Author Interviews
17 Aug Delayed Umbilical Cord Clamping in Preterm Infants May Reduce Complications and Need For Transfusions
MedicalResearch.com Interview with:
Arpitha Chiruvolu MD FAAP
Neonatologist
Baylor University Medical Center
Department of Neonatology
Dallas, TX 75246
MedicalResearch: What is the background and main findings of the study?
Dr. Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes.
We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort.
Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort. A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities.
17 Aug Cooked Carbohydrates May Have Boosted Human Brain Growth Over Time
MedicalResearch.com Interview with:
Dr. Karen Hardy
ICREA, Catalan Institution for Research and Advanced Studies
Departament de Prehistòria
Facultat de Filosofia i Lletres
Universitat Autònoma de Barcelona
Barcelona, Spain
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Hardy: There continues to be little clear agreement on what quantitatively constitutes a healthy diet. The global increase in the incidence of obesity and diet-related metabolic diseases have intensified interest in ancestral or “Palaeolithic” diets as it is clear that to a first order of approximation our physiology should be optimized to the diet that we have experienced during our evolutionary past. However, reconstructing ancestral diets is very challenging, and exactly what was eaten during the Palaeolithic remains largely unknown.
Until now, there has been a heavy focus on the role of animal fats and protein in the development of the human brain and there is little doubt that increases in meat consumption from around 3.4 million years ago, was a major driver. However, the role of carbohydrates, particularly in the form of starch-rich plant foods, has largely been overlooked. But the human brain today uses up to 25 % of the body’s energy budget and up to 60 % of blood glucose as a general rule, while pregnancy and lactation in particular, place additional demands on the body’s glucose budget. In this study we integrated multiple lines of evidence from human genetics, archaeology, anthropology, physiology, and nutrition, to hypothesise that cooked carbohydrates played an important part in the evolution of the body, and particularly the brain, over the last 800,000 years.
Our results suggest that while meat was important, brain growth is less likely to have happened without the energy obtained from carbohydrates. While cooking has also been proposed as contributing to early brain development, it has a particularly profound effect on the digestibility of starch. Furthermore, humans are unusual among primates in that they have many copies of the salivary amylase gene (average of around six salivary amylase genes, other primates have only two) leading to more efficient starch digestion. This suggests that cooking starch-rich plants and having more amylase coevolved. We don’t know exactly when the number of amylase gene copies multiplied, but genetic data suggest it was in the last million years; a timeframe that brackets archaeological evidence for cooking and when our brain size increase accelerated (around 800,000 years ago). Salivary amylases are largely ineffective on raw crystalline starch, but cooking substantially increases both their energy-yielding potential and glycemia.
17 Aug Urine Biomarker Panel Detects Early Pancreatic Cancer
MedicalResearch.com Interview with:
Tatjana Crnogorac-Jurcevic MD PhD
Reader Centre for Molecular Oncology
Barts Cancer Institute, Queen Mary
University of London
London UK
Medical Research: What is the background for this study? What are the main findings?
Dr. Crnogorac-Jurcevic: Pancreatic adenocarcinoma (PDAC) is one of the most difficult cancers to detect. More than 80% of patients usually present at a late stage, with either locally advanced or with already metastatic disease. This is one of the major reasons for a bleak prognosis of this malignancy, which is typically 3-6 months and with <5% five-year survival. However, if patients are diagnosed with stage II disease, the survival rate is 20%, and at stage I, in patients with very small tumours, the five-year survival can increase up to 60%.
In order to find biomarkers for early detection of this disease, we have performed in depth GeLC/MS/MS (SDS-PAGE-liquid chromatography-tandem mass spectrometry) analysis of 18 proteomes of urine samples collected from healthy controls, chronic pancreatitis, and patients with Pancreatic adenocarcinoma and obtained around 1500 non-redundant proteins. From these, three proteins, LYVE-1, REG1A, and TFF1, were selected for further analysis based on their known biological functions and statistical difference in comparisons of the experimental groups. These biomarkers were subsequently validated using ELISA assays in a multicenter cohort of urine samples: 87 from healthy people, 92 from patients with chronic pancreatitis, and 192 from PDAC patients.
Multiple logistic regression was then applied: when comparing Pancreatic adenocarcinoma with healthy urine specimens, the resulting areas under the receiver-operating characteristic curves (AUC) of the three biomarkers combined into a panel were 0.89 (95% confidence interval: 0.84–0.94) in the training dataset (70% of the data) and 0.92 (95% confidence interval: 0.86–0.98) in the validation dataset (30% of the data). When the results from the analysis of PDAC stage I–II (n=71) urine samples were compared with the healthy urine specimens, the panel achieved AUCs of 0.90 (95% confidence interval: 0.84–0.96) and 0.93 (95% confidence interval: 0.84–1.00) in the training and validation datasets, respectively. In comparison to matching plasma CA19.9 values, the only Pancreatic adenocarcinoma biomarker in widespread clinical use (albeit mostly for monitoring of the disease), the panel achieved a higher AUC of 0.97 (95% confidence interval: 0.94–0.99) than CA19.9 (AUC 1/4 0.88; 95% confidence interval: 0.81–0.95, P=0.005). When combined with CA19.9, increased AUC of 0.99 (95% confidence interval: 0.97–1.00, P=0.04) was achieved, but this was not seen in a panel combined with plasma CA19.9 in stage I–IIA PDAC (n =17) vs. healthy sample comparison.
