Author Interviews, Gastrointestinal Disease, PLoS / 03.04.2015

MedicalResearch.com Interview with: Ricardo Battaglino, Ph.D. Department of Mineralized Tissue Biology The Forsyth Institute, Cambridge, Massachusetts Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, Boston, Massachusetts,MedicalResearch.com Interview with: Ricardo Battaglino, Ph.D. Department of Mineralized Tissue Biology The Forsyth Institute, Cambridge, Massachusetts Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Dr. Battaglino: Mutations in sorting nexin 10 (Snx10) have recently been found to account for roughly 4% of all human malignant osteopetrosis, some of them fatal. To study the disease pathogenesis, we investigated the expression of Snx10 and created mouse models in which Snx10 was knocked down globally or knocked out in osteoclasts. We found that Snx10, a molecule expressed in osteoclasts, was also expressed in the stomach. Studies in tissue specific or global knock-down mice showed that Snx10 deficiency resulted in a phenotype that was a consequence of deficiencies in both osteoclasts and gastric zymogenic cells. Our studies add to a growing list of genes, including atp6i (Tcirg1), whose expression is required both in bone and stomach to maintain normal gastric acidification and calcium absorption. Medical Research: What should clinicians and patients take away from your report? Dr. Battaglino: Our work provides additional insight into the mechanisms governing the regulation of bone accrual by the gastrointestinal tract. Because osteopetrorickets has not been described clinically in Snx10-related osteopetrosis, these findings highlight the importance of considering impaired acidification in both stomach and bone in osteopetrotic patients with mutations in SNX10 and other genes with similar patterns of expression and activities. Reliance solely on hematopoietic stem cell transplantation can leave hypocalcemia uncorrected with sometimes fatal consequences. Because defects in gastric differentiation and/or gastric acidification may cause or contribute to hypocalcemia, bone insufficiency, and early death, our results suggest that dietary calcium supplementation could be a life-saving intervention in these patients. (more…)
Author Interviews, Biomarkers, Infections / 03.04.2015

Wikipedia mosquitoMedicalResearch.com Interview with: Amalia Z. Berna CSIRO Food and Nutrition Flagship Acton ACT 2601 MedicalResearch: What is the background for this study? What are the main findings? Response: Globally an estimated 3.2 billion people in 97 countries are at risk of malaria and, in 2013, an estimated 198 million cases and 584,000 deaths were attributed to this infection. Accurate diagnosis of malaria is important to provide adequate treatment, conserve valuable drugs, and help prevent the emergence of resistant strains of the parasite. It is becoming important to be able to diagnose low level and asymptomatic cases, to support the drive towards local and/or global eradication. Detection of volatile chemicals in expired breath has been used to diagnose or monitor a small number of diseases, including Helicobacter pylori infection, diabetes and lung inflammation but, if breath analysis is to be more broadly useful, we need to identify reliable biomarkers for a wider range of diseases and to develop more robust methods for breath analysis. In collaboration with Professor James McCarthy of the QIMR Berghofer Institute and Associate Professor Kevin Saliba of the ANU, we found:
  1. Four specific thioether biomarkers in the breath of volunteers with experimentally induced blood stage Plasmodium falciparum
  2. That the levels of the volatiles strongly correlate with the levels of malaria parasitaemia.
  3. That the thioethers are not produced by in vitro cultures of falciparum.
  4. That although we do not know the metabolic origin of the thioethers, our results suggest that interplay between host and parasite metabolic pathways is involved in their production.
We think it is important to emphasise that no volunteer was infected with malaria primarily for the purpose of this study. Our research was entirely piggy-backed on pre-existing trials of malaria therapeutics. (more…)
Author Interviews, Endocrinology, JCEM, Metabolic Syndrome, Sleep Disorders / 03.04.2015

CDC- sleepMedicalResearch.com Interview with: Nan Hee Kim M.D., Ph.D., Professor Korea University Ansan Hospital, Gojan1-dong, Danwon-gu, Gyunggi-do, Korea MedicalResearch: What is the background for this study? Dr. Nan Hee Kim: Many individuals in modern society experience a discrepancy between social and biological time. Especially during the work or school week, we are often forced to be awake against our preferred time. In addition, the increase of light, TV, computer and internet make people stay up late at night. However, night owls (evening persons) have been reported to have more health and behavioral problems than morning persons. Evening persons experience eating disorders, negative mood and insufficient sleep compared to morning persons. They initiate sleep later in the night but need to wake up earlier than their biologic morning due to social demands. There is abundant evidence that short sleep duration and insomnia are significant risk factors for obesity and diabetes. Therefore, we feel the necessity to reveal whether evening persons are associated with metabolic abnormalities in the general population. MedicalResearch: What are the main findings? Dr. Nan Hee Kim: In middle-aged adults, people who stayed up late had a 1.7-fold increased risk for type 2 diabetes and metabolic syndrome, and a 3.2-fold increase in risk for sarcopenia as compared with morning persons, independent of sleep duration and lifestyle. Evening persons were associated with reduced muscle mass in men and increased fat mass including visceral fat in women. (more…)
Author Interviews, FDA, Flu - Influenza, Geriatrics, Lancet, Vaccine Studies / 03.04.2015

