Author Interviews, Cancer Research, Nature, UT Southwestern / 03.05.2015

Dr. Alec (Chengcheng) Zhang Michael L. Rosenberg Scholar in Medical Research Associate Professor of Physiology and Developmental Biology Member of the Harold C. Simmons Comprehensive Cancer Center UT Southwestern Medical CenterMedicalResearch.com Interview with: Dr. Alec (Chengcheng) Zhang Michael L. Rosenberg Scholar in Medical Research Associate Professor of Physiology and Developmental Biology, Member of the Harold C. Simmons Comprehensive Cancer Center UT Southwestern Medical Center Medical Research: What is the background for this study? What are the main findings? Response: Acute myeloid leukemia (AML) is the most common acute leukemia affecting adults. Treatments for AML yield poor outcomes, especially for the typical senior patients. The medical need for new therapies for AML is underscored by the fact that no new therapies for AML have been approved in over 30 years. There are over 50 experimental agents in clinical trials for the treatment of AML today, although only a few agents have promising data to date. New molecular targets and therapeutic strategies are needed for AML treatment. In 2012, we published a paper showing that we cloned the human leukocyte immunoglobulin-like receptor B2 (LILRB2) as a receptor for several angiopoietin-like proteins (Angptls) (Zheng et al 2012 Nature 485:656-660). The LILRB family receptors contain immunoreceptor tyrosine-based inhibitory motifs (ITIMs) and are classified as inhibitory receptors because ITIM motifs can recruit phosphatases SHP-1, SHP-2, or SHIP to negatively regulate immune cell activation. Surprisingly, in that work, we showed that PirB, the mouse ortholog of LILRB2, is expressed by AML stem cells (AML-SCs) and supports AML development. Although counterintuitive, this result is consistent with the generally immune-suppressive and thus tumor-promoting roles of the inhibitory receptors in the immune system. In the current paper, we continued the research and report that a number of receptors containing the ITIMs are crucial for the development of AML. We mainly focus on studying the function and downstream signaling of LAIR1 as a representative ITIM-containing receptor. We found that the deletion of LAIR1 does not affect normal hematopoiesis but abolishes leukemia development in several different mouse leukemia models. We also identified a mechanism by which LAIR1 supports AML development, showing that the LAIR1/SHP-1/CAMK1/CREB pathway sustains the survival and self-renewal of AML cells. Importantly, our findings are well supported by bioinformatics analysis of AML patient databases and experimental results of human leukemia cells. Since certain ITIM-containing receptors are essential for AML cells but not critical for normal hematopoiesis, and blocking their signaling can boost immunity, these ITIM-containing receptors including LAIR1 represent ideal targets for treating AML.
Aging, Author Interviews, Nature / 03.05.2015

Juan Carlos Izpisua Belmonte PhD Professor, Gene Expression Laboratory Roger Guillemin Chair Salk Institute For Biological ScienceMedicalResearch.com Interview with: Juan Carlos Izpisua Belmonte PhD Professor, Gene Expression Laboratory Roger Guillemin Chair Salk Institute For Biological Science MedicalResearch: What is the background for this study? What are the main findings? Response: Werner protein (WRN) plays roles in DNA replication, transcription, repair as well as telomere maintenance. Mutations in WRN are associated with Werner syndrome. In the current study we discovered that WRN was interacting with proteins implicated in heterochromatin maintenance. We observed that mutations in the WRN protein led to alterations in heterochromatin and those alterations are drivers of the aging process.
Author Interviews, Genetic Research, PLoS / 02.05.2015

G. Mandela Fernández-Grandon PhDNatural Resources Institute,University of Greenwich,Chatham, United KingdomMedicalResearch.com Interview with: G. Mandela Fernández-Grandon PhD Natural Resources Institute, University of Greenwich, Chatham, United Kingdom Medical Research: What is the background for this study? Response: People often wonder why, when they are out with their friends or family, one person seems to get ravaged by mosquitoes but others come away relatively bite free. Mosquito bites can be a nuisance to many of us but they are no trivial matter. Mosquitoes are one of the most serious threats to public health through the transmission of diseases such as malaria, dengue fever, yellow fever, chikungunya and others. We knew that mosquitoes rely on odour to find their hosts but until now the link between our body odour and genes had only been shown using human sniffers1. In a strictly controlled laboratory environment, we were able to present the odours of individuals in identical and non-identical twin pairs to mosquitoes allowing them following the odour stream of whichever they found to be more attractive. Medical Research: What are the main findings? Response: Mosquitoes are equally attracted to identical twins in a pair but with non-identical twins they display a preference for one individual. The ability of mosquitoes to distinguish non-identical twins but not identical twins suggests a genetic basis for our odour profile, a genetic difference which plays a role in whether we get bitten more or less than others.
Author Interviews, Cancer Research, Exercise - Fitness, Lymphoma / 02.05.2015