16 Aug Hydrogel Will Potentially Coat and Heal Ulcerative Colitis Lesions
Posted at 21:27h
in Author Interviews, Brigham & Women's - Harvard, Gastrointestinal Disease, Technology
MedicalResearch.com Interview with:
Dr. Jeff Karp Ph.D
Associate Professor of Medicine
Brigham and Women's Hospital
Harvard Medical School
Cambridge, MA 02139 and
Giovanni Traverso M.B., B.Ch., Ph.D
The David H. Koch Institute for Integrative Cancer Research
Massachusetts Institute of Technology, Cambridge, MA
Medical Research: What is the background for this study? What are the main findings
Dr. Karp: Almost all patients with ulcerative colitis will require enema-based therapy at some point in their treatment. Enema therapy has 3 major issues.
- It is difficult to retain
- There is high systemic absorption of the drug (that can lead to toxic side effects), and
- Compliance is low as patients must take enemas every day.
16 Aug Steroids May Improve Outcomes For Community-Acquired Pneumonia
MedicalResearch.com Interview with:
Reed A.C. Siemieniuk, MD
Department of Clinical Epidemiology & Biostatistics
Ontario Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Siemieniuk: Local and cytokine-mediated systematic inflammatory responses help clear bacterial pathogens in community-acquired pneumonia (CAP), but often they can also cause harm. Pneumonia is the most common cause of the acute respiratory distress syndrome (ARDS), an often fatal inflammatory complication. Two randomized trials were published earlier this year, each of which suggested the possibility of benefit from adjunctive corticosteroid therapy. We decided to perform a systematic review and meta-analysis, taking all available data into consideration.
Corticosteroids may be effective for reducing the incidence of ARDS by 6%, the need for mechanical ventilation by 5%, and mortality by 3% (all moderate confidence). They also reduce time to clinical stability and time to discharge by approximately 1 day (high confidence).
16 Aug Hospital Improvements Have Led To Marked Decreased In Inpatient Mortality Over Ten Years
MedicalResearch.com Interview with: Kevin Heslin, Ph.D., Staff Service Fellow, Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality Medical Research: What is the background for this study? Dr. Heslin: Previous trends in inpatient mortality suggest that rates have been decreasing for acute myocardial infarction (AMI), congestive heart failure (CHF), stroke, and pneumonia (Hines et al., 2010; Stepanova et al., 2013). Continued study of these trends can help researchers and policymakers assess the impact of health care quality efforts. Further, examining trends across patient and hospital subgroups may inform strategies for addressing disparities in health care quality by identifying groups that are leading and lagging in improvement. Medical Research: What is the background for this study Dr. Heslin: From 2002 to 2012, inpatient mortality decreased among patients admitted to U.S. hospitals for pneumonia (45 percent decrease, from 65.0 to 35.8 deaths per 1,000 admissions), AMI (41 percent decrease, from 94.0 to 55.9 deaths per 1,000 admissions), CHF (29 percent decrease, from 44.4 to 31.4 deaths per 1,000 admissions), and stroke (27 percent decrease, from 112.6 to 82.6 deaths per 1,000 admissions). The inpatient mortality rate for all four conditions decreased among both younger and older patients, and among men and women.15 Aug MMR Vaccination May Not Be Reliable in HIV+ Children
MedicalResearch.com Interview with:
George K Siberry, MD, MPH, Medical Officer
Maternal and Pediatric Infectious Disease (MPID) Branch
Eunice Kennedy Shriver National Institute of Child Health and Human Development
National Institutes of Health
Bethesda, MD
Medical Research: What is the background for this study?
Dr. Siberry: Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger.
Medical Research: What are the main findings?
Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control. When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection. For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment.
