Alcohol, Author Interviews, Brigham & Women's - Harvard, Cancer Research, Dermatology / 26.10.2015

MedicalResearch.com Interview with: Shaowei Wu, MD, PhD Department of Dermatology, Warren Alpert Medical School Brown University, Providence, Rhode Island Department of Dermatology Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: Basal cell carcinoma (BCC) of the skin is the most prevalent cancer in the US, and is responsible for substantial morbidity and billions of dollars of health care expenditures. Knowledge on the modifiable risk factors of BCC is required for targeted prevention of cancer incidence. Alcohol consumption is a well-known risk factor for human cancer and has been linked to a number of cancers, including breast, prostate, pancreatic, and colon cancers. Interestingly, a large epidemiological study has reported a positive association between alcohol consumption and increased prevalence of severe sunburn, an established skin cancer risk factor. It is hypothesized that metabolites of alcohol (e.g., acetaldehyde) can serve as photosensitizers and promote skin carcinogenicity in the presence of UV radiation. However, epidemiological evidence for the association between alcohol consumption and BCC risk has been limited and a few previous studies on this topic have yielded conflicting results. Therefore we conducted a comprehensive prospective study to investigate this question using data from three large cohorts including the Nurses’ Health Study (1984-2010), Nurses’ Health Study II (1989-2011), and Health Professionals Follow-up Study (1986-2010). We documented a total of 28,951 incident Basal cell carcinoma cases over the study follow-up. We found that increasing alcohol intake was associated with an increased Basal cell carcinoma risk in both women and men. In the combined analysis with all 3 cohorts, those who consumed 30 grams or more alcohol per day had a 22% higher risk of developing BCC when compared to nondrinkers. This increased risk was consistent in people with different levels of sun exposure. We also found that BCC risk was associated with alcohol intake levels more than a decade ago, suggesting that alcohol may have a lagged effect that can persist for a long-term period. Among the individual alcoholic beverages, white wine and liquor were positively associated with Basal cell carcinoma risk whereas red wine and beer were not associated with BCC risk. This difference may be due to some other chemicals accompanying alcohol in the specific beverages. For example, red wine contains higher amounts of phenolic compounds compared to white wine, and these compounds have antioxidant activities which may be beneficial for counteracting the potential carcinogenic properties of alcohol and its metabolites. (more…)
Author Interviews, Gluten, Pediatrics / 26.10.2015

MedicalResearch.com Interview with: Maria Ines Pinto Sanchez, MD MSc​ Post-doctoral Clinical ​ Research Fellow and Dr Elena Verdu, MD, PhD Farncombe Family Digestive Health Research Institute McMaster University Health Sciences Centre Hamilton, ON Medical Research: What is the background for this study? What are the main findings? Response: Celiac disease is a condition caused by ingestion of gluten in people with genetic predisposition, in which the finger like projections of the intestinal lining are damaged by inflammation. The “celiac” genes are necessary, but not sufficient, to develop celiac disease. For this reason, it is believed that additional factors could influence the risk of a predisposed child to develop celiac disease. Some studies have indeed suggested that the ideal time for the introduction of gluten to the diet would fall between the 4th and 6th month of life, when gluten should be introduced in “small quantities” and progressively, while maintaining breastfeeding whenever possible. The Nutrition Committee of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition recommended avoiding the introduction of gluten before 4 months and after 7 months of age in an attempt to prevent celiac disease. However, not all clinical studies reached this conclusion and we therefore conducted an updated analysis of the literature published on this subject to evaluate the relationship between time and amount of gluten introduction, breastfeeding and the risk of developing celiac disease. Our systematic analysis revealed that based on the studies published to date there is no strong support that early gluten introduction to an infant’s diet increases the chances to develop celiac disease or that breastfeeding specifically protects from it. (more…)
Author Interviews, Genetic Research, Kidney Disease, Nature, Stem Cells / 24.10.2015

MedicalResearch.com Interview with: Benjamin Freedman, Ph.D. Assistant Professor | University of Washington Department of Medicine | Division of Nephrology Member, Kidney Research Institute Member, Institute for Stem Cell and Regenerative Medicine Seattle WA 98109  Medical Research: What is the background for this study? What are the main findings? Dr. Freedman: We are born with a limited number of kidney tubular subunits called nephrons. There are many different types of kidney disease that affect different parts of the nephron. The common denominator between all of these diseases is the irreversible loss of nephrons, which causes chronic kidney disease in 730 million patients worldwide, and end stage renal disease in 2.5 million. Few treatments have been discovered that specifically treat kidney disease, and the therapeutic gold standards, dialysis and transplant, are of limited availability and efficacy. Pluripotent stem cells are a renewable source of patient-specific human tissues for regeneration and disease analysis. In our study, we investigated the potential of pluripotent cells to re-create functional kidney tissue and disease in the lab. Pluripotent cells treated with a simple chemical cocktail matured into mini-kidney 'organoids' that closely resembled nephrons. Using an advanced gene editing technique called CRISPR, we created stem cells with genetic mutations linked to two common kidney diseases, polycystic kidney disease (PKD) and glomerulonephritis. Mini-kidneys derived from these genetically engineered cells showed specific 'symptoms' of these two different diseases in the petri dish. (more…)
Author Interviews, CDC, Occupational Health, Toxin Research / 24.10.2015