MedicalResearch.com Interview with: Terry Boyle, PhD CIHR Fellow, MSFHR Trainee, Honorary UBC Killam Fellow Cancer Control Research, BC Cancer Agency School of Population and Public Health, The University of British Columbia Australian NHMRC Early Career Fellow The University of Western Australia Cancer Control Research, BC Cancer Agency Vancouver BC Canada Medical Research: What is the background for this study? What are the main findings? Dr. Boyle : Little is known about what causes non-Hodgkin lymphoma (NHL), so trying to identify risk factors is particularly important for the prevention and control of this cancer. There is really good evidence that people who are physically active have a lower risk of some cancers (such as colon and breast cancers), but not many studies have investigated whether being physical active is associated with the risk of non-Hodgkin lymphoma. The key finding of this case-control study was that study participants who were in the higher (second, third, and fourth) quartiles of vigorously intense physical activity performance in their lifetimes had about 25 percent to 30 percent lower risk for NHL, compared with those who were in the lowest (first) quartile of vigorously intense physical activity.
Author Interviews, Dermatology / 02.05.2015

Warren J. Winkelman, MD, MBA, PhD, FRCPC, FAAD Director, Medical Affairs Galderma Laboratories, L.P. Fort Worth TXMedicalResearch.com Interview with: Warren J. Winkelman, MD, MBA, PhD, FRCPC, FAAD Director, Medical Affairs Galderma Laboratories, L.P. Fort Worth TX MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Winkelman: Rosacea is a common dermatologic facial disorder estimated to affect 16 million Americans. Rosacea is a chronic condition of the central face, including the nose, chin, cheeks and forehead, and is often characterized by flare-ups and remissions. While the cause of rosacea is unknown and there is no cure, its signs and symptoms can become markedly worse in the absence of treatment. Rosacea can be managed with topical and oral medications, and physicians often resort to using these medications in combination for more severe or resistant cases. Doxycycline 40 mg modified release (MR) and metronidazole 1% gel are FDA-approved oral and topical therapies, respectively, indicated to treat the papules and pustules of rosacea. We conducted a phase 2 study to assess the relapse rate, efficacy, and safety of doxycycline 40 mg MR compared to placebo after an initial 12-week once-daily combination regimen of doxycycline 40 mg MR and metronidazole 1% gel in subjects with moderate to severe disease. Of the 235 subjects enrolled in the study, 71% were women, 94% were white, and 75% had Fitzpatrick skin type I, II or III. The mean age was 47.4 years. The percentage of subjects who achieved a success score of 0 (clear) or 1 (near clear) improved from 0% at baseline to 51% at week 12. Clinician’s erythema assessment scores, inflammatory lesion counts, and quality of life scores also improved. Most subjects reported no or mild scaling, stinging/burning, and dryness. Five adverse events were reported that were considered probably or definitely related to treatment: fungal infection, vulvovaginal mycotic infection, pain in extremity, erythema, and skin exfoliation.
Artificial Sweeteners, Author Interviews, Diabetes, Diabetologia, Nutrition, Sugar / 02.05.2015

Dr Nita Forouhi, MRCP, PhD, FFPHM MRC Programme Leader and Consultant Public Health Physician MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge Biomedical Campus Cambridge UKMedicalResearch.com Interview with: Dr Nita Forouhi, MRCP, PhD, FFPHM MRC Programme Leader and Consultant Public Health Physician MRC Epidemiology Unit University of Cambridge School of Clinical Medicine Cambridge Biomedical Campus Cambridge UK Medical Research: What is the background for this study? What are the main findings? Dr. Forouhi: Consumption of soft drinks is known to cause obesity and may contribute to the development of type 2 diabetes. We had previously published findings from the EPIC-InterAct study in 8 European countries that habitual consumption of sugar sweetened beverages increases the risk of developing type 2 diabetes, and we now wanted to probe deeper to understand more about this relationship between sweet beverages and diabetes. We conducted research in the large EPIC-Norfolk study which included more than 25,000 men and women aged 40–79 years living in Norfolk, UK. Study participants recorded everything that they ate and drank for 7 consecutive days covering weekdays and weekend days, with particular attention to type, amount and frequency of consumption, and whether sugar was added by the participants. During approximately 11 years of follow-up, 847 study participants were diagnosed with new-onset type 2 diabetes. By using this detailed information on diet, we were able to study several different types of sugary beverages, including sugar-sweetened soft drinks, sweetened tea or coffee and sweetened milk drinks as well as artificially sweetened beverages (ASB) - such as diet soft drinks - and fruit juice, and to examine what would happen if plain water, unsweetened tea or coffee or artificially sweetened beverages were substituted for sugary drinks. Our study provided three main findings: First, there was an approximately 22% increased relative risk of developing type 2 diabetes per extra serving per day habitually of each of soft drinks, sweetened milk beverages and ASB consumed, even after accounting for a range of important factors including other lifestyle and social factors and for total energy intake. However, after further accounting for body mass index and waist girth as markers of obesity, there remained a higher risk of diabetes associated with consumption of both soft drinks and sweetened milk drinks, but the link with ASB consumption no longer remained, possibly because artificially sweetened beverages was likely to be consumed by those who were already overweight or obese. Second, when we estimated the likely effects of replacing a habitual serving of soft drinks with a serving of water or unsweetened tea or coffee, we found that the risk of diabetes could have been cut by 14%; and by replacing a habitual serving of sweetened milk beverage with water or unsweetened tea or coffee, that reduction could have been 20%–25%.  However, consuming ASB instead of any sugar-sweetened drink was not likely to reduce the risk of diabetes, when accounting for baseline obesity and total energy intake. Third, we found that each 5% of higher intake of energy (as a proportion of total daily energy intake) from total sweet beverages (soft drinks, sweetened tea or coffee, sweetened milk beverages, fruit juice) was associated with a 18% higher risk of diabetes. We estimated that if study participants had reduced the energy they obtained from sweet beverages to below 10%, 5% or 2% of total daily energy, 3%, 7% or 15% respectively of new-onset type 2 diabetes cases could have been potentially avoided.
Author Interviews, Heart Disease, Mayo Clinic, Psychological Science / 01.05.2015