Dr Richard Forshee PhD Food and Drug Administration, Silver Spring, MD MedicalResearch.com Interview with: Dr Richard Forshee PhD Associate Director for Research in the Office of Biostatistics and Epidemiology Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring, MD On behalf of the study authors Medical Research: What is the background for this study? What are the main findings? Dr. Forshee: Influenza continues to be a major public health concern causing illness, hospitalization, and death. The elderly are at highest risk for seasonal influenza complications, including hospitalization and death. As people grow older their ability to raise a strong protective immune response can weaken.  The availability of a vaccine that uses a higher dose to induce a stronger immune response could reduce the serious impact of influenza in this age group.  The purpose of this study was to determine whether a high-dose inactivated influenza vaccine was more effective for prevention of probable influenza infections and influenza-related hospital admissions, compared to standard-dose inactivated influenza recipients. In December 2009, the U.S. Food and Drug Administration (FDA) licensed Fluzone High Dose, an injectable inactivated trivalent seasonal influenza vaccine for people ages 65 years and older. This high-dose vaccine contains four times more hemagglutinin—the active ingredient in influenza vaccines that cause the human body to produce antibodies against the influenza viruses—than the standard-dose vaccine. The FDA approved the high-dose vaccine using the accelerated approval regulatory pathway, which allows the agency to approve products for serious or life-threatening diseases based on reasonable evidence of a product’s effectiveness.  This pathway reduces the time it takes for needed medical products to become available to the public.  Studies conducted prior to licensure showed an enhanced immune response to the high-dose vaccine compared with the standard-dose vaccine in individuals 65 years of age and older indicating that the high-dose vaccine was reasonably likely to be more effective in preventing influenza disease. As part of the accelerated approval process, the manufacturer, Sanofi Pasteur, was required to conduct a randomized clinical study post-licensure to confirm that the high-dose vaccine decreased seasonal influenza disease after vaccination relative to standard dose vaccine. This confirmatory study demonstrated that the high–dose vaccine prevented 24% more cases of laboratory-confirmed influenza illness compared to standard-dose vaccines in people 65 years of age and older. However, the study was not large enough to determine efficacy of the vaccine against severe disease. A team of scientists from FDA, the Centers for Disease Control and Prevention, Centers for Medicare and Medicaid Services, and Acumen LLC ( an independent research organization) studied the relative effectiveness of the high-dose influenza vaccine in the U.S. population ages 65 years and older.  The observational study, which covered the 2012-2013 influenza season, found a significant reduction both in influenza-associated illness and in influenza-related hospitalizations among individuals who received the high-dose vaccine, compared to those receiving the standard dose. Additional background about this study: “Comparative effectiveness of high-dose versus standard-dose influenza vaccines in US residents aged 65 years and older from 2012 to 2013 using Medicare data: a retrospective cohort analysis” is available at: http://dx.doi.org/10.1016/S1473-3099(14)71087-4 A commentary on the study titled “Novel observational study designs with new influenza vaccines” is available at: http://dx.doi.org/10.1016/S1473-3099(15)70020-4 (more…)
Author Interviews, Dermatology, Melanoma / 03.04.2015

MedicalResearch.com Interview with: Suzanne Dobbinson PhD Senior Research Fellow Centre for Behavioural Research in Cancer Cancer Council Victoria Melbourne AustraliaMedicalResearch.com Interview with: Suzanne Dobbinson PhD Senior Research Fellow Centre for Behavioural Research in Cancer Cancer Council Victoria  Melbourne Australia MedicalResearch: What is the background for this study? What are the main findings? Dr. Dobbinson: Australia has one of the highest skin cancer rates in the world due to the country’s high levels of ultraviolet (UV) radiation and a population with susceptible skin types. Two in three Australians will be diagnosed with skin cancer by the age of 70, with more than 40,000 new cases annually in the state of Victoria alone. Since the 1980s there have been broad public education programs to raise awareness of skin cancer. Television campaigns have been central to these multi-component prevention programs, including SunSmart, which is the longest-running program in Victoria. This study examined SunSmart television advertisements broadcast over summers between 1987 to 2011 to determine what effect – if any – these advertisements had on people’s sun protection attitudes and behaviours. Cross-sectional weekly telephone surveys of Melbourne residents were conducted over summers during the study period. Population exposure to campaign TV advertisements was also measured as cumulated weekly target audience rating points (TARPs) for 4 weeks prior to interview. Using multiple logistic and linear regression models, we examined whether there was a relationship between the TARPs and responses of the surveys. We found that increasing TARPs were related to an increased preference for no tan, increased sunscreen use and overall reduced mean percentage of skin exposed to the sun. Also of note was that this behavioural impact was consistent across all age groups. (more…)
Author Interviews, Dermatology / 03.04.2015