MedicalResearch.com Interview with: Geoffrey M. Calvert MD Division of Surveillance, Hazard Evaluations, and Field Studies National Institute for Occupational Safety and Health CDC Cincinnati, Ohio Medical Research: What is the background for this study? Dr. Calvert: Since 1987, acute occupational pesticide-related illness and injury has been one of the conditions under surveillance by NIOSH. NIOSH supports these surveillance activities by providing cooperative agreement funding and technical support to state health departments. The SENSOR-Pesticides program is also partially funded by EPA. A total of 12 states currently participate in the SENSOR-Pesticides program. With the 2015 publication of the Summary of Notifiable Non-Infectious Conditions and Disease Outbreaks – United States, official statistics for the occurrence of acute occupational pesticide-related illness and injury were published for the first time in the same volume of the MMWR with information on nationally notifiable infectious diseases. (more…)
Accidents & Violence, Author Interviews, Occupational Health / 24.10.2015

MedicalResearch.com Interview with: Matthew S. Thiese, PhD, MSPH Assistant Professor Rocky Mountain Center for Occupational and Environmental Health University of Utah School of Medicine Medical Research: What is the background for this study? Dr. Thiese: The nearly 3 million truck drivers in the United States face many challenges including a lack of physical activity, limited healthy food choices, work-related stress, high physical job demands of loading and unloading trucks and a high risk of being involved in crashes. The purpose of the study was to describe truck driver health and assess relationships between both personal and occupational factors and risk of being involved in a crash. This is why it is important to get yourself checked out by a doctor before carrying out any activity involving being on the road. Depending on your job, you can be driving for a long period of time and it is most likely that you'll become tired. A tired driver being a wheel is at a high risk of being involved in an accident. If you are soon to visit your local doctor for any problems you may have, it may be good to look into something like jj keller eld reviews to give you another way of staying safe on the roads and to help you prevent any accidents that could occur. The main thing for anyone to do before driving is checking they are physically fit to get behind the wheel. The next step though is to make sure that you can actually drive a truck. There are loads of places that you can training from, for example, you could just check out a website like MyCDLTraining.com to help you learn how to drive a truck. Medical Research: What are the main findings? Dr. Thiese: There were many personal and occupational factors that were significantly related to being involved in a crash. Among the personal factors assessed, drivers were more likely to be involved in a crash if they used a cell phone regularly, drank alcohol regularly, had a prior diagnosis of heart problems, reported snoring at night, had low back pain in the past year and if they had a high pulse pressure, which is the difference between the systolic and diastolic measures and is indicative of cardiovascular disease. Occupational factors related to being involved in a crash included how long subjects had been a commercial truck driver and how physically exhausted they felt after work; drivers reporting higher physical exhaustion were more likely to be involved in a crash. If you have been involved in a crash check out an Atlanta Truck Accident Lawyer. (more…)
Author Interviews, Biomarkers, Infections / 24.10.2015

MedicalResearch.com Interview with: Dr. Johannes Kettunen Computational Medicine, Institute of Health Sciences, University of Oulu National Institute for Health and Welfare, Helsinki NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio Finland   Medical Research: What is the background for this study? What are the main findings? Dr. Kettunen: The initial discovery of the mortality biomarkers was made 1.5 years ago when we published the first paper describing four biomarkers indicative of 5-year mortality in two cohorts totaling over 17 000 population based samples (http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001606). We wanted to understand the molecular background of the strongest mortality predictor and this is how the current study was started. Here,  The network was enriched with defense response genes and we had an idea to test if the biomarker was predictive of future severe infections. We were able to show that chronic inflammation creates extra stress to immune system and predisposes to future infections. (more…)
Author Interviews, Cancer Research, CDC, Gender Differences, Race/Ethnic Diversity / 24.10.2015