Shannon M. Dunlay, M.D. M.S. Advanced Heart Failure and Cardiac Transplantation Assistant Professor of Medicine and Health Care Policy and Research Mayo Clinic RochesterMedicalResearch.com Interview with: Shannon M. Dunlay, M.D. M.S. Advanced Heart Failure and Cardiac Transplantation Assistant Professor of Medicine and Health Care Policy and Research Mayo Clinic Rochester MedicalResearch: What is the background for this study? What are the main findings? Dr. Dunlay: Left ventricular assist devices (LVAD) are increasingly utilized as destination therapy (DT) in patients that are not candidates for heart transplantation. Optimal patient selection is essential in improving outcomes, but many of the factors associated with favorable outcomes remain poorly understood. It is important for us to better understand the role that psychosocial factors may play in outcomes after DT LVAD. Unlike transplant, where the limited organ supply requires choosing candidates with optimal psychosocial characteristics, DT LVAD therapy is more readily available as it does not rely on organ donors. There are no clear guidelines on what constitutes an acceptable psychosocial risk prior to DT LVAD. As a result, many programs will offer DT LVAD to candidates despite psychosocial concerns if it is felt they will otherwise benefit. Data are needed to inform programs about whether such candidates are truly at elevated risk of adverse outcomes. In our single-center study including 131 patients, we found that several psychosocial characteristics are predictive of readmission after DT LVAD. A history of illegal drug use and depression are associated with a higher risk of readmission, while tobacco use is associated with lower readmission risk. Psychosocial characteristics were not significant predictors of death after DT LVAD.
Aging, Author Interviews, Exercise - Fitness, Geriatrics, Lifestyle & Health, Nutrition / 01.05.2015

Yunhwan Lee, MD, DrPH Director, Institute on Aging Professor of Preventive Medicine & Public Health Ajou University School of Medicine Suwon, South KoreaMedicalResearch.com Interview with: Yunhwan Lee, MD, DrPH Director, Institute on Aging Professor of Preventive Medicine & Public Health Ajou University School of Medicine Suwon, South Korea Dr. Lee wishes to acknowledge Jinhee Kim, PhD, the lead author of the study. Medical Research: What is the background for this study? Dr. Lee: We have known for some time that there is a progressive loss of muscle mass with aging, where older people lose on average about 1% of their skeletal muscle mass per year. A decline in muscle mass is serious in that it increases the person’s risk of falls, frailty, disability, and death. Because there is currently no “cure” for muscle mass loss, prevention is the best strategy. Over the years, researchers have studied various lifestyle factors to identify potentially modifiable behaviors that may prevent or slow the loss of muscle mass. The majority of prior research so far have found that diet, in the form of protein supplementation, and exercise, especially resistance exercise, may confer some benefits. More recently, the scientific community have begun to pay attention to the positive role of vegetables and fruits intake on the muscle. The role of aerobic exercise on muscle mass is, however, less clear. Also, because people tend to adopt various lifestyles, we were interested in finding out whether those engaging in healthier patterns of diet and exercise retained higher muscle mass. This is why bodybuilders pay such close attention to their diet and make sure their muscle mass is at it's peak. They can also take supplements like SARMs (see SARMS.io for more information about that) to improve muscle mass but their diet has a massive effect on it too. This is where some of the inspiration for this research came from as we knew what an effect food had on bodybuilders so we wondered how it could effect the elderly. Using data from a nationally representative sample of older adults, we investigated whether those who had healthier diet and participated in regular exercise, individually and in combination, maintained higher muscle mass. We looked at five healthy lifestyle factors that included dietary intake of three food groups (meat, fish, eggs, legumes; vegetables; and fruits) and participation in two types of exercise (aerobic and resistance).
Author Interviews, Psychological Science, Sleep Disorders / 01.05.2015

