.H Assistant Professor of Surgery Division of General Surgery UCSF Medical Research: What is the background for this study? What are the main findings? Dr. Callcut: San Francisco General Hospital (SFGH) responded on July 6, 2013 to one of the larger multiple casualty events in the history of our institution.  Asiana Airlines flight 214 crashed on approach to San Francisco International Airport with 307 people on board.  192 patients were injured and SFGH received the highest total of number of patients of area hospitals. The majority of data that is available on disaster response focuses on initial scene triage or initial hospital resources required to respond to these types of major events.  Our paper focuses on some additional considerations for optimizing disaster response not typically included in literature on these events including nursing resources, blood bank needs, and radiology studies. As an example, over 370 hours of nursing overtime were needed just in the first 18 hours following the disaster to care for patients.  This type of information in traditionally not been included in disaster planning, but clearly was a critical element of providing optimum care to our patients. (more…)
Author Interviews, HPV, JAMA / 22.01.2016

More on HPV on MedicalResearch.com  MedicalResearch.com Interview with: Ilir Agalliu, M.D., Sc.D. Assistant Professor, Department of Epidemiology & Population Health and Department of Urology Albert Einstein College of Medicine Jack and Pearl Resnick Campus Bronx, NY Medical Research: What is the background for this study? Dr. Burk: We performed this study since we had previously detected an unusually high prevalence of HPV types found on the skin and skin cancers in the oral cavity in addition to HPV16 and other high-risk (HR) types (as defined by their association with cervix cancer) (see Journal of Infectious Diseases 204:787, 2011). We wished to determine if these types were associated with risk of head and neck cancers (HNSCCs). In addition, we wished to determine if HPV detection preceded the diagnosis of HNSCCs and might serve as a biomarker. Currently there are no good screening tests for HNSCC. Dr. Agalliu: To-date, there have been no prospective studies examining the temporal relationship between oral HPV detection and risk of head and neck squamous cell carcinoma (HNSCC). In this manuscript we examined prospectively associations between detection of a wide spectrum of oral HPVs (alpha, beta and gamma) with incident HNSCC in a nested case-control study among ~100,000 participants who provided mouthwash samples in the American Cancer Society-CPS II cohort and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Dr. Agalliu: Oral HPV16 detection, which preceded cancer development on average for 4 years, was associated with a 22-fold increased risk for incident oropharyngeal cancer. Detection of other oral HPVs (beta1 HPV5, and gamma11 and 12 species) were associated with a 3.3 to 5.5-fold higher risk of  head and neck squamous cell carcinoma after adjustment for smoking, alcohol and HPV16. Associations of beta and gamma HPVs, which have been identified in the skin, with risk of HNSCC suggest a broader role for HPVs in HNSCC etiology. (more…)
Addiction, Author Interviews, Methamphetamine, Pediatrics, UCLA / 22.01.2016

More on Pediatrics on MedicalResearch.com MedicalResearch.com Interview with: Lynne M. Smith, MD FAAP LA BioMed lead researcher Vice Chair for Academic Affairs Professor of Clinical Pediatrics Department of Pediatrics Division of Neonatology Medical Director, High Risk Infant Follow-up Program Associate Program Director, Neonatal-Perinatal Fellowship Training Program Co-Director, Third Year Medical Student Clerkship Founding co-Leader, Schwartz Rounds at Harbor-UCLA David Geffen School of Medicine at UCLA Harbor-UCLA Medical Center Torrance, CA Medical Research: What is the background for this study? What are the main findings? Dr. Smith: It is the first study of its kind, and it holds hope for improving outcomes for children exposed to the methamphetamine in the womb. The study found that while prenatal methamphetamine exposure can lead to targeted behavioral issues, a supportive home environment significantly decreases the severity and risk of these issues. The study is a follow-up to the Infant Development, Environment and Lifestyle (IDEAL) study, which is a prospective, multi-center, longitudinal study of children exposed to methamphetamine in the womb. It is designed to address some of the limitations of earlier studies. The IDEAL study enrolled children from Los Angeles; Des Moines, IA; Tulsa, OK, and Honolulu, HI, who had been exposed to methamphetamine in utero. Previous reports from the IDEAL study documented the outcomes up to age 5 and found emotional issues and attention deficit hyperactivity disorders in the children with prenatal methamphetamine exposure. The new study surveyed 290 children enrolled in IDEAL up to age 7.5 years and found a strong relation between prenatal methamphetamine exposure and rule-breaking and aggressive behavior. It also found a strong relation between adversities in the home and rule-breaking and aggressive behavior. Among the adverse conditions considered were maternal substance abuse, extreme poverty, changes in the primary caregiver, sexual abuse of the caregiver and maternal depression. The researchers concluded that while prenatal methamphetamine exposure is strongly related to behavioral and emotional control issues, early adversities may be a strong determinant of behavioral outcomes. (more…)
Author Interviews, Dermatology, Infections / 22.01.2016