Emma Guttman-Yassky, MD, PhD Department of Dermatology Icahn School of Medicine at Mount Sinai Medical Center New York, NY 10029MedicalResearch.com Interview with: Emma Guttman-Yassky, MD, PhD Department of Dermatology Icahn School of Medicine at Mount Sinai Medical Center New York, NY 10029 Medical Research: What is the background for this study? What are the main findings? Dr. Guttman-Yassky: Atopic dermatitis/AD is the most common inflammatory skin disease. Increased knowledge about the molecular phenotype of atopic dermatitis has contributed to development of novel therapeutics, including trials with targeted therapeutics. Genomic skin data from these trials largely rely on microarrays that are based on hybridization of labeled RNA/cDNA to single stranded DNA sequences that translate to expression levels. We have recently shown that the atopic dermatitis transcriptome (defined as differentially expressed genes [DEGs] between lesional and non-lesional skin) is reversible with broad and specific therapeutics. For future mechanistic studies within clinical trials, it is important to determine the agreement between microarrays and RNA-seq and to evaluate whether RNA-seq offers additional benefits. This is the first report of the lesional atopic dermatitis phenotype by RNA-seq, and the first direct comparison between the microarray and RNA-seq platforms in this disease. Both platforms robustly characterize the AD transcriptome. Through RNA-seq, we unraveled novel atopic dermatitis disease pathology, including increased expression of the novel TREM-1 signaling pathway and IL-36 cytokine, which might have a pathogenic role in atopic dermatitis. Importantly, good agreement with real time PCR, which serves as the "gold standard" for detection of gene expression was observed for both technique. Overall good agreement was observed with RT-PCR for both RNA-seq and microarrays, but key atopic dermatitis immune cytokines (such as interleukin 13, and interleukin 22), which are highly elevated in atopic dermatitis lesions were only detected by RT-PCR. Overall, both RNA-seq and microarrays can similarly characterize the lesional AD transcriptome and serve as valuable tools for molecular tissue studies within large clinical trials and a core atopic dermatitis pathology is common to microarray and the RNA-seq transcriptomes. RNAseq might play a complementary role for unravelling novel disease pathology, although analyses tools for RNAseq are still being developed. (more…)
Author Interviews, Cancer Research, Nature, NYU / 03.04.2015

MedicalResearch.com Interview with: Alka Mansukhani Ph.D. Associate Professor Department of Microbiology NYU Langone Medical CenterMedicalResearch.com Interview with: Alka Mansukhani Ph.D. Associate Professor Department of Microbiology Member of the Laura and Isaac Perlmutter Cancer Center NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Mansukhani: Osteosarcoma is a highly aggressive pediatric bone cancer that is almost always advanced at diagnosis. Treatment outcomes have not improved in three decades and 40% of patients eventually succumb to the disease. A few years ago we identified that normal bone stem cells relied on the function of a gene called Sox2 to remain immature an self-renew. We went on to find that osteosarcoma cancer stem cells, that arise from immature bone cells, express high levels of Sox2. Like their normal counterparts, these cancer cells also need Sox2. Sox2 maintains the stemness properties of the cancer cells as well as their ability to form tumors in mice. Depleting Sox2 resulted in cells that had reduced tumor-forming potential and instead, were able to become mature bone cells. http://www.stbaldricks.org/blog/post/new-discovery-may-hold-the-key-to-destroying-osteosarcoma/ In this new study we have identified the mechanism by which Sox2 maintains the properties of osteosarcoma cancer stem cells. Sox2 inactivates the growth restraining function of the well-known tumor suppressive hippo pathway. Hippo signaling restrains the activity of a potent oncogene, YAP. In the osteosarcoma stem cells, Sox2 directly represses two genes (Nf2 and WWC1) in the hippo pathway and thereby unleashes the growth promoting activity of YAP. Like Sox2, YAP is required to maintain the tumorigenic properties of osteosarcoma cells. Consistently, we found high YAP and low NF2 and WWC1 expression in human osteosarcoma tissues. Our study makes a direct connection between Sox2 and repression of hippo signaling to enable YAP activity in osteosarcomas. This mechanism also operates in glioblastoma, an aggressive brain tumor. (more…)
Author Interviews, Baylor University Medical Center Dallas, Dermatology, Sexual Health / 03.04.2015

MedicalResearch.com Interview with: Caitriona Ryan, MD Baylor University Medical Center, DallasMedicalResearch.com Interview with: Caitriona Ryan, MD Baylor University Medical Center, Dallas MedicalResearch: What is the background for this study? What are the main findings? Dr. Ryan: Psoriasis is a common, chronic, inflammatory disorder of the skin which has a considerable impact on social functioning and personal relationships. Genital involvement can have devastating psychosexual implications for psoriasis patients. In a study examining the stigmatization experience in psoriasis patients, involvement of the genitalia was found to be the most relevant, regardless of the overall psoriasis severity. Although sexual function is an integral component of quality of life, dermatology-specific and psoriasis-specific scales largely neglect the impact of disease on sexual health. Despite major advances in other aspects of psoriasis research, there has been little emphasis in recent times on the identification and treatment of genital psoriasis and few studies have examined predisposing risk factors, phenotypical associations or its impact on quality of life and sexual functioning. This study was designed to examine the prevalence and nature of genital involvement in patients with psoriasis, to ascertain risk factors for the development of genital psoriasis, to determine the impact of genital disease on quality of life and sexual functioning, and to assess patient satisfaction with current topical treatments for genital psoriasis. (more…)
Author Interviews / 02.04.2015