Jaime L. Tartar PhD Behavioral Neuroscience Major Chair Division of Social and Behavioral Sciences Nova Southeastern University Fort Lauderdale, FloridaMedicalResearch.com Interview with: Jaime L. Tartar PhD Behavioral Neuroscience Major Chair Division of Social and Behavioral Sciences Nova Southeastern University Fort Lauderdale, Florida Medical Research: What is the background for this study? What are the main findings? Dr. Tartar: We set out to understand how poor sleep quality can influence emotion processing. Our rationale for this study was that although sleep perturbations are known to impair cognitive performance, it is not currently clear how poor sleep alters emotion processes. However, given that poor sleep quality is closely associated with the development of mood disorders, it is important to understand how sleep quality affects emotional functioning. We specifically examined the possibility that poor sleep quality creates a cognitive bias in memory and interpretation for emotionally negative stimuli. This would result in maladaptive emotional experiences- for example, through enhanced memory for emotionally negative events (which is also a common characteristic of depression). The idea that negative cognitive bias occurs with poor sleep quality is also consistent with the finding that sleep loss increases sensitivity to emotional stimuli as well as increases undesirable mood states like irritability, anger, and hostility.  It is particularly noteworthy that sleep perturbations result in increased emotionality since sleep perturbations are shown to result in a decrease in non-emotional cognitive processes (attention and memory).  In order to clarify the role of sleep quality on emotion processing, we tested the relationship between sleep quality and a negative cognitive bias through the use of an emotional memory task.  We also aimed to contrast these findings with performance on a non-emotional attention task since sleep impairments have previously been shown to cause impairments in (non-emotional) sustained attention. An interesting feature of the study was that we also accounted for potential confounding effects of stress sensitivity and chronotype (ones preferred time of day) since these are both factors known to be related to sleep quality. We found that, compared to those who reported good subjective sleep quality, participants who reported poor subjective sleep quality showed a negative cognitive bias towards emotionally negative stimuli. Also in agreement with previous work, we show that poor sleep quality has a negative effect on affective symptom measures- poor sleep quality relates to increased depressive symptoms, greater state and trait anxiety, and higher total mood disturbance (increased tension, fatigue, confusion and less vigor). Consistent with previous findings, we also found that subjective sleep quality was related to a decrease in performance on a sustained attention task. Although previous research suggests that stress sensitivity and chronotype would be important variables to consider in the impact of sleep perturbations on emotion processing, we did not find any stress, chronotype, or time of testing effects on these measures.
Author Interviews, Cancer Research, Gastrointestinal Disease, Genetic Research, NIH / 30.04.2015

Dr. Steven Wank MDMedicalResearch.com Interview with: Dr. Stephen Wank MD Digestive Diseases Branch, NIDDK National Institutes of Health, Bethesda, Maryland MedicalResearch: What is the background for this study? Dr. Wank: Small intestinal carcinoids are rare and difficult to diagnose because symptoms may be absent or mistaken for more common diseases. Because carcinoids usually grow slowly over several years before spreading or causing symptoms, patients often seek medical attention late with advanced, incurable disease. However, when diagnosed at an early stage, carcinoid can be surgically cured. Presently, there are no long-term effective therapies for surgically non-resectable disease. Although carcinoids occur sporadically, there have been reports of family clusters (more than one blood relative with carcinoid). Hereditary small intestinal carcinoid has not been recognized as a disease and causative genetic factors have not been identified in either sporadic cases or families with multiple affected members. If small intestinal carcinoid occurs in families on a hereditary basis, we hypothesized that asymptomatic relatives in families with carcinoid are at a high risk of harboring an undiscovered tumor. To test this, we established a clinical research protocol at the National Institutes of Health in Bethesda, Maryland to screen asymptomatic relatives in families with at least two cases of small intestinal carcinoid in the hope of detecting their tumors at an early surgically curable stage. If successful in our endeavor, we would improve the outcome of the disease in these asymptomatic relatives and position ourselves to discover the genetic basis for their disease. Understanding the gene mutations causing small intestinal carcinoid would allow us to screen for the disease with a blood test, help us understand what causes the disease, and treat the disease with specific targeted therapies.
Author Interviews, Columbia, Opiods / 30.04.2015

Silvia S. Martins, MD, PHDAssociate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032MedicalResearch.com Interview with Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University New York, NY 10032 MedicalResearch: What is the background for this study? What are the main findings? Dr. Martins: The background for this study is former studies showing links between nonmedical use of prescription opioids and transition to heroin and other illegal substances, prescription opioid-related and heroin-related fatal overdoses . In addition, a particular public health concern is that the transition to heroin and further injecting heroin may increase the risk of bloodborne infections. We used data from the National Survey on Drug Use and Health, a large nationally representative household sample of 67,500 people, and self-reported heroin use within the last 12 months, the researchers examined the change in patterns of past-year non-prescription drug and heroin use between 2002-2005 and 2008-2011 across racial and ethnic groups. The most significant rise in heroin use was among Hispanics and non-Hispanic whites, where the rate of heroin use for the latter group increased by 75 percent in 2008-2011 compared to earlier years. Regarding frequency of use, for Hispanics, increases were significant only among those using opioids about 1-29 days in the past year. Among blacks and whites, significant increases in the rate of heroin use were observed among those using prescription opioids more frequently (100-365 days) in the past year.
Author Interviews, Genetic Research, Lancet, Pediatrics / 29.04.2015

MedicalResearch.com Interview with: Stephen F. Kingsmore MB ChB BAO DSc FRCPath Dee Lyons/Missouri Endowed Chair in Genomic Medicine, Children’s Mercy - Kansas CityMedicalResearch.com Interview with: Stephen F. Kingsmore MB ChB BAO DSc FRCPath Dee Lyons/Missouri Endowed Chair in Genomic Medicine, Children’s Mercy - Kansas City Medical Research: What is the background for this study? Response: The background to this study is that genetic diseases are the leading cause of death in infants and, especially, in infants in neonatal intensive care units. Making a molecular (etiologic) diagnosis of the specific genetic disease is critical for optimal care and decision making for acutely ill infants who are likely to have such diseases. However there are over 5000 known genetic diseases and their presentations overlap considerably in infants. Until now it has not been possible to make timely diagnoses in these infants. Medical Research: What are the main findings? Response: Rapid whole genome sequencing is a new way of making a genetic disease diagnosis in acutely ill newborns in neonatal intensive care units. It appears to be effective for diagnosis.
Addiction, Author Interviews, Case Western, Psychological Science / 29.04.2015