MedicalResearch.com Interview with: Dr. Simple Singh MD Epidemiologist Division of Cancer Prevention and Control CDC  Medical Research: What is the background for this study? Dr. Singh: This report provides official federal statistics on the occurrence of cancer for 2011 and trends for 1999–2011 as reported by CDC and the National Cancer Institute (NCI). Cancer incidence data are from population-based cancer registries that participate in CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) program reported as of November 2013. Cancer mortality data are from death certificate information reported to state vital statistics offices in 2013 and compiled into a national file for the entire United States by CDC’s National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS). This report is a part of the first-ever Summary of Notifiable Noninfectious Conditions and Disease Outbreaks — United States, which encompasses various surveillance years but is being published in 2015. Medical Research: What are the main findings? Dr. Singh: In 2011, approximately 1.5 million invasive cancers were diagnosed in the United States, an annual incidence rate of 451 cases per 100,000 persons. In the same year, approximately 576,000 persons died of cancer nationally, an annual death rate of 169 deaths per 100,000 persons. Cancer incidence and death rates increase with age. Overall, 54% of cancer cases and 69% of cancer deaths in 2011 occurred among persons aged ≥65 years. Among men in 2011, blacks had the highest cancer incidence and death rates in the United States, and American Indians/Alaska Natives and Asians/Pacific Islanders had the lowest cancer incidence and death rates. Among women in 2011, whites had the highest cancer incidence rates and blacks had the highest cancer death rates. American Indians/ Alaska Natives had the lowest cancer incidence rates, and Asians/Pacific Islanders had the lowest cancer death rates. By state, overall (all cancer sites combined) cancer incidence rates in 2011 ranged from 374 to 509 cases per 100,000 persons, and overall cancer death rates ranged from 126 to 201 deaths per 100,000 persons. Four cancer sites accounted for half of all cases diagnosed in 2011, including 209,292 prostate cancers, 220,097 female breast cancers, 207,339 lung and bronchus cancers (110,322 among men and 97,017 among women), and 135,260 colon and rectum cancers (70,099 among men and 65,161 among women). These four sites also accounted for half of cancer deaths in 2011, including 156,953 lung cancer deaths, 51,783 colon and rectum cancer deaths, 40,931 female breast cancer deaths, and 27,970 prostate cancer deaths. During 1999–2011, cancer incidence rates declined from 485 cancer cases per 100,000 population in 1999 to 444 cases in 2011. Although lung cancer incidence declined steadily among men from 1999 to 2011, it increased among women from 1999 to 2005 and has since declined from 2005 to 2011. Prostate cancer incidence declined from 170 cases per 100,000 men in 1999 to 128 cases in 2011. Colorectal cancer incidence declined from 57 cases per 100,000 persons in 1999 to 40 cases in 2011. Female breast cancer incidence declined from 135 cases per 100,000 women in 1999 to 121 cases in 2005, increased to 125 cases in 2009, and declined again to 122 cases in 2011. During 1999–2011, cancer death rates declined from 201 deaths per 100,000 persons in 1999 to 169 deaths in 2011; during the same period, death rates declined for each of the top four cancers. (more…)
Author Interviews, Clots - Coagulation, Heart Disease, JACC / 24.10.2015

H.A. (Hendrika) van den Ham PharmD Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences Utrecht University The Netherlands.MedicalResearch.com Interview with: H.A. (Hendrika) van den Ham PharmD Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences Utrecht University The Netherlands. Medical Research: What is the background for this study? What are the main findings? Dr. van den Ham: Atrial fibrillation (AF) is associated with a substantial risk of ischemic stroke and thromboembolism. The CHADS2 and the CHA2DS2-VASc risk scores are developed to guide the decision to prescribe anticoagulants. Recently a new clinically-based risk score, the ATRIA study risk score, was developed. We compared the predictive ability of the ATRIA risk score with the CHADS2 and CHA2DS2-VASc risk scores in a large, independent, community-based cohort of Atrial fibrillation patients in the United Kingdom. We found that the ATRIA score more accurately identified low risk patients that the CHA2DS2-VASc score assigned to higher risk categories.  Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with Atrial fibrillation. (more…)
Author Interviews, Pediatrics, Weight Research / 24.10.2015

MedicalResearch.com Interview with: Brian S. Schwartz, MD, MS Professor of Environmental Health Sciences, Epidemiology, and Medicine Co-director, Program on Global Sustainability and Health Senior Investigator, Geisinger Center for Health Research (Danville, PA) Johns Hopkins Bloomberg School of Public Health Baltimore, Maryland 21205 Medical Research: What is the background for this study? What are the main findings? Dr. Schwartz: Sub-therapeutic doses of antibiotics (not a high enough dose to treat an infection in the animal) have been added to animal feeds for decades to promote weight gain. An increasing number of studies of therapeutic uses of antibiotics in humans have reported weight gain, mostly in young children. Using electronic health record data on over 163,000 children between 3 and 18 years of age from the Geisinger Health System, our study was the first one to study the full childhood age range among mostly healthy children; to find effects of antibiotics on weight gain at all ages; to find that the more the cumulative number of antibiotics the greater the weight gain; and that some of the effects were progressive, in that the cumulative number of antibiotics caused an increasing divergence of the body mass index trajectory over time from the trajectory in children who had not received antibiotics. (more…)
Author Interviews, Bipolar Disorder, Kidney Disease, Lancet, Mental Health Research, Pharmacology / 24.10.2015