CDC file: bedbugsMedicalResearch.com Interview with: Susan C. Jones, Ph.D. Professor, The Ohio State University Department of Entomology Rothenbuhler Research Lab. Columbus, OH 43210 Medical Research: What is the background for this study? Response: Bed bugs are important public health pests that have made a huge comeback in developed countries throughout the world which are leading to people needing to buy a new mattress like the ones on Leesa.com. Human health effects from bed bugs include allergic reactions, secondary bacterial infections, asthma, anaphylactic shock, sleeplessness, agitation, and anxiety. Your health should be your top priority. So if you are suffering from bed bug infestation in the home or any form of pests for that matter, the best way to solve this is through looking into something like Pest Control Des Moines to help get this issues sorted. Bed bugs require multiple integrated pest management (IPM) strategies such as extremely thorough inspections, sanitation, a wide variety of nonchemical and chemical measures, and follow-up monitoring. If you experience this you need bed bugs treatment so it does not get any worse. Evaluating the effectiveness of various bed bug products is an ongoing effort of my research lab. Medical Research: What are the main findings? Response: In this study, we provide data demonstrating decreased feeding and fecundity (egg production) of bed bugs after just 10 minutes of exposure to ActiveGuard fabric as compared to untreated fabric. The ActiveGuard Mattress Liner, which is impregnated with 550 mg permethrin per m2, was effective even against bed bug populations that were resistant to pyrethroids. (more…)
Author Interviews, Brigham & Women's - Harvard, Melanoma, Surgical Research / 02.04.2015

MedicalResearch.com Interview with: Lyn McDivitt Duncan, MD Professor of Pathology, Harvard Medical School Chief, Dermatopathology Unit and Su Luo, MD Dermatology Resident Massachusetts General Hospital Boston, MA 02114 Medical Research: What is the background for this study? What are the main findings? Response: We studied 475 patients with cutaneous melanoma diagnosed at the Massachusetts General Hospital (MGH) who also had a sentinel lymph node biopsy procedure performed.  There is a practice gap in the sentinel lymph node biopsy procedure ranging from removal of one “sentinel” lymph node to removing the hottest lymph node and any lymph nodes with radioactive tracer of 10% or more of the hottest lymph node’s counts (with an average of three lymph nodes removed).  At the MGH we use this latter method.  We examined the sentinel lymph nodes in each case to determine whether the positive cases with microscopic melanoma metastases had metastases only in the most radioactive, or "hottest", node or whether tumor was also present in the less hot nodes. We found that in 19% of positive cases there were metastases present only in the less hot nodes. We also performed survival analysis and showed that the less hot nodal positive cases are of equivalent prognostic significance.  We found that removal of only the hottest lymph node would have led to under-staging of 19% of patients with melanoma. (more…)
Author Interviews, Diabetes, Diabetologia, Lifestyle & Health, University of Pittsburgh / 02.04.2015

MedicalResearch.com Interview with: Bonny Rockette-Wagner, Ph.D. Director of physical activity assessment, University of Pittsburgh Graduate School of Public Health and Andrea Kriska, Ph.D. Professor of epidemiology, University of Pittsburgh Graduate School of Public Health Researchers’ Note: Drs. Kriska and Rockette-Wagner: It should be noted that this study looked at adults at high risk for diabetes. Not everyone in the general population would be at high risk. We would hypothesis that the risk increase from TV watching may be lower in those not at high risk for diabetes, but obviously could not test that in our study population. MedicalResearch: What is the background for this study? Response: In this research effort focused on participants in the Diabetes Prevention Program (DPP) study (published in 2002 and funded by the National Institute of Digestive and Diabetes and Kidney Diseases [NIDDK] section of the US National Institutes of Health [NIH]). That study enrolled 3,234 overweight US adults (1996–1999) of at least 25 years of age with the goal of delaying or preventing type 2 diabetes in high risk individuals with either a metformin drug or lifestyle intervention. The DPP demonstrated that the lifestyle intervention was successful at reducing the incidence of diabetes and achieving its goals of 150 minutes per week of moderate intensity activity (such as brisk walking) and a 7% weight loss (New England Journal of Medicine, 2002). There was no goal to reduce sitting in the Diabetes Prevention Program. Results from other studies suggest that it is unclear if interventions focusing on increasing physical activity also reduce time spent sitting. This current investigation examined whether the Diabetes Prevention Program lifestyle intervention, which was shown to be effective at increasing physical activity, also decreased self-reported sitting time. The effect of sedentary behavior on diabetes development was also examined. MedicalResearch: What are the main findings? Response: For the lifestyle participants, a reduction in reported TV watching alone and the combination of TV watching and work sitting was observed. This reduction was significantly greater than any changes seen in the other two randomized groups, who did not receive the intervention. Because these reductions were accomplished without an explicit program goal to reduce sitting we feel optimistic that with better awareness of sitting behaviors and goal setting to reduce sitting it may be possible to have an even greater impact than what was achieved in this cohort. Additionally, our results showed that for every hour spent watching TV there was a 3.4% increased risk of developing diabetes during the 3 year follow-up period in individuals at high risk for diabetes. This finding means that reductions in sitting can translate into a positive health effect separate from improvements in moderate-vigorous activity. (more…)
Author Interviews, CT Scanning, Duke, Heart Disease, NEJM / 02.04.2015