Maria Pagano, PhD Case Western Reserve University School of Medicine Department of Psychiatry, Division of Child Psychiatry Cleveland, OHMedicalResearch.com Interview with: Maria Pagano, PhD Case Western Reserve University School of Medicine Department of Psychiatry, Division of Child Psychiatry Cleveland, OH MedicalResearch: What is the background for this study? Dr. Pagano: Socially anxious adolescents quickly figure out that alcohol and drugs can provide ease and comfort in social situations that are anxiety provoking.  Reaching for a substance to change how you feel can quickly become a knee-jerk reaction, can develop into an addiction, and robs youths of learning how to tolerate interpersonal differences and uncomfortable feelings, developing emotional maturity, and cultivating self acceptance. Adolescents who fear being criticized by their peers are likely to not speak up in group therapies during treatment, which can limit their benefit from treatment.  There is a lot of healing that comes sharing your insides with others. Socially anxious patients may not get this healing nor let others really get to know who they are and give input to their lives Higher peer helping in AA during treatment means getting active in low intensity tasks like putting away chairs, or making coffee at a 12-step meeting.  It is less about needing peer assistance or expecting praise or recognition from giving service.  It is more about adopting the attitude of "how can I be helpful?"
Author Interviews, Blood Pressure - Hypertension, JAMA, Salt-Sodium / 29.04.2015

Lynn L. Moore, DSc, MPH Department of Medicine Boston University School of Medicine Boston, Massachusetts MedicalResearch.com Interview with: Lynn L. Moore, DSc, MPH Department of Medicine Boston University School of Medicine Boston, Massachusetts Medical Research: What is the background for this study? Dr. Moore: The USDA’s current Dietary Guidelines for sodium intake have become increasingly controversial. Current recommendations include restricting sodium intake after the age of 2 years to no more than 2300 mg per day. For African-American adults and children, intakes should be restricted to no more than 1500 mg per day. Actual intake levels are much higher, with most Americans consuming about 3500 mg per day. Our goal was to estimate the effects of dietary sodium and potassium intakes on the change in blood pressure throughout adolescence. We used data from the National Growth and Health Study, a prospective study of more than 2000 girls who were 9-10 years of age at the time of enrollment. Lifestyle factors were assessed repeatedly throughout the study, and blood pressure was measured annually. Dietary sodium and potassium were assessed using multiple sets of three-day diet records. We used longitudinal modeling to estimate the effects of dietary sodium and potassium on blood pressure change over 10 years. Medical Research: What are the main findings? Dr. Moore: In this study, there was no evidence for a beneficial effect of reduced sodium intake on blood pressure change during adolescence. By 19-20 years of age, girls who consumed more than 4000 mg of sodium per day had systolic and diastolic blood pressure levels that were similar to those seen among girls with lower levels of sodium intake. Specifically, there was no beneficial effect on blood pressure associated with sodium intakes of less than 2500 mg per day. These results were similar for blacks and whites. In contrast, the repeated measures analyses showed that girls who consumed more than 2400 mg of potassium per day had lower blood pressures throughout adolescence compared with girls consuming less than 1800 mg per day of potassium.
Author Interviews, Brigham & Women's - Harvard, CHEST, Sleep Disorders / 29.04.2015

dr-matthias-eikermann.jpgMedicalResearch.com Interview with: Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia, Harvard Medical School Director of Research, Critical Care Division Massachusetts General Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Eikermann: Obstructive sleep apnea occurs in about 5% of pregnant women, worsens as pregnancy progresses and is likely to persist into the early postpartum period. A main cause of anesthesia-related maternal death is postpartum airway obstruction. We observed among early postpartum women, that 45° upper body elevation increased upper airway diameter and mitigated sleep apnea, without adverse effects on quality of sleep after delivery.
Author Interviews, Blood Pressure - Hypertension / 29.04.2015

George S. Stergiou, MD, FRCP Professor of Medicine & Hypertension Hypertension Center STRIDE-7 Third University Department of Medicine Sotiria Hospital Athens, GreeceMedicalResearch.com Interview with: George S. Stergiou, MD, FRCP Professor of Medicine & Hypertension Hypertension Center STRIDE-7 Third University Department of Medicine Sotiria Hospital Athens, Greece Medical Research: What is the background for this study? What are the main findings? Dr. Stergiou: This study explored the relationship among blood pressure measurements taken in the office, at home and with daytime ambulatory monitoring in 642 untreated subjects aged from 5 to 78 years referred to a university hospital hypertension clinic. The main finding is that the relationship between office and out-of-office blood pressure (home and ambulatory) differs across different age groups. More specifically, in children daytime ambulatory blood pressure is higher than both office and home blood pressure. The differences are progressively eliminated with increasing age and after the age of 30 years daytime ambulatory blood pressure is similar to home blood pressure and both are lower than office blood pressure. In individuals aged 60 years and older daytime ambulatory blood pressure may be lower than home blood pressure. Age, gender and hypertension status are the main predictors of the differences among blood pressure values obtained by different methods.
Author Interviews, Pediatrics, UCSD, Weight Research / 28.04.2015