MedicalResearch.com Interview with: Dr. Stefan Clos MSc Applied Health Statistics Psychiatrist Murray Royal Hospital Scotland UK Medical Research: What is the background for this study? Dr. Clos: For more than 40 years there has been a debate about the long-term effect of lithium maintenance therapy on renal function. There is a lack of good quality data from randomized clinical trials and two previous meta-analyses from 2010 and 2012 suggest that little evidence exists for a clinically significant reduction in renal function in most patients who are on lithium therapy. However, the two publications point out the poor quality of available study data, emphasising the need for large scale epidemiological studies that control for confounders. Several population-based studies have since attempted to address this problem, but had insufficient ability to adjust for confounders or had limitations because of inappropriate cross-sectional study design or did not include an appropriate comparator group.  (more…)
Author Interviews, Dermatology, Melanoma, Primary Care / 24.10.2015

MedicalResearch.com Interview with: Simone Ribero,  M.D., Ph.D.  University of Turin Department of Medical Sciences Italy & King’s College London Department of Twin Research and Genetic Epidemiology St Thomas’ campus London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Ribero: The total body naevus count is the principal risk factor for melanoma. having more than 100 moles increases  6 times the risk of developping a melanoma. In our study we described a model to predict the total number naevus count with the count of one arm. (more…)
Anesthesiology, Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, PTSD, Pulmonary Disease / 24.10.2015

MedicalResearch.com Interview with: Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo Medical Research: What is the background for this study? What are the main findings? Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter. Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD. This is why many veterans are trying to claim disability benefits using va benefits and disability lawyer Tennessee to help them fight their case. (more…)
Author Interviews, FDA, Immunotherapy, Lung Cancer / 24.10.2015

MedicalResearch.com Interview with: Dickran Kazandjian, MD Office of Hematology and Oncology Products Center for Drug Evaluation and Research US Food and Drug Administration Silver Spring, Maryland Medical Research: What is the background for this study? What are the main findings? Dr. Kazandjian: Nivolumab is the first approved immunotherapy, for the treatment of metastatic squamous non–small-cell lung cancer (NSCLC) after platinum-based chemotherapy.  FDA initiated an expedited review after obtaining the data monitoring committee report of a planned interim analysis of a second-line squamous NSCLC trial demonstrating a large overall survival benefit (CheckMate 017). Nivolumab efficacy in metastatic Squamous (SQ) NSCLC has been previously reported in two studies.  CheckMate 063 was a single-arm trial in 117 patients with metastatic SQ NSCLC who had progressed after previous treatment with 2 systemic regimens including platinum-based doublet chemotherapy (Rizvi et al)  CheckMate 017 was a randomized study of nivolumab compared to docetaxel in 272 patients with metastatic SQ NSCLC who had progressed after prior platinum-based doublet chemotherapy (Brahmer et al).  The median survival of patients randomized to nivolumab was 9.2 months vs 6.0 months for docetaxel (hazard ratio, 0.59; 95%CI, 0.44-0.79; P < .001) a 41% improvement in the risk of death. Approval was supported by the single-arm study which demonstrated an objective response rate of 15% and at the time of analysis, 10 of the 17 responding patients (59%) had response  durations of 6 months or longer. The FDA approved nivolumab on March 4, 2015, saving 6 months by not waiting for formal preparation of data by the sponsor and 2.5 months by expediting review. (more…)
Author Interviews, Infections, NEJM, OBGYNE / 24.10.2015

Alfredo Mayor Aparicio PhD Associate Research Professor Barcelona Institute for Global HealthMedicalResearch.com Interview with: Alfredo Mayor Aparicio PhD Associate Research Professor Barcelona Institute for Global Health Medical Research: What is the background for this study? What are the main findings? Dr. Mayor: The malaria parasite is a well-adapted pathogen which can persist and reappear in areas where infection is no longer circulating or at very low levels. Prevention of such reinfections and resurgences is critical for the current goal of malaria eradication. However, little is known about the determinants and consequences of malaria declines and resurgences. For this reason, understanding the relationship between malaria transmission, immunity and disease burdens is essential to rationalise malaria interventions aimed at reducing host-parasite encounters. We have described changes in prevalence among pregnant women delivering between 2003 and 2012 at antenatal clinics in Southern Mozambique, and showed that a reduction of malaria-specific immunity associated with drops in transmission is accompanied with an increase the severity of malaria infection among those women becoming infected. These results suggest that success of control and elimination activities may lead through a transitional period where infrequent infections will likely slowdown the rate of acquisition of host defenses and will be thus associated with more deleterious effects during pregnancy, thus requiring more precise diagnosis and surveillance methods, as well as improved prevention. (more…)
Author Interviews, Cancer Research, MD Anderson, Nature / 23.10.2015