Pamela S. Douglas, M.D. Duke University School of Medicine Duke University Medical Center Durham, NC 27715MedicalResearch.com Interview with: Pamela S. Douglas, M.D. Duke University School of Medicine Duke University Medical Center Durham, NC 27715 Medical Research: What is the background for this study? Dr. Douglas: The primary objective of the PROMISE study was to compare the health outcomes of people who went to the doctor with new symptoms such as shortness of breath and/or chest pain that were suggestive of coronary artery disease and that required additional evaluation. This was an important investigation because no large research trial has ever been conducted to help guide the care of such patients. Instead, the selection of tests for such patients—which constitutes at least 4 million patients in the United States each year—has been largely left up to physician and patient preference rather than proven results. Medical Research: What are the main findings? Dr. Douglas: 10,003 patients from 193 different medical facilities across the US and Canada agreed to be part of the PROMISE study and  were randomized to a functional stress test or an anatomic test Using CT angiography.  The study found that the clinical outcomes of participants with suspected coronary artery disease were excellent overall, and were similar in terms of death and major cardiac conditions regardless of whether patients had a functional stress test or a computed tomographic scan. However, the CT scan may be better at ruling out the need for subsequent tests and procedures in patients who are free of heart disease, and involved a lower radiation exposure relative to a stress nuclear study. We also found, in a separately reported study, that the costs of the two diagnostic strategies were similar. (more…)
Author Interviews, Biomarkers, Emergency Care, Heart Disease / 02.04.2015

MedicalResearch.com Interview with: Anne Vorlat MD Department of Cardiology Antwerp University Hospital Department of Cardiology, Edegem, Belgium MedicalResearch: What is the background for this study? What are the main findings? Dr. Vorlat: Early diagnosis of myocardial infarction is critical for optimal treatment and prognosis of the patient. The third universal definition of myocardial infarction states that a rise and/or fall of cardiac biomarkers (preferably troponin) with at least one value above the 99th percentile of the upper reference limit is mandatory with symptoms and or ST segment changes on the ECG. Since the development of more sensitive assays for cardiac troponins, myocardial injury can be detected earlier. This has permitted to shorten the timing of the second sampling of cardiac biomarkers from 6h to 3h after the first sampling. Recent studies have tested biomarker protocols with a very short delay (e.g., 1 hour) or with a single measurement of troponin and copeptin (a marker of endogenous stress, not cardiac specific) to rule in or to rule out myocardial injury in a population with chest pain. Although these newer protocols appear to be promising, early presenters (chest pain for less than 2 hours) are underreported. The present study evaluated the usefulness of early rule-in and rule-out biomarker protocols to estimate ischemia-induced myocardial injury in an early presenter model. The “early presenter” model was tested in 107 stable patients after a short period of myocardial ischemia, induced by stenting of a significant coronary artery stenosis. High-sensitivity troponin T (hsTnT), hsTnI and copeptin were measured at the start, and 90, 180 and 360 minutes after stent implantation. We confirmed our hypothesis that short biomarkers protocols underestimate myonecrosis in early presenters. (more…)
Antibiotic Resistance, Author Interviews, Infections, NEJM / 02.04.2015

Henri van Werkhoven PhD student | Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht, The NetherlandsMedicalResearch.com Interview with: Henri van Werkhoven PhD student and Douwe-PostmaDouwe Postma PhD student Julius Center for Health Sciences and Primary Care University Medical Center Utrecht, Utrecht, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Community-acquired pneumonia is an important cause of hospitalization and death worldwide. Recommendations for antibiotic treatment in patients hospitalized to a non-ICU ward vary widely between guidelines, because the optimal antibiotic strategy is unknown. Interpretation of the available evidence from clinical studies is complicated by the heterogeneity in designs and findings. In our study, we hypothesized that the most conservative strategy, beta-lactam monotherapy, would be non-inferior to strategies with a broader range of antibiotic coverage. The latter strategies are potentially related to increased antibiotic resistance. For this purpose, we randomized hospitals to follow three different strategies of preferred antibiotic treatment in consecutive periods of four months. Physicians were allowed to deviate from the preferred antibiotic treatment for medical reasons. We found that a strategy with beta-lactam monotherapy (e.g. amoxicillin) as the preferred treatment was non-inferior to the strategies with beta-lactam/macrolide combination therapy or fluoroquinolone monotherapy for 30 and 90-day all-cause mortality. Also there was no difference in length of hospitalization and rate of complications. (more…)
Author Interviews, HIV, JAMA, Pediatrics, University of Pennsylvania / 02.04.2015

Elizabeth Lowenthal, MD MSCE Assistant Professor of Pediatrics Children's Hospital of PhiladelphiaMedicalResearch.com Interview with: Elizabeth Lowenthal, MD MSCE Assistant Professor of Pediatrics Children's Hospital of Philadelphia Medical Research: What is the background for this study? What are the main findings? Dr. Lowenthal: Between 2005 and 2012, HIV related deaths declined by 30% worldwide. However, during the same time period, HIV related deaths increased 50% among adolescents. Over 90% of HIV-infected children and adolescents live in sub-Saharan Africa and HIV is the leading cause of death among adolescents in Africa. Treatment is available that can allow babies born with HIV to live to be healthy adults. However, strict adherence to these medicines is necessary and often becomes a great challenge during adolescence. In our study of 300 adolescents (ages 10-19) in Botswana, my team found that adolescents who come to clinic without a parent or guardian have a 4.5X greater odds of failing their HIV treatment. (more…)
Author Interviews, Rheumatology / 01.04.2015