Mark D. DeBoer, MD, MSc, MCR Associate Professor of Pediatrics Division of Pediatric Endocrinology, University of VirMedicalResearch.com Interview with: Mark D. DeBoer, MD, MSc, MCR Associate Professor of Pediatrics Division of Pediatric Endocrinology, University of Virginia Medical Research: What is the background for this study? What are the main findings? Dr. DeBoer: The American Academy of Pediatrics recommends that children watch no more than 2 hours of TV daily. We wanted to see if children watching shorter amounts of TV were more likely to have higher weight status. We found that children in kindergarten who watched 1-2 hours a day were more than 40% more likely to be overweight and obese and gained more unhealthy weight over the next year.
Author Interviews, Brigham & Women's - Harvard, Hematology / 28.04.2015

MedicalResearch.com Interview with: John M. Higgins, MD MGH Center for Systems Biology Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Higgins: Hundreds of studies over the past 8 years have shown that increased variation in the size of red blood cells (RBCs) is associated with increased risk for a very wide range of common diseases, like heart disease, many types of cancer, infection, many autoimmune diseases, and lots of other conditions.  The size of red blood cells (RBCs) in the circulation of a healthy person usually varies by about 12-14%, meaning that if you took a sample of the cells, most of the bigger cells would be about 14% larger than the smaller cells.  People whose red blood cells show more variation in size have a greater risk of developing a wide range of diseases.  Also, among patients already diagnosed with many common diseases like heart disease or cancer, those with higher RBC size variation have worse outcomes.  It is unknown how all of these different diseases could be connected to variation in the size of red blood cells.  The study explains a major cause for this connection.  We find that the human body seems to slow down the production and destruction of RBCs in just about every major disease very slightly.  Since red blood cells gradually become smaller as they age, a delay in destruction will increase the fraction of small cells, and the overall variation in size increases.  The study also describes a method to estimate a patient’s RBC clearance rate.
Accidents & Violence, Author Interviews, CDC, Nursing, Occupational Health / 28.04.2015

MedicalResearch.com Interview with: Ahmed Gomaa, MD, ScD, MSPH Medical Officer / Surveillance Branch Division of Surveillance Hazard Evaluation and Health Studies National Institute for Occupational Safety and Health (NIOSH) Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? Dr. Gomaa:  In 2013, one in five reported nonfatal occupational injuries occurred among workers in the health care and social assistance industry, the highest number of such injuries reported for all private industries. In 2011, U.S. health care personnel experienced seven times the national rate of musculoskeletal disorders compared with all other private sector workers. To reduce the number of preventable injuries among health care personnel, CDC's National Institute for Occupational Safety and Health (NIOSH), with collaborating partners, created the Occupational Health Safety Network (OHSN) to collect detailed injury data to help target prevention efforts. OHSN, a free, voluntary surveillance system for health care facilities, enables prompt and secure tracking of occupational injuries by type, occupation, location, and risk factors.
Alzheimer's - Dementia, Author Interviews, Diabetes, JAMA / 28.04.2015

MedicalResearch.com Interview with: Dimitry S. Davydow, MD, MPH Associate Professor Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle, WA 98195 Dr, Davydow wishes to acknowledge Dr. Wayne Katon, the lead investigator of the study, who passed away on March 1, 2015. Medical Research: What is the background for this study? Dr. Davydow: The medical and public health communities have known for quite a while that diabetes and depression are both potential risk factors for developing dementia later in life. Dr. Wayne Katon previously published two articles detailing the results of two studies of relatively large groups of patients (one with nearly 4,000 patients and the other with 29,000 patients) with diabetes showing that those with diabetes and co-existing depression had a greater risk of developing dementia later in life than those patients with just diabetes. These initial studies were important since patients with diabetes are 3 to 4-times more likely to suffer from depression compared to the general population. However, it remained unclear when comparing to a population without either diabetes or depression, to what extent each independently raised the risk of developing dementia, and then to what extent having both conditions increased an individual’s subsequent risk of dementia. We sought to answer these questions with this study. In addition, with the growing obesity epidemic, which carries with it higher burdens of both diabetes and depression, there is reason to be concerned that the risk of dementia could be higher at even younger ages. To address this issue, we also wanted to see if there was a differential impact of the combination of diabetes and co-existing depression on dementia risk among those younger than 65 compared to individuals 65 or older. We were fortunate to be able to examine health data from all Danish citizens 50 or older over a 6 year period, a population numbering nearly 2.5 million people to be able to answer these questions. Medical Research: What are the main findings? Dr. Davydow: We found that compared to individuals without diabetes or depression, those with diabetes alone had about a 15% greater risk of developing dementia, those with depression alone had about an 83% greater risk of developing dementia, and those with both diabetes and co-existing depression had a 107% greater risk of developing dementia compared to those without either condition. We also found that of all of the cases of dementia diagnosed in Denmark among individuals 50 or older between 2007 through 2013, 6% were potentially due to combination of having both diabetes and depression. This was also true for those 65 or older, where 6% of all diagnosed dementia was potentially attributable to the combination of both diabetes and depression. However, among individuals under age 65, we found that 25% of all cases of dementia may have been directly attributable to the combination of diabetes and co-existing depression.
Author Interviews, Hospital Readmissions / 27.04.2015

MedicalResearch.com Interview with: Rachel Mosher Henke, Ph.D. Truven Health Analytics Director of Research Cambridge, MA Medical Research: What is the background for this study? What are the main findings? Dr. Henke: We wanted to see what percentage of patients return to the same hospital for their readmission.  Hospitals are increasingly at risk for the cost of readmissions through new initiatives, such as bundled payment programs.  If a patient goes to another hospital for their readmission, the original hospital has little control over the decision to admit and the intensity of care provided. We found about three quarters of patients do go back to the same hospital for 30-day readmissions, with some variation in rates by condition.  Patients admitted through the emergency department and patients who live in the same county as the hospital were more likely to return to the same hospital for their readmission.
Author Interviews, End of Life Care, Heart Disease, JAMA, Kidney Disease / 27.04.2015