15 Aug Biopolymers from Algae May Provide Broad Spectrum Photoprotection
Susana C. M. Fernandes, PhD Researcher (Individual Marie Curie Fellowship - IEF) and Professor Vincent Bulone Division of Glycoscience, School of Biotechnology Royal Institute of Technology (KTH), Stockholm, Sweden and ARC Centre of Excellence in Plant Cell Walls, School of Agriculture, Food and Wine, University of Adelaide, Waite campus, Urrbrae, South Australia Australia MedicalResearch: What is the background for this study? What are the main findings? Response: We have exploited unique properties of natural compounds to develop novel materials that are capable of absorbing both UV-A and UV-B radiations. The active UV-absorbing molecules are known as mycosporines and mycosporines like-amino acids and they occur in different organisms such as algae, photosynthetic bacteria (cyanobacteria) and some fish species that thrive in, e.g., the tropical waters of the Great Barrier Reef. These compounds were combined with a carbohydrate polymer found in the shells of crustaceans, the exoskeleton of insects and the cell walls of fungi. Chitosan provided a matrix on which mycosporines were attached using a simple chemical method already used for other purposes in, e.g., the pharmaceutical industry. Chitosan can typically be extracted from food waste such as the shells of shrimps. The immobilization of mycosporines on chitosan allowed the development of unique materials that have many potential applications relevant to a wide range of sectors, including cosmetics, sunscreen creams, wound dressings, plasticizers in paints and varnishes, coatings of outdoor furniture and other materials such as fabrics for shades, textiles, car dashboards, etc. In addition to being highly efficient for protection against UV-A and UV-B, the materials were shown to be photostable, thermoresistant and biocompatible. Compared to existing sunblock formulations, the materials have no detrimental effects on health and the environment. They are also fully recyclable.15 Aug Hospital Mortality Outcomes Differ After Lung Cancer Surgery Complications
Posted at 01:10h
in Author Interviews, Lung Cancer, Outcomes & Safety, Surgical Research, University of Michigan
MedicalResearch.com Interview with:
Tyler Grenda, MD
House Officer VI
Section of General Surgery
Department of Surgery
University of Michigan
Medical Research: What is the background for this study? What are the main findings?
Dr. Grenda: The main purpose for this study was to better understand the factors underlying differences in mortality rates for hospitals performing lung cancer resection. The methodology we used included only the highest and lowest mortality hospitals (Commission on Cancer accredited cancer programs) so the sampling frame was specific. There are wide variations in mortality rates across hospitals performing lung cancer resection (overall unadjusted mortality rates were 10.8% vs. 1.6%, respectively.
14 Aug Men More Likely To Develop Diabetes If Spouse Has Gestational Diabetes
MedicalResearch.com Interview with:
Dr. Kaberi Dasgupta MD, MSc, FRCPC
Associate Professor, Department of Medicine
Divisions of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism
Royal Victoria Hospital
Quebec, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Dasgupta: We know that health behaviours can contribute to developing gestational diabetes and type 2 diabetes (e.g., eating out frequently, lack of fruits and vegetables, not walking enough, spending most of the day sitting). We also know that genetic factors are important. Sometimes we focus more on the genetic factors than on health behaviours. By showing that spouses share diabetes risk, we highlight the importance that behaviour and environment play as spouses are not generally related biologically. In a previous meta-analysis, we showed that spouses were concordant for diabetes (if one had it, there was a 24% relative risk increase that the other did too.)
In the study Gestational Diabetes Mellitus in Mothers as a Diabetes Predictor in Fathers: A Retrospective Cohort Analysis, we took it further and compared men whose partners had gestational diabetes and men whose partners did not. Over a 13 year period of follow-up, the men whose partners had gestational diabetes were 33% more likely to develop diabetes.
14 Aug Gang Violence Spreads Like An Infectious Disease
MedicalResearch.com Interview with:
April M. Zeoli, PhD, MPH
Associate Professor
School of Criminal Justice
Michigan State University
Lansing, MI 48824
Medical Research: What is the background for this study? What are the main findings?
Dr. Zeoli: My team and I are interested in whether an infectious disease model can be applied to homicide. In other words, can homicide be described as being “contagious” and does it spread through a city in a systematic pattern? In our previous research, we showed that homicide did spread through Newark, New Jersey, in a manner similar to an infectious disease (http://msutoday.msu.edu/news/2012/homicide-spreads-like-infectious-disease/). However, not all types of homicide may be “contagious.” In this research, we looked at seven motive types of homicide to determine which, if any, of them clustered and spread from one place to another over time.
Of the seven types of homicide we examined, only gang-motivated homicides displayed a pattern of clustering and spreading through Newark, NJ. However, while drug-motivated and revenge homicides did not spread, they did cluster in the same general geographic areas during much of the same time that gang-motivated homicides clustered together.
14 Aug Music Reduces Need For Pain Medications After Surgery
MedicalResearch.com Interview with:
Dr Martin Hirsch
Clinical Research Fellow
Women’s Health Research Unit
Queen Mary University of London and
Dr Jenny Hole
Foundation Year 1 Doctor
Kettering University Hospital
MedicalResearch: What is the background for this study? What are the main findings?
Response: As doctors we see medicines being prescribed on a daily basis and the benefit but also harm that they can cause. We wanted to assess the role of non pharmaceutical interventions which can benefit patients with a low or minimal potential for harm. We all have an interest in music of different genres and we agreed that we didn’t know anybody who did not like music of one sort or another. On the basis that we all have gained pleasure from music, we wanted to see if this pleasurable experience at the time of a difficult and painful stimulus could reduce the problems encountered as people recover from surgery.
We searched all published medical literature and found 73 of the highest quality studies (randomised controlled trials) to compare and combine their findings in a meta-analysis. This technique aims to strengthen the validity by producing a combined result.
We found that using music before during or after surgery reduced pain, reduced the requirement for pain killers, reduced anxiety, and improved satisfaction.
14 Aug Social Media Seen As Important Resource For LVAD Patients and Caregivers
MedicalResearch.com Interview with:
Dr. Kristin Kostick PhD on behalf of the authors
Research Associate - Decision Making and Ethics Research Program
Center for Medical Ethics and Health Policy
Baylor College of Medicine
Houston, TX
Medical Research: What is the background for this study? What are the main findings?