More on Dermatology on MedicalResearch.com MedicalResearch.com Interview with: Gregory R. Delost, DO University Hospitals Regional Hospitals Richmond Heights, OH MedicalResearch.com: What is the background for this study? Dr. Delost: Acne vulgaris is a common dermatological disorder with an incidence of approximately 85% in adolescents and young adults. Treatment options include topical antibiotics, topical retinoids, benzoyl peroxide, oral antibiotics and isotretinoin. Antibiotics are generally prescribed for cases of moderate to severe acne. However, long-term antibiotic use may affect the normal flora bacteria and perhaps promote the development of antibiotic resistant bacteria. There is little prospective research in outpatient settings to determine if these concerns are valid. In our study, we used a prospective, cross-sectional, quasi-experimental design, which compared colonization of Staphylococcus aureus in 263 patients undergoing treatment for clinically diagnosed acne in two northeastern Ohio dermatology practices. (more…)
Author Interviews, Heart Disease / 22.01.2016

MedicalResearch.com Interview with: Jimmy T. Efird, PhD, MSc Director Center for Epidemiology and Outcomes Research East Carolina Heart Institute Brody School of Medicine East Carolina University NC Medical Research: What is the background for this study? What are the main findings? Dr. Efird: While postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass graft surgery (CABG), little is known about the association among obesity, POAF, and race in this population. Recently, increased body mass index (BMI) has been shown to be a stronger predictor for incident atrial fibrillation (AF) in blacks compared with whites in the general population. However, a similar finding has not been examined in patients undergoing CABG. In this study of 13,594 patients undergoing CABG at the East Carolina Heart Institute, risk for postoperative atrial fibrillation increased with obesity severity among black not white patients, after adjusting for demographics and prior medical history/comorbidities. (more…)
ALS, Author Interviews / 22.01.2016

More on Alzheimer's Disease on MedicalResearch.com MedicalResearch.com Interview with: Sandra Anne Banack Institute for Ethnomedicine Jackson Hole, WY Medical Research: What is the background for this study? What are the main findings? Response: Villagers from the island of Guam had 50-100x the incidence rates of ALS when compared with Western populations. Although the disease on Guam  was first identified as ALS it is now known as ALS/PDC because it can also have clinical features of Parkinson’s and Alzheimer's diseases. The pathological features of this disease include brain tangles and amyloid plaques that are also the diagnostic features of Alzheimer's disease.  We found that an environmental neurotoxin causes brain tangles and amyloid deposits in an animal model. This is the first time that brain tangles, known technically as neurofibrillary tangles, have been created in an animal model along with the amyloid deposits. The animal model can be used to screen potential drugs for Alzheimer's and potentially other neurodegenerative diseases quicker and at a fraction of the cost and risk of current methods using human subjects. In addition, we found that L-serine significantly reduced the formation of brain tangles exposed to this toxin. (more…)
Author Interviews, CDC, Lyme / 21.01.2016

More on Lyme Disease on MedicalResearch.com MedicalResearch.com Interview with: Rebecca Eisen PhD research biologist and Ben Beard, Ph.D.  Chief, Bacterial Diseases Branch Division of Vector-Borne Diseases Centers for Disease Control and Prevention Medical Research: What is the background for this study? Dr. Eisen: Since the late 1990s, the number of reported cases of Lyme disease in the United States has tripled and the number of counties in the northeastern United States that are considered high-risk for Lyme disease has increased by more than >320%. In 1998, a comprehensive review was published that described the geographic distributions of the blacklegged tick (Ixodes scapularis) and the Western blacklegged tick (Ixodes pacificus). These ticks are responsible for infecting humans with the pathogens that cause Lyme disease, anaplasmosis, and babesiosis. Medical Research: Would you tell us about the methodology? Response: CDC researchers recently published an update to the 1998 tick distribution map. The authors reviewed the scientific literature and individual state health department websites for data. Additionally, they contacted public health officials, entomologists, and Lyme disease investigators throughout the United States to assess county-level tick collection data. Researchers characterized counties with Ixodes scapularis and Ixodes pacificus ticks as “established” if at least 6 individual ticks or at least 2 of the 3 tick life stages had been identified during a collection period. Counties were characterized as “reported” if at least one tick of any life stage had been identified at any time in that county, or if county records did not specify the number of ticks or life stages collected. (more…)
Author Interviews, Melanoma, Race/Ethnic Diversity / 21.01.2016

More on Dermatology on MedicalResearch.com MedicalResearch.com Interview with: Dr. Jennifer A. Stein MD PhD Associate Professor Department of Ronald O. Perelman Department of Dermatology NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Stein: Although acral melanoma is not a common cancer, it is the most common form of melanoma in African Americans. There is low awareness about acral melanoma, and it tends to get detected later and is more often fatal than other types of melanoma. Our study looked at awareness of and the prevalence of pigmented lesions on the hands and feet. People with darker skin were more likely to have a pigmented lesion on their soles or palms than people with lighter skin. We found that more than half of the people in the study were not aware that they had a pigmented lesion on their feet. Our study found that most pigmented lesions on the hands and feet are benign, and that an imaging technique called dermsocopy can be used to distinguish benign from malignant acral lesions. (more…)