MedicalResearch.com Interview with: Susan P. Y. Wong, M.D. Acting Instructor & Senior Research Fellow Division of Nephrology University of Washington Medical Research: What is the background for this study? What are the main findings? Dr. Wong: There is a paucity of information on the use of cardiopulmonary resuscitation (CPR) and its outcomes among patients receiving maintenance dialysis. To address this knowledge gap, we performed a retrospective study to define contemporary trends in in-hospital CPR use and its outcomes among a nationally representative sample of 663,734 patients receiving maintenance dialysis between 2000 and 2011. We found that in-hospital CPR use among this cohort of patients was very high—nearly 20 times more common than that found in the general population. The rate of in-hospital CPR use has also been increasing among patients receiving maintenance dialysis despite evidence of poor long-term survival among these patients. Median survival after hospital discharge for members of this cohort was only 5 months, and this has not change substantially in the recent decade. We also found that a large proportion  of dialysis patients who died in hospital settings had received CPR during their terminal hospitalization. This proportion has also been steadily increasing over time, and in 2011, 1 in 5 dialysis patients who died in hospital had received CPR during their terminal hospitalization.
AACR, Author Interviews, HPV, University Texas, Vaccine Studies / 27.04.2015

Jacqueline Hirth, PhD, MPH Assistant Professor andMedicalResearch.com Interview with: Jacqueline Hirth, PhD, MPH Assistant Professor and Dr. Abbey B. Berenson MD, MMS, PhD Center for Interdisciplinary Research in Women's Health Obstetrics and Gynecology The University of Texas Medical Branch at Galveston TexasDr. Abbey B. Berenson MD, MMS, PhD Center for Interdisciplinary Research in Women's Health Obstetrics and Gynecology The University of Texas Medical Branch at Galveston Texas

Medical Research: What is the background for this study? What are the main findings? Response: In this sample of young women, vaccination was effective at reducing prevalence of vaccine-type HPV (6,11,16,18) compared to women who were unvaccinated. We also found a dose response, with young women who received at least 2 doses of the 3 dose vaccine series having a lower rate of vaccine-type HPV compared to those who only received one dose (8.6% compared to 16.9%, respectively).
Author Interviews, Cancer Research, Hepatitis - Liver Disease, UCSD / 27.04.2015

Lisa M. Nyberg, MD, MPH Transplant Hepatologist Director, Hepatology Research Kaiser Permanente, Garfield Specialty Center San Diego, CA 92111MedicalResearch.com Interview with: Lisa M. Nyberg, MD, MPH Transplant Hepatologist Director, Hepatology Research Kaiser Permanente, Garfield Specialty Center San Diego, CA  92111 Medical Research: What is the background for this study? What are the main findings? Dr. Nyberg: The overall cancer rates were higher in patients with Hepatitis C (HCV) vs those without HCV. Of note, though, the HCV cohort had higher rates of alcohol abuse, tobacco use, cirrhosis and diabetes mellitus (DM). However, even after stratification for the variables alcohol abuse, tobacco use, body mass index (BMI) and DM; the increased cancer rates remained significant for total cancer sites, liver cancer and NHL. Note that this study does not establish a cause and effect relationship between Hepatitis C and cancer. A strength of this study is that it is an evaluation of a large patient population (n=35,712 with HCV and 5,297,191 without HCV). Limitations of the study are those inherent in epidemiological studies using large databases. For example, confounders may not be accurately recorded in automated databases (smoking and alcohol abuse may be under-recorded).
Author Interviews, Nutrition / 27.04.2015

Esther Lopez-Garcia, PhD Dept. Preventive Medicine and Public Health School of Medicine Universidad Autónoma de Madrid Madrid,SpainMedicalResearch.com Interview with: Esther Lopez-Garcia, PhD Dept. Preventive Medicine and Public Health School of Medicine Universidad Autónoma de Madrid Madrid,Spain Medical Research: What is the background for this study? What are the main findings? Dr. Lopez-Garcia: Health-related quality of life (HRQL) is a global indicator of perceived health status, which includes physical and mental domains. Assessing the association between individual foods and HRQL is important because both the food industry and the population as a whole are interested in knowing whether general well-being could be improved by consuming specific foods. Several biological mechanisms might support an association between consumption of yogurt and better Health-related quality of life. However, to our knowledge, the effect of yogurt on HRQL has not yet been studied in epidemiological investigations in the general population. Thus, the objective of this article was to examine the prospective association between habitual yogurt consumption and the physical and mental components of HRQL among the general adult population. In this study, we found no association between yogurt consumption and the physical and mental components of HRQL after 3.5 years of follow-up of a population-based cohort. The results also held for whole-milk and reduced-fat yogurt.
Author Interviews, Breast Cancer, Genetic Research / 27.04.2015