Response: The idea of this study came from a larger research study we’re doing to develop and test a decision aid for patients and caregivers considering LVAD treatment. As part of that study, we interviewed LVAD patients, candidates, caregivers and decliners of LVAD treatment to explore their decisional needs. One of the things that kept coming up in these interviews was the need for “support,” which everyone, including clinicians, identified as a crucial aspect of post-implant recovery. There is an excellent clinical support team at our partnering hospital in Houston, as well as a community of LVAD recipients and caregivers where people can get together to share their stories and resources face-to-face. But for other people who find it difficult to get to the hospital, either because they have transportation barriers or they simply live too far away, we began to wonder whether support services might be available to them in virtual settings. So we decided to do this analysis to see what social media sites exist for the LVAD community. What is the content of these sites? Are there different kinds for different support needs? What are patients getting from them? How might they be used in the future for improving patient care and support?
14 Aug Radiation of Internal Mammary Nodes May Have Small Breast Cancer Survival Benefit
MedicalResearch.com Interview with:
Philip M.P. Poortmans PhD MD
Head of Department, Radiation Oncology
ESTRO President
Radboud university medical center
The Netherlands
Medical Research: What is the background for this study?
Dr. Poortmans: Based on the former hypothesis that breast cancer sequentially spreads from breast to lymph nodes and from there to distant organs, up to the eighties it was very custom to perform extended radical surgery and to irradiate extensively locoregional for most patients. With the growing interest in systemic treatments to prevent development (= from already present undetectable cancer cells to really visible and threatening metastases) of distant metastases, new information about possible late side effects and our increasing knowledge about the biological behaviour of breast cancer in the eighties and the nineties, the extend of especially locoregional treatment was gradually reduced. For radiation therapy, often the irradiation of the internal mammary lymph nodes was left aside, as this was linked to the delivery of radiation dose to the heart, possibly or probably leading to late side effects. At the start of the study, about half of the radiation oncology departments did include irradiation of the internal mammary lymph nodes in patients with risk factors, while the other half did not. Hereby we had an ideal base for the investigation of the value of treating the non-operated part of the regional lymph nodes.
14 Aug Over 10% US Adults Live With Pain Every Day
MedicalResearch.com Interview with:
Richard L. Nahin, Ph.D., M.P.H
National Center for Complementary and Integrative Health
National Institutes of Health, Bethesda, Maryland
Medical Research: What is the background for this study?
Dr. Nahin: In 2011 the Institute of Medicine published a blueprint for transforming pain care in the United States. In this report the IOM noted the lack of a comprehensive picture of pain’s prevalence and severity in the U.S., and especially noted that lack of data examining racial and ethnic groups. The current analysis of data from the 2012 National Health Interview survey is a step toward addressing these deficiencies.
Medical Research: What are the main findings?
Dr. Nahin: The analyses found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain. Those with severe pain are also likely to have worse health status. There were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, while Asians were less likely. Minorities who did not choose to be interviewed in English are markedly less likely to report pain.
14 Aug Compromised Antimicrobial Response Tied to Infections in Diabetes
MedicalResearch.com Interview with:
Wesley M. Williams, PhD
Cell molecular biologist
Department of Biological Sciences
Case Western Reserve University School of Dental Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Williams: Individuals with uncontrolled blood sugar levels frequently present with higher than normal rates of infection and protracted wound healing. The beta-defensin family of antimicrobial peptides responds to bacterial, fungal and viral invasion. As part of the innate immune system, these cationic peptides normally expressed by epithelial cells are important early responders that, together with other components of the innate immune response, act to inhibit microbial infection. Our initial observations led us to question whether glucose or a metabolite of glucose could contribute to antimicrobial peptide dysfunction, and thus compromise control of infection. Elevated levels of glucose result in increased production of dicarbonyls, a class of molecule that can selectively react with proteins having an unusually high content of cationic amino acids, such as arginine and lysine. We first investigated the effects of two well-characterized dicarbonyls, methylglyoxal (MGO) and glyoxal (GO) on recombinant beta-defensin 2 (rHBD-2) structure using MALDI TOF and LC/MS/MS mass spectral analysis of the recombinant peptide. We found MGO to be particularly reactive with the rHBD-2 peptide as it readily and irreversibly adducted to two arginine residues and the N-terminal glycine. Next we tested in vitro for the effects of adducted rHBD-2 on antimicrobial and chemotactic functions, both essential to an effective innate and adaptive immune response in vivo. Through radial diffusion testing on gram-negative E. coli and P. aeruginosa, and gram-positive S. aureus, and a chemotaxis assay for CEM-SS cells, we found that both antimicrobial and chemotactic functions of rHBD-2 were significantly compromised by MGO.
14 Aug Abnormal Lung Microbiome Linked To Severe Asthma
MedicalResearch.com Interview with:
Yvonne J. Huang, MD
Assistant Professor, Division of Pulmonary & Critical Care Medicine
University of Michigan Health System
Ann Arbor, MI 48109-5642
Medical Research: What is the background for this study?