MedicalResearch.com Interview with: Dihua Yu, M.D., Ph.D. Professor and Deputy Chair Dept.  of Molecular and Cellular Oncology Hubert L. and Olive Stringer Distinguished Chair in Basic Science University Distinguished Teaching Professor Co-Director, Center of Biological Pathways Univ. of TX MD Anderson Cancer Center Houston, TX 77030 Medical Research: What is the background for this study? What are the main findings? Dr. Yu: Metastasis is the number one cause of cancer-related mortality. Despite the continuous advancement of modern medicine in better controlling primary cancer progress, brain metastasis incidence constantly and steadily increases. Major neoplastic diseases such as melanoma, lung, breast, and colon cancers have high incidences of brain metastases. One-year survival after diagnosis of brain metastasis is less than 20%. Cancer cells dynamically interacts with specific organ microenvironments to establish metastasis as depicted by the “seed and soil” hypothesis. Many research have focused on how tumor cells modulate the metastatic microenvironment, but the reciprocal effect of the organ microenvironment on tumor cells has been overlooked. The brain tissue is very distinct from primary tumor environment for metastatic cancer cells. Brain metastasis frequently manifests in the late stages of cancer, and a long period of dormancy often precedes relapse. This implies that additional regulations imposed by the brain microenvironment are essential for metastatic colonization and outgrowth. Yet it is unclear when and how disseminated tumor cells acquire the essential traits from the brain microenvironment that primes their subsequent metastatic outgrowth. (more…)
Author Interviews, Surgical Research, Technology / 23.10.2015

[wysija_form id="5"]MedicalResearch.com Interview with: Professor Philip Breedon Professor of smart technologies Nottingham Trent University Design for Health and Wellbeing Research Group  Medical Research: What is the background for this study? Prof. Breedon: This report presented an innovative approach of enhancing the efficiency of spinal surgery by utilizing the technological capabilities and design functionalities of wearable headsets, in this case Google Glass. The overall aim was to improve the efficiency of the Selective Dorsal Rhizotomy ( SDR) neurosurgical procedure through the use of Google Glass via an innovative approach to information design for the intraoperative monitoring display. (more…)
Author Interviews, Beth Israel Deaconess, CHEST, Education, Pulmonary Disease / 23.10.2015

MedicalResearch.com Interview with: Dr. George Cheng MD Beth Israel Deaconess Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Cheng: Since the introduction of flexible bronchoscope in late 1960s, flexible bronchoscopy has gained wide popularity and with over 500,000 procedures being performed in the USA annually.  Bronchoscopy training has been undergoing rapid advancement in recent years.  Virtual bronchoscopy, either web-based training or VR bronchoscopic simulators, were used to teach and to improve performance in bronchoscopy.  However, virtual reality simulators often cost over $100,000 dollars.  Given the prohibitive high cost, recent CHEST expert panel recommended that high fidelity simulators be offered only in regional simulation centers.  Therefore, low cost realistic bronchoscopy training models are an area of need. Recent development in 3D printing and 3D medical modeling has allowed clinicians to utilize CT scans to create physical models.  This approach can be used to create affordable 3D printed, anatomically accurate bronchoscopy training models.  However, the 3D printed tracheobronchial model has never been evaluated as a bronchoscopy simulation tool.  We aimed to address this question with our study. The 3D printed bronchoscopy model was generated from flexible nylon material and stained to match the airway mucosa coloration.  Participants of varies training levels performed bronchoscopy on both standard and 3D printed bronchoscopy model, graded each on a sliding scale from 0-100.  Overall, clinicians preferred the 3D printed model regardless of their level of training. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Race/Ethnic Diversity, Surgical Research / 23.10.2015

MedicalResearch.com Interview with: Dr. Quoc-Dien Trinh MD Assistant Professor of Surgery Harvard Medical School  Brigham and Women's Hospital Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Trinh:  Blacks who undergo radical prostatectomy, e.g. surgical removal of the prostate for cancer, are more likely to experience complications, emergency room visits, readmissions compared to their non-hispanic White counterparts. As a result, the 1-year costs of care for Blacks is significantly higher than non-hispanic Whites. Interestingly, despite these quality of care concerns, the survival of elderly Blacks and Whites undergoing prostatectomy is the same. Medical Research: What should clinicians and patients take away from your report? Dr. Trinh: A possible interpretation of our findings is that the biological differences in tumor aggressiveness among Blacks  (e.g. Blacks have more aggressive prostate cancer than Whites) may have been exaggerated, and that the perceived gap in survival is a result of lack of access or cultural perceptions with regard to surgical care for prostate cancer or other factors that differentiate who makes it to the operating table. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Transplantation / 22.10.2015