Adam Culvenor Ι B.Physio(Hons), PhD Division of Physiotherapy School of Health & Rehabilitation Sciences The University of QueenslandMedicalResearch.com Interview with: Adam Culvenor Ι B.Physio(Hons), PhD Division of Physiotherapy School of Health & Rehabilitation Sciences The University of Queensland Medical Research: What is the background for this study? Dr. Culvenor: Knee injury, such as anterior cruciate ligament (ACL) rupture, is a well-recognised risk factor for the accelerated development of knee osteoarthritis (OA). Previous studies report high rates of knee osteoarthritis with radiographs (x-rays) more than 5-10 years following ACL injury and reconstruction (ACLR). However, once OA becomes well-established and visible on radiographs, management options are limited. Potential therapies may be better placed to target the early stages of disease when management strategies, such as optimising knee load, may be more efficacious. Magnetic resonance imaging (MRI) enables the assessment of early osteoarthritis features affecting any joint tissue. Yet, MRI has not previously been used to assess early knee OA within the first year following ACLR. Medical Research: What are the main findings? Dr. Culvenor: Of the 111 patients who were one year following an anterior cruciate ligament  rupture, the prevalence of early knee OA assessed with MRI was much higher than previously recognised. Medial and lateral tibiofemoral osteoarthritis was observed in 6% and 11%, respectively, while 17% had patellofemoral OA. These patterns of early OA are similar to previous radiographic findings; the patellofemoral joint is at particular risk of OA. Specifically, the femoral trochlea was the region most affected by bone marrow lesions, cartilage lesions and osteophytes. The prevalence of structural pathology was much higher than the uninjured control group of similar age and activity level, highlighting the impact of knee trauma (injury and/or surgery). (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, Microbiome / 01.04.2015

Michael J Sadowsky Ph.D Director, BioTechnology Institute University of MinnesotaMedicalResearch.com Interview with: Michael J Sadowsky Ph.D Director, BioTechnology Institute University of Minnesota MedicalResearch: What is the background for this study? What are the main findings? Dr. Sadowsky: Fecal microbiota transplantation (FMT) has become increasingly common in the treatment of patients with refractory Clostridium difficile infection (CDI). It also holds promise for the treatment of medical conditions ranging from inflammatory bowel and Crohn’s disease to diabetes and metabolic syndrome. In contrast to standard antibiotic therapies, which further disrupt intestinal microflora and may contribute to the recurrence of CDI, FMT restores intestinal microbiome and healthy gut function. Despite therapeutic successes, little is known about the stability of transplanted microbiota over time. This report contributes to our understanding of the short-and long-term composition of gut microbiota following Fecal microbiota transplantation. In this study, fecal samples collected before and after treatment were compared with data from the Human Microbiome Project (HMP). Treatment using FMT resulted in the rapid normalization of microbial composition in the patient, with the post-treatment profiles closely resembling the normal distribution of fecal microbiota from the donor. While the composition of fecal microbiota in the donor and recipient varied over time, both remained in the large band characterized as normal in hundreds of healthy individuals collected as part of the HMP. Furthermore, while the composition of the microflora in Fecal microbiota transplantation recipients and donors diverges over time, the recipient profiles stay within the same dynamic range as the original implanted donor material. (more…)
Author Interviews, JAMA, Mental Health Research, Pediatrics / 01.04.2015

Dr. Julie Magno Zito, PhD University of Maryland, Baltimore, MD 21201MedicalResearch.com Interview with: Dr. Julie Magno Zito, PhD University of Maryland, Baltimore, MD 21201 MedicalResearch: What is the background for this study? Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’. (more…)
Author Interviews, Dental Research, Primary Care / 01.04.2015

Judith Haber, PhD, APRN, BC, FAAN Associate Dean, Graduate Programs The Ursula Springer Leadership Professor in Nursing New York, NY 10003MedicalResearch.com Interview with: Judith Haber, PhD, APRN, BC, FAAN Associate Dean, Graduate Programs The Ursula Springer Leadership Professor in Nursing New York, NY 10003 Medical Research: What is the background for this study? What are the main findings? Dr. Haber: The background of the project originally aligns with publication of the Surgeon General's Report (2000), challenging health providers to think about the "mouth as a window to the body".  More recent Institute of Medicine (IOM) reports, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) highlighted the extant problems with oral health access, oral health disparities and outcomes and the potential role of the primary care workforce in addressing this population health issue.  However, there is a dearth of curricular focus on oral health in the curriculum of health professionals.  The IOM challenged the Health Resource and Service Administration (HRSA) to convene an Expert Panel to develop interprofessional oral health core clinical (IPOHCC) competencies; the report, Integrating Oral Health and Primary Care Practice, delineating the IPOHCC competencies, was published in 2014.   Our HRSA funded initiative, Teaching Oral-Systemic Health (TOSH), focuses on building interprofessional oral health workforce capacity with a special focus on the nursing, medical and dental professions.  We have operationalized the IPOHCC competencies by transforming the HEENT component of the health history, physical exam, risk assessment, diagnosis, and management plan, including collaboration and referral, to the HEENOT approach.  When a health professional uses the HEENOT approach, he or she cannot forget about oral health. (more…)
Author Interviews, JAMA, Melanoma, Technology, UCSF / 01.04.2015