Dr. Huang: Asthma is a disease with many different clinical manifestations, and it is likely that multiple mechanisms play a role in asthma. Understanding the biological processes that contribute to this heterogeneity is an important goal of current translational research in asthma. One hypothesis that dates back several decades is whether asthma, at least in some forms, is linked to chronic airway infection or colonization by particular species of bacteria. Results of early investigations in this regard were mixed, in part due to reliance on less sensitive methods to detect bacterial infection, but a new spin on this hypothesis has emerged in recent years. This stems from the technological advances that now enable one to molecularly profile all bacteria present in a sample, such as via sequence analysis of conserved bacterial genes (such as that for 16S ribosomal RNA). 16S rRNA-based methods are now commonly used to profile bacterial microbiota in a variety of human niches, including in studies of respiratory disease.
Prior to our current study, a few investigations had shown that the lower respiratory microbiome in adult asthmatics differs in bacterial composition (i.e. the types and relative abundance of bacteria present), compared to healthy controls. In a previous study of patients with mild-moderate asthma, we also had found that clinical features of asthma, such as bronchial hyper-responsiveness, were associated with increased abundance of specific bacterial groups. However, whether similar relationships between clinical features and the microbiome exist in severe asthma was unknown, which we addressed in the current study.
14 Aug Insulin Resistance Linked To Poor Verbal Fluency in Women
MedicalResearch.com Interview with:
Laura Ekblad, MD, researcher
Turku PET Centre
Medical Research: What is the background for this study? What are the main findings?
Dr. Ekblad: The background for our study is that the metabolic syndrome and diabetes have been shown to increase the risk for cognitive decline and dementia. Also, insulin resistance is thought to play a pivotal role in the pathophysiology of Alzheimer´s disease. In addition, intranasal insulin administration is being studied as a promising treatment for Alzheimer´s disease. Previous studies indicate that both gender and APOE epsilon 4 genotype modulate the effects of insulin on cognition.
Our main findings are that insulin resistance is associated with poorer verbal fluency, but only in women. Our population-based study consisted of adults from 30-97 years of age and we had nearly 6000 participants. Age did not modulate the association of insulin resistance and cognition, which means that our results apply even to young adults. We also found that insulin resistance associated with poorer verbal fluency only in non-carriers of the APOE epsilon 4 genotype.
14 Aug Asians and Hispanics May Underutilize EMS Services For Stroke Symptoms
MedicalResearch.com Interview with:
Heidi Mochari-Greenberger Ph.D., M.P.H
Associate research scientist
Columbia University Medical Center
New York, N.Y
MedicalResearch: What is the background for this study?
Dr. Mochari-Greenberger: Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity or sex among a contemporary, diverse national sample of hospitalized acute stroke patients.
MedicalResearch: What are the main findings?
Dr. Mochari-Greenberger: Use of EMS transport among hospitalized stroke patients was less than 60% and varied by race/ethnicity and sex; EMS use was highest among white females and lowest among Hispanic males. Our analyses showed that Hispanic and Asian men and women were significantly less likely than their white counterparts to use EMS; black females were less likely than white females to use EMS, but black men had a similar rate to white men. These observed associations between race/ethnicity and sex with EMS use persisted after adjustment for stroke symptoms and other factors known to be associated with EMS use, indicating they were not driven solely by stroke symptom differences.
14 Aug Simple Scoring System Stratifies Colon Cancer Risk in Adults
MedicalResearch.com Interview with:
Thomas F. Imperiale, MD
Indiana University Medical Center
Regenstrief Institute
Indianapolis, IN 46202
Medical Research: What is the background for this study?
Dr. Imperiale: The background is that colorectal cancer (CRC) screening is effective and cost-effective, but it is underutilized (35% of eligible persons in the U.S. are not current with screening; 28% have never been screened) and inefficient (persons at low risk have colonoscopy; persons at high risk have stool blood testing or nothing). We know about several risk factors for colorectal cancer and advanced, precancerous polyps. We wanted to see how those factors perform together in stratifying (or separating) risk among the 85% of the U.S. population that is considered to be “average-risk”.
Medical Research: What are the main findings?
Dr. Imperiale: We found that age, sex, whether a first-degree relative has or had colorectal cancer, cigarette smoking, and waist circumference do a good job in separating risk into the 4 categories described in the paper. When tested in the validation subgroup, the risk estimates reproduced themselves fairly well.
13 Aug Panel Testing Identifies More Management-Changing Genes Than BRAC1/2 Alone
MedicalResearch.com Interview with:
Leif W. Ellisen, M.D., Ph.D
Professor of Medicine, Harvard Medical School
Program Director, Breast Medical Oncology
Co-Leader, Breast Cancer Program
MGH Research Scholar MGH Cancer Center
Boston, MA 02114
Medical Research: What is the background for this study? What are the main findings?