Nasim Mavaddat M.B.B.S. MPhil PhD PhD Centre for Cancer Genetic Epidemiology Department of Public Health and Primary Care University of Cambridge, Cambridge, UKMedicalResearch.com Interview with: Nasim Mavaddat M.B.B.S. MPhil PhD PhD Centre for Cancer Genetic Epidemiology Department of Public Health and Primary Care University of Cambridge, Cambridge, UK MedicalResearch: What is the background for this study? What are the main findings? Dr. Mavaddat: Recent large-scale genome wide association analyses have led to the discovery of genetic variation- called single nucleotide polymorphisms (SNPs) associated with breast cancer risk. Individually these variants confer risks that are too small to be useful for risk prediction. But when combined as a single score, called a polygenic risk score (PRS), this score may be used to stratify women according to their risk of developing breast cancer. This stratification could guide strategies for screening and prevention. Our study was a large international collaboration involving 41 research groups from many different countries and included 33,673 breast cancer patients and 33,381 controls. We found that the genetic variants act more or less independently, and that the more risk variants a woman has the higher her risk of breast cancer. When women were ranked according to their PRS, women with scores in the top 1% had a threefold increased risk of breast cancer. This translates into an absolute risk of breast cancer of 29% by age 80. By contrast, women with the lowest 1% scores had a risk of 3.5%. The PRS was effective in stratifying women with and without a family history of breast cancer, so that highest risk was for women with a family history and a high PRS. Finally, we showed that the PRS was better at predicting the risk of ER-positive breast cancer (potentially relevant to the application of risk stratification to chemoprevention for example, with tamoxifen, raloxifene or aromatase inhibitors). There has been much debate as to whether genomic profiles are useful for individual risk prediction, especially in the context of the preventative strategies available at the present time. The estimates provided in this study will help inform these debates.
AACR, Author Interviews, Biomarkers / 27.04.2015

MedicalResearch.com Interview with: Joanna Kitlinska, PhD Assistant Professor Georgetown University Medical Center Department of Biochemistry and Molecular & Cellular Biology Washington, DC 20057 MedicalResearch: What is the background for this study? What are the main findings? Dr. Kitlinska: Neuroblastoma is a pediatric malignancy with extremely heterogeneous phenotypes, ranging from spontaneously regressing to aggressive, untreatable tumors. Consequently, treatment strategies vary significantly between patients, depending on the initial risk assessment. Given the severe late effects of anti-cancer treatment administered to infants and children, proper disease stratification is of utmost importance for neuroblastoma patients. Due to their neuronal origin, neuroblastomas secrete neuropeptide Y (NPY), a small protein normally released from mature nerves. This, in turn, may result in elevated NPY levels in blood of neuroblastoma patients. We have found that serum NPY is particularly high in patients with aggressive, metastatic disease. Consequently, patients with elevated NPY levels have significantly worse survival. This finding is in agreement with our previous data indicating crucial role for NPY in stimulation of neuroblastoma tumor growth.
Author Interviews, Cancer Research, OBGYNE / 27.04.2015

MedicalResearch.com Interview with: Joanna Kitlinska, PhD Assistant Professor Georgetown University Medical Center Department of Biochemistry and Molecular & Cellular Biology Washington, DC 20057 MedicalResearch: What is the background for this study? What are the main findings? Dr. Kitlinska: Neuroblastoma is a pediatric tumor which arises due to defects in normal fetal neuronal development. Although the disease is associated with genetic changes, there are also clinical and experimental data implicating non-genetic factors in its etiology. We hypothesized that maternal stress during pregnancy can be one such factor, as it leads to fetal hypoxia and elevated cortisol levels – the two factors known to alter normal neuronal development and increase aggressiveness of neuroblastoma. Indeed, using an animal model of neuroblastoma, we have found that offspring of mothers which have been subjected to stress during pregnancy develop tumors twice as frequently as those from intact pregnancies. Moreover, tumors developing in prenatally-stressed mice were spreading more often to distant organs.
Author Interviews, Education, Outcomes & Safety / 27.04.2015

MedicalResearch.com Interview with: Henry J. Michtalik MD, MPH, MHS Department of Medicine, Johns Hopkins University Armstrong Institute for Patient Safety and Quality Baltimore, MarylandMedicalResearch.com Interview with: Henry J. Michtalik MD, MPH, MHS Department of Medicine, Johns Hopkins University Armstrong Institute for Patient Safety and Quality Baltimore, Maryland Medical Research: What is the background for this study? What are the main findings? Dr. Michtalik: Current healthcare reform emphasizes providing high-value, evidence-based care.  Compliance with practice guidelines and best-practices remains a challenge in the ever-changing healthcare environment.  Multiple methods are typically used to enhance compliance with these guidelines, including physician education, computerized order entry systems with clinical decision support, provider feedback, and payment incentives.  These strategies are used for many conditions, including heart failure and venous thromboembolism (VTE), blood clots. The purpose of this study was to examine the impact of an individualized physician dashboard and pay-for-performance program on improving VTE prophylaxis rates amongst hospitalists.  We performed a retrospective analysis of over 3000 inpatient admissions to a hospitalist service.  We examined the impact of a web-based hospitalist dashboard which provided VTE prophylaxis feedback, both alone and in combination with a pay-for performance program which provided a small financial payment for achieving compliance rates greater than 80%. We found that compliance significantly increased from 86% during baseline to 90% during the dashboard alone phase.  Addition of the pay-for-performance program further increased compliance to 94%.  The fastest improvement occurred during the dashboard only phase.  Annual physician payments ranged from $53 to $1244, with 17 of the 19 payments under $1000.