Maria L. Wei, M.D., Ph.D. Associate Professor of Dermatology Director, Melanoma Surveillance Clinic Multidisciplinary Melanoma Program University of California, San Francisco Staff Physician Veterans Affairs Medical Center, San FranciscoMedicalResearch.com Interview with: Maria L. Wei, M.D., Ph.D. Associate Professor of Dermatology Director, Melanoma Surveillance Clinic Multidisciplinary Melanoma Program University of California, San Francisco Staff Physician Veterans Affairs Medical Center, San Francisco Medical Research: What is the background for this study? Dr. Wei: Effective physician-patient communication is essential for optimal medical care. There are now many methods available to notify patients of their biopsy results: a clinic visit (the method traditionally preferred by patients), a telephone call, secure online patient portals to access medical charts, email and texts. In addition, there is variability from state to state in the guidelines regulating the release of biopsy results online. Until recently, some states did not allow the on-line release of biopsy results. There have been few systematic studies on patient preferences for communication of biopsy results. (more…)
Author Interviews, Duke, HPV, Stem Cells / 01.04.2015

Marc Ryser PhD Visiting Assistant Professor Department of Mathematics Duke University Durham, North CarolinaMedicalResearch.com Interview with: Marc Ryser PhD Visiting Assistant Professor Department of Mathematics Duke University Durham, North Carolina Medical Research: What is the background for this study Dr. Ryser: Infection with the human papillomavirus (HPV) is responsible for approximately 5% of all cancers worldwide. In addition to cervical cancers, HPV is associated with various other female and male cancers, including cancers of the anus and oropharynx. Despite expansive screening and vaccination programs, HPV-related cancers remain a serious public health concern in the US and abroad. To further improve public health interventions against HPV, a thorough understanding of the underlying biology is critical. The lifetime risk of getting infected with HPV is as high as 80%, yet most individuals remain asymptomatic and clear the virus after 1-2 years.  However, if an infection with a high-risk type of HPV persists, the virus can interfere with the replication mechanism of the host cells, and initiate tumor growth. Even though our understanding is incomplete to date, clearance of HPV infections is primarily attributed to an effective immune response. Interestingly, recent studies about the stem cell dynamics in epithelial tissues - the types of tissues that are affected by HPV -  have shown that the fate of these stem cells is random: most of the time, a stem cell divides into a new stem cell and a differentiating daughter cell; however, every now and then, a stem cell divides either into two stem cells, or into two differentiating daughter cells. These dynamics have not been acknowledged by the HPV community, and our goal was to develop mathematical models to examine whether the random division patterns of stem cells could play a role in the clearance of HPV infections. (more…)
Antioxidants, Author Interviews, Diabetes, Nutrition / 01.04.2015

MedicalResearch.com Interview with: Isao Saito, MD, PhD Department of Basic Nursing and Health Science, Ehime University Graduate School of Medicine Toon, Ehime Medical Research: What is the background for this study? What are the main findings? Response: Type 2 diabetes is a major lifestyle-related disease with a rapid increasing prevalence in Japan. One meta-analysis of six cohort studies showed that an increase in daily food intake of 1.15 servings of green leafy vegetables was associated with a 14% reduction in the incidence of type 2 diabetes. Therefore, it is evident to think that green and yellow vegetables have beneficial effects against type 2 diabetes. Nonetheless, the relationship of their nutritive content with insulin resistance is poorly understood. We conducted the Toon Health Study initiated in 2009, which was a prospective cohort study of the Japanese general population. The cohort study was intended to characterize environmental risk factors related to incident diabetes and cardiovascular disease. Participants were recruited from the general population aged 30–79 years who were living in Toon City, Ehime Prefecture, Japan. Of them, we investigated 951 Japanese men and women aged 30–79 years who were not undergoing treatment for diabetes and measured their serum β-carotene and retinol concentrations. A 75-g oral glucose tolerance test was performed and the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and the Matsuda Index were calculated as measures of insulin resistance. Multivariable-adjusted odds ratios of the highest quartile of serum β-carotene compared with the lowest quartile for HOMA-IR >1.6 and Matsuda Index <4.9 were 0.56 (95% confidence interval, 0.34–0.94) and 0.62 (0.37–1.02), respectively. When stratified by sex and overweight status, these associations were observed for women and non-overweight individuals. Serum retinol concentration was not associated with either index. Furthermore, according to the nutritional survey, serum β-carotene concentration was associated with green and yellow vegetable intake (p = 0.01). (more…)
Author Interviews, Infections, Microbiome, Urology / 01.04.2015

Alan J. Wolfe PhD, Professor Department of Microbiology and Immunology Stritch School of Medicine, Loyola University Chicago Maywood, ILMedicalResearch.com Interview with: Alan J. Wolfe PhD, Professor Department of Microbiology and Immunology Stritch School of Medicine, Loyola University Chicago Maywood, IL