Dr. Ellisen: The traditional approach to genetic testing for women with suspected hereditary breast and/or ovarian cancer risk is to test for BRCA1 and BRCA2 alone. Recent studies have shown that testing with a multi-gene panel finds relevant risk gene mutations in substantially more women than does testing for BRCA1 and BRCA2 alone. However, one of the concerns about broader multi-gene testing has been that the results really wouldn’t change what you told women about their risk and management – either because the risk associated with the other genes may not be as high as for BRCA1/2, or because the clinical practice guidelines associated with some of the other genes are less specific.
Our study sought to determine how often testing such women using a multi-gene panel would find mutations in genes other than BRCA1/2, and more importantly to ask whether finding those mutations would change how you would manage the patient and their family. We found that multi-gene panel testing finds relevant risk gene mutations in substantially more women (approximately 40% more) than does testing for BRCA1 and BRCA2 alone. Furthermore, in a case-by-case analysis we showed that finding mutations in these other genes is likely to change the clinical management that is considered or recommended for the majority of the mutation-positive women and their families. Notably, our analysis of the predicted management change is based not just on the gene mutation alone, but on how the gene appears to be behaving in that particular family.
13 Aug Fresh Donor Eggs Result In More Live Births Than Frozen
MedicalResearch.com Interview with:
Vitaly A Kushnir MD
The Center for Human Reproduction
New York, NY 10021
Medical Research: What is the background for this study? What are the main findings?
Dr. Kushnir: In January 2013, the American Society for Reproductive Medicine declared the technique of oocyte cryopreservation no longer experimental, although they body did call for further study.
Vitaly A. Kushnir, M.D., of the Center for Human Reproduction, and colleagues used 2013 data from 380 U.S fertility centers to compare live birth and cycle cancellation rates using either fresh or cryopreserved donor oocytes.
The study found roughly 20 percent of donor cycles used cryopreserved oocytes and 80 percent fresh oocytes. Of those embryos transferred, 56 percent that started as fresh oocytes resulted in live births compared to just 47 percent of those that started as cryopreserved oocytes.
13 Aug Dementia Patients on Cholinesterase Inhibitors Risk Substantial Weight Loss
MedicalResearch.com Interview with:
Meera Sheffrin MD
Geriatrics Fellow
Division of Geriatrics | Department of Medicine
San Francisco VA Medical Center
University of California, San Francisco
Medical Research: What is the background for this study? What are the main findings?
Dr. Sheffrin: The main drug treatments for dementia are a class of medications called cholinesterase inhibitors. They have only modest effects on cognition and function in most patients, but since they are one of the few available treatments for dementia and thus very commonly prescribed. However,they are known to cause GI side effects (nausea, vomiting, diarrhea, and anorexia) in many patients when first started. It is plausible they could also caust weight loss, espeically considering they cause nausea and anorexia. However, the data on weight loss from randomized controlled trials is very limited and inconclusive, so we did a very large observational study in a real-world of the VA national healthcare system who were newly started on these medications, to see if they were associated with weight loss.
We found that patient with dementia started on cholinesterase inhibitors had a substantially higher risk of clinically significant weight loss over a 12-month period compared to matched controls.
1,188 patients started on cholinesterase inhibitors were matched to 2,189 similar patients who were started on other new chronic medications. The primary outcome was time to a 10-pound weight loss over a 12-month period, as this represents a degree of loss that would be clinically meaningful – not only noticed by a clinician but would perhaps prompt further action in considering the causes of the weight loss and medical work-up.
We found that starting cholinesterase inhibitors was associated with a 24% greater risk of developing weight loss. Overall, 29% of patients started on cholinesterase inhibitors experienced a weight loss of 10 pounds or more, compared with 23% of the control group. This corresponds to a number needed to harm of 21 over 1 year; meaning only 21 patients need to be treated with a cholinesterase inhibitor over the course of a year for one patient to experience a 10 pound weight loss.
12 Aug Penn Developed Sarcoidosis Score Reliably Measures Disease Activity
Posted at 20:51h
in Author Interviews, Biomarkers, Dermatology, JAMA, Pulmonary Disease, University of Pennsylvania
MedicalResearch.com Interview with:
Misha A. Rosenbach, MD
Assistant Professor of Dermatology at the Hospital of the University of Pennsylvania
Assistant Professor of Dermatology in Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Rosenbach: Sarcoidosis is an inflammatory disease of unknown etiology where genetically susceptible patients develop multi-organ granulomatous inflammation in response to an as-yet unidentified stimulus. Patients with sarcoidosis typically have granulomatous inflammation in their lungs, but the second most commonly affected organ is the skin; the eyes, lymph nodes, liver, heart, brain, and other organs can be affected as well. Patients with sarcoidosis can experience a few disease trajectories; some spontaneously recover, while others have persistent, active inflammation, whereas another group can experience inflammation which leads to scarring and fibrosis. It can be challenging to distinguish these cohorts of patients based on their lungs alone.
The skin is much easier to evaluate, as it is right there on the surface, and can be examined by physicians without resorting to invasive tests or radiography. At Penn, we developed a novel cutaneous sarcoidosis assessment tool, called the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI), which is designed to accurately measure how inflamed skin sarcoid lesions are in a given patient, as well as describing which type of cutaneous lesion patients’ have. The CSAMI has in previously studies been shown to be reliable when used by dermatologists, with excellent inter-rater and intra-rater reproducibility.