MedicalResearch.com Interview with: Monika Fischer, MD, MSCR Assistant Professor of Clinical Medicine Division of Gastroenterology and Hepatology Indiana University Indianapolis, IN 46202  Medical Research: What is the background for this study? What are the main findings? Dr. Fischer: Cumulative evidence based upon case series and randomized trials suggest high success rate with 10-20 % failing a single FMT (fecal microbiota transplant). Predictors of failures are not known. In a collaborative study between Indiana and Brown Universities we aimed to identify clinical predictors of FMT failure. Results were the following:
  • N= 345 patients
    • Brown: N=166
    • IU: N=179
  • Average age: 62 years
  • Females: 72%
  • IBD: 18%
  • Immunosuppression: 24%
  • Indication for FMT
    • Recurrent CDI: 74%
    • Refractory CDI: 26%
    • Severe/complicated CDI: 13%
  • Inpatient FMT: 17%
  • Patient directed donor: 40%
Overall failure rate was 23.7%. Broken down by fecal microbiota transplant indication, while only 18% of patients failed and  needed further therapy in the non-severe category, 1 in 2 (50%) severe C. difficile infection (CDI) patients failed a single fecal microbiota transplant and needed further therapy for cure. (more…)
Author Interviews, Endocrinology, Genetic Research, Weight Research / 22.10.2015

Urszula T. Iwaniec, Ph.D. Associate Professor Skeletal Biology Laboratory School of Biological and Population Health Sciences Oregon State University Corvallis, OR 97331MedicalResearch.com Interview with: Urszula T. Iwaniec, Ph.D. Associate Professor Skeletal Biology Laboratory School of Biological and Population Health Sciences Oregon State University Corvallis, OR 97331 Medical Research: What is the background for this study? What are the main findings? Dr. Iwaniec: Excessive weight gain in adults is associated with a variety of negative health outcomes. Unfortunately, dieting, exercise, and pharmacological interventions have had limited long-term success in weight control and can result in detrimental side effects, including accelerating age-related bone loss.  Leptin, a hormone produced by fat cells plays an essential role in weight regulation. Delivery of leptin directly into the hypothalamus by gene therapy normalizes body weight. We investigated the efficacy of using hypothalamic leptin gene therapy as an alternative method for reducing weight in skeletally-mature female rats and determined the impact of leptin-induced weight loss on bone. Our findings show that hypothalamic leptin gene therapy reduced body weight with minimal effects on bone mass or microarchitecture. (more…)
Author Interviews, NEJM, Orthopedics / 22.10.2015

MedicalResearch.com Interview with: Søren Thorgaard Skou PT, PhD Postdoc Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark Clinical Nursing Research Unit Aalborg University Hospital  Medical Research: What is the background for this study? What are the main findings? Response: Total knee replacement has been performed for decades. The number of procedures are increasing and is expected to reach 1 million procedures per year in the US alone in the near future, highlighting the associated future economic burden. However, no studies have compared it to non-surgical alternatives, even though this is important to investigate its effectiveness. We found that in patients with knee osteoarthritis eligible for total knee replacement, treatment with total knee replacement followed by non-surgical treatment (exercise, education, dietary advice, use of insoles, and pain medication) were associated with greater pain relief and functional improvement after 12 months than the non-surgical treatment alone. However, both groups had clinically relevant improvements, and patients who underwent total knee replacement had more serious adverse events. Furthermore, most patients who were assigned to receive non-surgical treatment alone did not undergo total knee replacement within the 12 months. (more…)
Author Interviews, BMJ, Dental Research, Pediatrics, Smoking / 22.10.2015

MedicalResearch.com Interview with: Koji Kawakami, MD, PhD Professor and Chair, Department of Pharmacoepidemiology and Clinical Research Management Graduate School of Medicine and Public Health Director, Science for Innovation Policy Unit, Center for Promotion of Interdisciplinary Education and Research Kyoto University Kyoto city Kyoto Japan Medical Research: What is the background for this study? What are the main findings? Dr. Kawakami: The prevalence of caries in deciduous teeth in developed countries remains high, while established measures for caries prevention in young children is limited to sugar restriction, oral fluoride supplementation and fluoride varnish. In this study of 76920 children in Japan, exposure to tobacco smoke at 4 months of age, which was experienced by half of all children of that age, was associated with an increased risk of caries in deciduous teeth by approximately 2-fold. Medical Research: What should clinicians and patients take away from your report? Dr. Kawakami: Our findings would support extending public health and clinical interventions to reduce secondhand smoke. For example, the chance of education on the harm of secondhand smoke would increase if dentists become aware of the caries risk due to secondhand smoke as well as tobacco smoking of their patients. (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease, Primary Care / 22.10.2015

Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105MedicalResearch.com Interview with: Elizabeth Broussard, MD Clinical Assistant Professor Division of Gastroenterology Harborview Medical Center Seattle, WA 98105 Medical Research: What is the background for this study? What are the main findings? Dr. Broussard: I am a clinical assistant professor of gastroenterology and I practice and teach fellows and residents GI at a safety-net hospital in Seattle and I was seeing too many late stage colorectal cancer (CRC) in our patient population. CRC is preventable with screening, and I wanted to see how the primary care clinics were performing in getting patients screened. When I looked at the baseline percentages, I realized this was an opportunity for improvement. I teamed up with an internal medicine resident Kara Walter, and we did a deep dive into the process of screening. The results of the poster presentation are a product of this teamwork, with cooperation and input from the directors of the six primary care clinics at our hospital. The main findings are that performing the FIT test is complicated and tricky for some patients, that this process can be streamlined with providing a toilet hat, a prepaid postage envelope, and improved and visual instructions. After one year, we saw statistically significant increases in overall screening with FIT in our patient population. (more…)
Author Interviews, Geriatrics, Mineral Metabolism / 22.10.2015

MedicalResearch.com Interview with: Andrew M Hinson, MD UAMS Postdoctoral Research Fellow Thyroid/Parathyroid Diseases & Surgery and Donald L. Bodenner, MD, PhD Department of Otolaryngology-Head and Neck Surgery Department of Geriatrics University of Arkansas for Medical Sciences, Little Rock, Arkansas. Medical Research: What is the background for this study? Response: Proton pump inhibitors (PPIs)​ are widely prescribed, highly effective and generally safe for the treatment of acid-related gastrointestinal disorders. However, there are risks that may be elevated for some older people when PPIs are used in high doses over long periods of time. There is also evidence that fracture risk may even be higher in older patients who are being treated with concurrent oral bisphosphonate medications, which are used to prevent fractures in patients with osteoporosis. While the mechanism remains unknown, PPIs may increase fracture risk by decreasing gastrointestinal absorption (e.g., calcium, vitamin B12, and/or bisphosphonates) or by inhibiting a major mechanism by which bisphosphonates work. To learn more about this process, we studied patients 60 years or older with normal renal function and vitamin D levels to see how PPIs (with and without concurrent bisphosphonate administration) impacted measurements in parathyroid hormone (PTH) and calcium. Medical Research: What are the main findings? Response: We found that chronic PPI exposure in elderly adults is associated with mild secondary hyperparathyroidism regardless of concurrent oral blood pressure administration. Secondary hyperparathyroidism refers to the excessive secretion of PTH by the parathyroid glands in response to low blood calcium levels. This is often associated with renal failure; however, all of our patients had normal renal function. (more…)
Author Interviews, Infections, Lancet, Outcomes & Safety, Respiratory / 22.10.2015

MedicalResearch.com Interview with: Yuichiro Shindo, M.D., Ph.D. Assistant Professor Institute for Advanced Research, Nagoya University, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine Showa-ku, Nagoya Japan Medical Research: What is the background for this study? What are the main findings? Dr. Shindo: Appropriate initial antibiotic treatment is essential for the treatment of pneumonia.  However, many patients may develop adverse outcomes, even if they receive appropriate initial antibiotics.  To our knowledge, there have been no studies that clearly demonstrated the risk factors in patients who receive appropriate antibiotic treatment.  If these factors are clarified, we can identify those patients with pneumonia for whom adjunctive therapy other than antibiotic treatment can prove beneficial in terms of improved outcomes.  This study aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotic treatment and elucidate potential candidates for adjunctive therapy. In this study, the 30-day mortality in 579 pneumonia patients who received appropriate initial antibiotics was 10.5%.  The independent risk factors included albumin < 3.0 mg/dL, nonambulatory status, pH < 7.35, respiration rate ≥ 30/min, and blood urea nitrogen ≥ 20 mg/dL.  The 30-day mortality for the number of risk factors was 0.8% (0), 1.2% (1), 16.8% (2), 22.5% (3), and 43.8% (4–5). (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Mayo Clinic, Microbiome, Transplantation / 22.10.2015