Medical Research: What is the background for this study? Dr. Wolfe: Several years ago, Dr. Brubaker and I began a conversation. As a urogynecologist, she was concerned about the general lack of improvement in diagnosis and treatment in her urogynecological practice and thus in clinical outcome. As a microbiologist, I was extremely skeptical of the dogma that urine in the bladder was sterile in the absence of a clinical infection. This skepticism was based upon my former work in bacterial motility and biofilm formation and on the knowledge that most bacteria are not cultured by the standard clinical microbiology urine culture method. With the goal of ultimately improving urogynecological practice, and with the help of our colleagues in the Loyola Urinary Education and Research Collaborative (LUEREC), we decided to test the sterile bladder hypothesis by seeking evidence of bacteria in urine taken directly from the bladder to avoid vulva-vaginal contamination. To detect bacterial DNA, we used high-throughput DNA sequencing technology. To detect live bacteria, we developed an Expanded Quantitative Urine Culture (EQUC) protocol. We applied these complementary approaches to women with and without urgency urinary incontinence (UUI) whose standard clinical urine culture was negative. Medical Research: What are the main findings? Dr. Wolfe: First and foremost, the bladder is not sterile. We can detect bacteria and/or bacterial DNA in most women whether they have urgency urinary incontinence (UUI) or not. Thus, the female bladder contains a resident bacterial community, which we call the female urinary microbiome (FUM). We found that bacterial members of the FUM are distinct from the bacteria that typically cause urinary tract infections (UTI). Thus, the bacteria that make up the FUM are not the bacteria that cause typical UTIs. Indeed, detection of the female urinary microbiome was associated with reduced risk of UTIs that often occur after instrumentation or surgery. We therefore hypothesize that the FUM or some members of the FUM could protect against UTI. We also saw that the FUM in women with UUI differs from the FUM in women without UUI and that certain bacterial species were considerably more common in women with urgency urinary incontinence than in women without urgency urinary incontinence . We hypothesize that some of these bacteria could be causative or contributory to UUI or they could be a consequence of urgency urinary incontinence. (more…)
Author Interviews, Diabetes, JAMA, Pediatrics / 01.04.2015

MedicalResearch.com Interview with: Dr. Michele Jonsson Funk, PhD Research Associate Professor, Dept of Epidemiology Director, Methods Core, Center for Women’s Health Research University of North Carolina at Chapel Hill and Dr. Wendy Camelo Castillo, MD, PhD Post-doctoral fellow at the University of Maryland Medical Research: What is the background for this study? Response: Gestational diabetes is a condition that affects between 8-11% of pregnant women worldwide. In the United States, the prevalence of gestational diabetes has more than doubled since the 1990’s. Most women can control their blood glucose levels with changes in diet and exercise, but approximately 10% need to take medication during pregnancy. Over the last decade, the use of glyburide (a pill) to manage gestational diabetes has increased and it is now used more often than insulin (an injectable). Medical Research: What are the main findings? Response: Treatment with glyburide (compared with insulin) was associated with higher risks of admission to the neonatal intensive care unit (NICU) (by 41%), respiratory distress (by 63%), hypoglycemia in the newborn (40% ), birth injury (35% ) and being large for gestational age (43% ).  The risk of NICU admission, large for gestational age and respiratory distress between glyburide and insulin treated women was increased by 3.0%, 1.4% and 1.1% respectively. (more…)
Author Interviews, Heart Disease, Imperial College, JAMA, Outcomes & Safety / 01.04.2015

intra-aortic balloon pump, WikipediaMedicalResearch.com Interview with: Sayan Sen, PhD International Centre for Circulatory Health, National Heart and Lung Institute Imperial College London London, United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Sayan Sen: Intra-aortic balloon pumps (IABP) are often used in Acute Myocardial Infarction, particularly in patients with cardiogenic shock. We analysed the available Randomized Controlled Trials (RCT) and observational studies, spanning 30 years, to establish the evidence for this use. There is no identifiable group of patients with Acute Myocardial Infarction that have been demonstrated to derive a mortality benefit from insertion of an IABP. The studies, including over 17000 patients, have studied mortality in patients receiving IABP in comparison to mortality of patients that received no IABP in the era of no reperfusion, fibrinolysis and primary percutaneous intervention.  This lack of mortality reduction with IABP in AMI is consistent in patients with and without cardiogenic shock across both RCTs and observational studies; questioning the continued use of this technology in Acute Myocardial Infarction. (more…)
Author Interviews, Kidney Disease, OBGYNE, Pharmacology / 01.04.2015

Dr. Mala Sachdeva MD North Shore University Hospital, Long Island Jewish Medical Center Assistant Professor, Nephrology, Internal Medicine Hofstra North Shore-LIJ School of MedicineMedicalResearch.com Interview with: Dr. Mala Sachdeva MD North Shore University Hospital, Long Island Jewish Medical Center Assistant Professor, Nephrology, Internal Medicine Hofstra North Shore-LIJ School of Medicine Medical Research: What is the background for this study? Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis. Medical Research: What are the main findings? Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis. Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths. Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL.  75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient. There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception. So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge. (more…)
Author Interviews, FDA, Infections, Johns Hopkins / 01.04.2015

MedicalResearch.com Interview with: Benjamin Davis BA CLF-Lerner Fellow at the Johns Hopkins Center for a Livable Future. Medical Research: What is the background for this study? What are the main findings? Response: The Food and Drug Administration banned the inter-state sale of raw (i.e. unpasteurized) milk in 1987. Currently 30 states still allow raw milk sales on local farms or in stores. We were requested by the Maryland General Assembly's Health and Government Operations Committee to conduct a review of the health benefits and risks of raw versus pasteurized milk in response to proposed legislation that would legalize raw milk in the state. After reviewing over 80 scientific articles we concluded that raw milk carries a substantially higher risk of foodborne illness when compared to pasteurized milk. However drinking raw milk may reduce allergies among children in rural settings. (more…)