In this study, we had a group of Pulmonologists, Rheumatologists, and Dermatologists (representing the groups of physicians who most commonly care for patients with sarcoidosis, especially if there is skin involvement) evaluate a group of patients with cutaneous sarcoidosis, using the CSAMI and another sarcoidosis activity instrument, the SASI, which has also previously been used to measure skin sarcoidosis activity in a number of settings. We were able to demonstrate that these cutaneous scoring tools are reliable and reproducible and able to accurately measure cutaneous sarcoidosis disease activity in a variety of patients with a range of skin disease severity. We also compared the physician scores to patients’ own evaluations of their disease, and showed that the CSAMI (physician impression of disease) correlated well with patients’ own perception of their disease activity and severity.
12 Aug C- Section May Raise Attention Deficit Risk in Neonates
MedicalResearch.com Interview with:
Scott A. Adler, Ph.D.
Associate Professor Coordinator
Developmental Science Graduate Program Dept. of Psychology & Centre for Vision Research
Visual and Cognitive Development Project
York University
Toronto, Ontario Canada
Medical Research: What is the background for this study?
Dr. Adler: Experiences that we have early in life clearly have an impact on our brain development and behavior as we get older. Numerous studies have detailed these experiences, ranging from how we were fed as a baby to how many languages we hear to traumatic events. These experiences have been shown to influence formation, maintenance, and pruning of the networks of synaptic connections in our brain's that impact all manner of thought and behavior. Yet, the impact of one of the earliest experiences, that of being born, on brain and psychological behavior has not before been explored. A recent study with rat pups has strongly suggested that the birth process has a definite impact on initial brain development. If that is the case, what happens if the infant's birth is one in which she does not experience the natural birth process, such as occurs with caesarean section births?
Medical Research: What are the main findings?
Dr. Adler: There were two main findings from this study. We measured the speed and timing of infants' saccadic eye movements, which are overt indicators of attention, relative to the onset of visual events on a computer monitor. Moving attention and eye movements can occur through two general classes of processes. The first is bottom-up mechanisms in which attention is moved reactively and automatically to the appearance or existence of unique and salient events in the world. In this case, where attention goes is essentially controlled by the events in the world.
The second is top-down mechanisms in which we move attention voluntarily to what we determine to be relevant event in the world based on our own cognitive biases and goals.
This study found that 3-month-old infants born by caesarean section were significantly slower to move attention and make eye movements in reaction to the occurrence of visual events on the basis of bottom-up mechanisms than were infants born vaginally. In contrast, there was difference between infants in moving attention and making eye movements in anticipation of the appearance of visual events on the basis of top-down mechanisms. Additionally, maternal age, which has been shown to be related to the occurrence of caesarean sections, was found not to be related to the current effects.
12 Aug Synthetic Cannabinoids Put Teenagers at Cardiac Risk
MedicalResearch.com Interview with: Bradley C. Clark, MD Pediatric Cardiology Fellow – 3rd Year Division of Cardiology Children's National Health System Washington, DC 20010 Medical Research: What is the background for this study? What are the main findings? Dr. Clark: After consulting on multiple pediatric emergency room patients with K2 (synthetic cannabinoid) ingestion and electrocardiogram (ECG) abnormalities, my co-authors and I decided that it was worth taking a more detailed look at the potential cardiac effects of synthetic cannabinoids. We did a retrospective chart review and discovered a total of 8 patients in a 3 year period (2011 – 2014) at our institution with reported synthetic cannabinoid ingestion and concern for myocardial injury. There were 3 individuals with evidence of ECG abnormalities in a segmental pattern with increased cardiac enzyme levels (troponins). The other 5 individuals had ECG abnormalities either without troponin elevations or were not specifically tested. Each individual that had an echocardiogram performed had normal intracardiac anatomy with normal biventricular systolic function. Given the elevated troponin levels and ECG abnormalities, there was a suspicion for myocardial ischemia in this small subset of patients without meeting specific criteria for myocardial infarction. Interestingly, these individuals had completely normal echocardiograms and had no other potential cause of myocardial ischemia discovered by history. Additionally, these were all teenage pediatric patients with documented K2 exposure without evidence of exposure to illegal substances. K2 and other synthetic cannabinoids are known to cause analgesia and euphoria and can lead to a lack of symptomatology. Therefore, individuals with synthetic cannabinoid ingestion may not complain of the prototypical cardiac symptoms (chest pain, shortness of breath, palpitations) and may not have the workup to diagnose potential myocardial ischemia.12 Aug Liver Inflammation During Pregnancy Linked To Later Life Cancer, Cardiac and Autoimmune Disease
MedicalResearch.com Interview with:
Prof. Hanns-Ulrich Marschall
Professor of clinical hepatology
Wallenberg Laboratory
Sahlgrenska Academy
Göteborg, Sweden
Medical Research: What is the background for this study?