MedicalResearch.com Interview with: Dr. Sahil Khanna MBBS Assistant Professor of Medicine Mayo Clinic Medical Research: What is the background for this study? What are the main findings? Response: C. difficile infection patients are at a high risk of complications such as treatment failure. Gut microbiota signatures associated with CDI have been described but it is unclear if differences in gut microbiota play a role in response to therapy. No studies have identified predictors of treatment failure and we aimed to identified gut microbiota signatures to predict response to treatment for primary C. difficile . While there were no clinical predictors of treatment response, there were increases in certain genera in patients with successful treatment response in the fecal samples at initial diagnosis compared to non-responders. A risk index built from this panel of microbes highly differentiated between patients based on response and ROC curve analysis showed that this risk index was a strong predictor of treatment response, with a high area under the curve of 0.83.. (more…)
Author Interviews, Brigham & Women's - Harvard, Gastrointestinal Disease / 22.10.2015

MedicalResearch.com Interview with: Kyle Staller, MD, MPH Massachusetts General Hospital Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Staller: Constipation is exceedingly common and exerts a considerable economic effect.  Although many clinicians assume that the severity of constipation symptoms is the primary driver of obligation absenteeism, our data from over 100 patients undergoing physiologic evaluation for chronic constipation demonstrates that comorbid depression was a bigger predictor or work and school absenteeism than symptom severity and quality of life. (more…)
ADHD, Author Interviews, Mental Health Research, Nature, NYU / 22.10.2015

MedicalResearch.com Interview with: Michael M. Halassa, MD, PhD, Assistant professor Departments of Psychiatry and Neuroscience and Physiology The Neuroscience Institute Depts. of Psychitatry Langone Medical Center New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Halassa:  Attention is a vital aspect of our daily life and our minds are not merely a reflection of the outside world, but rather a result of careful selection of inputs that are relevant. In fact, if we indiscriminately open up our senses to what’s out there, we would be totally overwhelmed. Selecting relevant inputs and suppressing distractors is what we call attention, and as humans we are able to attend in a highly intentional manner. Meaning, we choose what to pay attention to, and we do so based on context. If you’re driving and getting directions from your GPS, you’ll be intentionally splitting your attention between your vision and hearing. Now, in one context, you might have just updated the GPS software, so you know it’s reliable; this would allow you to intentionally pay attention more to the voice coming from the GPS. In another context, the GPS software may be outdated making voice instructions unreliable. This context would prompt you to direct your attention more towards using visual navigation cues and less to the GPS voice. How the brain intentionally and dynamically directs attention based context is unknown. The main strength of our study is that we were able to study context-dependent attention in mice. Mice are unique models because they provide genetic tools to study brain circuits. Meaning, we can turn circuits on and off very precisely in the mouse, and in a way we cannot do in other experimental animals. The inability to do these types of manipulations has been the major roadblock for progress in understanding what brain circuits mediate attention and its intentional allocation. Because we couldn’t train mice to drive and listen to the GPS, we decided to do something much simpler. Based on context (the type of background noise in the experimental enclosure), a mouse had to select between conflicting visual and auditory stimuli in order to retrieve a milk reward. Mice love milk; it turns out, and will work tirelessly to do well on getting it. Each trial, the mouse is told ‘you need to pick the light flash’ or ‘you need to pick the auditory sweep’; these stimuli appeared on either side of the mouse randomly so the animal really had to pay attention in order to get its reward. It also had to take the context into account. We found that mice did this task, and as humans would do, they were reliant on the prefrontal cortex for determining the appropriate context. The major finding was that the prefrontal cortex changed the sensitivity of the brain to incoming stimuli (meaning, made the visual stimulus brighter when the mouse cared about vision and made the auditory stimulus louder when the mouse cared about hearing), by influencing activity in the thalamus. The thalamus is the major early relay station in the brain. The prefrontal cortex does that by instructing the brain’s switchboard, known as the thalamic reticular nucleus (TRN) to control how much visual or auditory information the thalamus was letting through. So in a sense, we discovered that executive function, represented by the prefrontal cortex, can talk to ‘attentional filters’ in the thalamus to determine what ultimately is selected from the outside environment to build our internal world. (more…)
Author Interviews, Metabolic Syndrome, Weight Research / 22.10.2015

Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital A member of Alameda Health System Oakland, CA 94602MedicalResearch.com Interview with: Robert Wong, M.D., M.S. Attending Physician, Gastroenterology & Hepatology Director, GI Education & Research Highland Hospital A member of Alameda Health System Oakland, CA 94602 Medical Research: What is the background for this study? What are the main findings? Dr. Wong: The rising prevalence of obesity and diabetes has led to concurrent rise in metabolic syndrome in the U.S.  Identifying metabolic syndrome is important to implement targeted treatment as metabolic syndrome contributes to cardiovascular disease, nonalcoholic fatty liver disease, and overall mortality.  However, while obesity is a major risk factor for metabolic syndrome, out study highlights the importance of considering metabolic syndrome even in individuals who do not meet criteria for obesity.  We demonstrated that nearly 20% of adults who do not meet current definitions of obesity still have metabolic syndrome in the U.S. (more…)