Dr. Marschall: Intrahepatic cholestasis of pregnancy, or ICP, is the most common liver disease during pregnancy, affecting 1.5% of all pregnancies in Sweden. ICP is characterized by otherwise unexplained pruritus with elevated bile acids and/or transaminases in the late second and third trimester of pregnancy. It is well established that ICP is associated with risks for the unborn child, in particular preterm delivery, but also stillbirth.
In contrast, for the mother, ICP has for a long time only been considered as an annoying but not serious condition that spontaneously resolves after delivery.
However, ICP obviously is not such a benign condition for the mother: We have recently shown that women with ICP have a 3- to 5-times increased risk of hepatobiliary diseases, such as hepatitis C, cirrhosis and gallstones. Here we extended our study to investigate the association between ICP and later cancer, diabetes mellitus and other autoimmune-mediated diseases, and cardiovascular diseases.
Medical Research: What are the main findings?
Dr. Marschall: Our study showed that women with ICP were at about 25% increased risk to be later diagnosed with immune-mediated diseases, in particular diabetes mellitus and Crohn’s disease but not ulcerative colitis. There was also a small increased risk of later cardiovascular disease, in particular if the woman with ICP also suffered from preeclampsia.
Most important were the data on the risk of later malignancy: We found a 2.5-times higher risk for cancer in the biliary tree and even a 3.5-times increased risk of liver cancer. Even after adjusting for a diagnosis of hepatitis C, which is very strongly associated with liver cancer, more than 30-times, women with ICP were still at 2.5-times increased risk of later liver malignancy.
12 Aug Music Can Affect Efficiency in Surgical Operating Rooms
MedicalResearch.com Interview with:
Sharon-Marie Weldon, MSc, RN
Department of Surgery and Cancer
Imperial College London, UK
Dr. Terhi Korkiakangas, PhD, MSc, BSc
UCL Institute of Education
University College London, UK
MedicalResearch: What is the background for this study?
Response: Our study draws on a broader video-based observational project on communication in the operating theatres. The effectiveness of team communication can be sometimes attributed to the working environment and the quality of information exchange between team members. Research on noise levels in the operating theatre has shown that the levels exceed World Health Organisation recommendations and thus can impact on teamwork. Interestingly, music is routinely played in an estimated 53-72% of surgical operations performed worldwide. Modern day operating theatre suites, like the ones in which we conducted observations, are often equipped with docking stations and MP3 players and music is played during surgical operations. Prior literature has addressed surgeons’ views on music through interviews, and some performance-based studies using background music have been conducted in controlled simulated settings. Some of the studies suggest that music is beneficial for the surgeons operating: it can improve their concentration. However, the ways in which music can impact on team communication have been relatively under researched, with little evidence on ‘real-time’ interactions.
MedicalResearch: What are the main findings?
Response: We used quantitative and qualitative approaches to examine video recordings of a total of 20 surgical operations in which music was either played or not played. Each operation was logged for communication events, notably requests/questions issued by surgeons, and nurses’ responses to these. Statistical analysis explored the difference between the proportion of repetitions of these requests, and whether music was playing or not. The request/response observations (N=5203) were documented. Chi-square test revealed that repeated requests were five times more likely to occur in cases that had music playing. A repeated request can add 4-68 seconds to operation time and increase tension due to frustration at ineffective communication. The interactional analysis elaborated on the fragments of interaction in which information was exchanged while music was playing. These showed how nurses communicated their difficulties in hearing by prompting surgeons to repeat themselves.
12 Aug Metformin Linked With Increased Mortality In Diabetic Kidney Disease Patients
[caption id="attachment_16540" align="alignleft" width="238"]
Prof. Der-Cherng Tarng[/caption]
MedicalResearch.com Interview with:
Prof. Der-Cherng Tarng, MD, PhD
Division of Nephrology
Taipei Veterans General Hospital, and
National Yang-Ming University, Taiwan
MedicalResearch: What is the background for this study? What are the main findings?
Prof. Tarng: Metformin is generally recommended as a first-line therapy for type 2 diabetes mellitus, but the use of metformin has been limited in patients with impaired kidney function because of the perceived risk of lactic acidosis. More recently, available evidence supports the cautious expansion of metformin use in patients with mild to moderate chronic kidney disease (CKD). However, no studies have yet examined whether metformin can be prescribed more widely to patients with advanced CKD.
We conducted a propensity score-matched cohort study using Taiwan’s National Health Insurance Research Database to assess the safety of metformin in patients with type 2 diabetes and serum creatinine levels >6 mg/dL, enrolled between January 1, 2000 and June 30, 2009 and followed-up until December 31, 2009, before Taiwan’s prescribing guidelines for metformin contraindicated its use in patients with CKD. From a consecutive sample of 12350 patients, 1005 (8.1%) were metformin users. Of these, 813 were successfully matched 1:3 to 2439 metformin nonusers. After multivariate adjustment, metformin use remained was an independent risk factor for mortality (hazard ratio 1.35, 95% confidence interval 1.20–1.45; p<0.0001). The increased risk was dose-dependent and was consistent across all subgroup analyses. However, metformin users compared with non-users were associated with a higher but insignificant risk of metabolic acidosis (hazard ratio 1.30, 95% confidence interval 0.88–1.93; p=0.188).