AHA Journals, Author Interviews, Blood Pressure - Hypertension, Duke, Race/Ethnic Diversity / 29.10.2014

Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research InstituteMedicalResearch.com Interview with: Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research Institute   Medical Research: What are the main findings of the study? Dr. Thomas: The number of participants with controlled blood pressure (readings of less than 140/90) increased by 12 percent in the six months between the first and last readings. Mean systolic blood pressure for the population decrease by 4.7mmHg. The number of participants who had high blood pressure in the range of 140-149/90-99 decreased systolic blood pressure by a mean of  8.8mmHg and those with readings in the higher range of 150/100 or above decreased systolic blood pressure by 23.7percent. The study concluded that a program that followed this type of approach was associated with improved blood pressures across a diverse  high-risk community.” (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC / 29.10.2014

Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195MedicalResearch.com Interview with: W. H. Wilson Tang, MD FACC FAHA Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195 Medical Research: What are the main findings of the study? Dr. Tang: A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk. (more…)
Author Interviews, General Medicine, Health Care Systems, Johns Hopkins / 29.10.2014

MedicalResearch.com Interview with: Eric Wan BS and Miceile Barrett BS Johns Hopkins University School of Medicine Baltimore, MD Medical Research: What is the background for this study? What are the main findings? Answer: Access to surgery is limited in resource-poor settings and low-and-middle income countries (LMICs) due to a lack of human and material resources. In contrast, academic hospitals in high-income countries often generate significant amounts of unused and clean medical supplies that cannot be re-used in the operating rooms of high-income countries. Programs such as Supporting Hospitals Abroad with Resources and Equipment (SHARE) provide an avenue for recovery of these supplies and donation to resource-poor hospitals in LMICs. From data collected from SHARE supplies donated by Johns Hopkins, we found that the nationwide impact for these programs to be $15.4 million among US academic hospitals, which accounts for only 19 categories of commonly recovered supplies. When we tracked our donated supplies to hospitals in Ecuador serving the poor, we found that the cost-effectiveness of these donations was US $2.14 per disability-adjusted life-year prevented. (more…)
Author Interviews, Heart Disease, JAMA, Lipids / 29.10.2014

George Thanassoulis, MD MSc FRCP(C) Director, Preventive and Genomic Cardiology FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien Assistant Professor of Medicine, McGill University McGill University Health Center Montreal, QCMedicalResearch.com Interview with: George Thanassoulis, MD MSc FRCP(C) Director, Preventive and Genomic Cardiology FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien Assistant Professor of Medicine, McGill University McGill University Health Center Montreal, QC Medical Research: What is the background for this study? What are the main findings? Dr. Thanassoulis: Although LDL-C (i.e. bad cholesterol) has been linked with aortic valve disease in several prior reports, randomized trials to lower cholesterol in aortic valve disease were not effective suggesting that cholesterol may not be important in valve disease. To address this, we performed a Mendelian randomization study, that showed that a genetic predisposition to LDL-C, was associated with both calcium deposits on the aortic valve and aortic stenosis (I.e. Valve narrowing).  These results can be viewed as the effect of a life-long increase in LDL-C on the incidence of aortic valve disease and suggest that increases in LDL-C cause aortic stenosis.   (more…)
Alzheimer's - Dementia, Author Interviews, Sleep Disorders / 29.10.2014

Christian Benedict PhD Associate Professor of Neuroscience Uppsala University Dept. of NeuroscienceMedicalResearch.com Interview with: Christian Benedict PhD Associate Professor of Neuroscience Uppsala University Dept. of Neuroscience   Medical Research: What is the background for this study? Answer: Our study involved ~1500 men who were followed from 1970 to 2010. All participants were 50 years old at the start of study. Medical Research: What are the main findings? Answer: Men with reports of sleep disturbances had a 50%-higher risk to develop Alzheimer's disease during the 40-year follow-up period, than men without reports of sleep disturbances. (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 28.10.2014

Luís A. Nunes Amaral PhD HHMI Early Career Scientist Professor of Chemical & Biological Eng. Professor of Medicine Howard Hughes Medical Institute Northwestern University, Evanston, IllinoisMedicalResearch.com Interview with: Luís A. Nunes Amaral PhD HHMI Early Career Scientist Professor of Chemical & Biological Eng. Professor of Medicine Howard Hughes Medical Institute Northwestern University, Evanston, Illinois

Medical Research: What is the background for this study? What are the main findings? Dr. Amaral: There is a well known difficulty in promoting the rapid adoption of best practices by physicians.  Because of their work load and because of the inability to figure out when some result is a true advance or just hype, doctors tend to stick to what they believe works. Unfortunately, as a 15 year old Institute of Medicine study shows, this lack of adoption of best practices costs society hundreds of thousands of lives a year in the US alone. The typical process for informing doctors of what best practices are (such as continual medical education and other broadcasting approaches) do not work well. We believe that a weakness of typical approaches is that they have a one talking to the many style, and they are out of a medical practice context.  Our hypothesis was that by seeding a few doctors with desired knowledge, one could have spread of the adoption through one-on-one contacts between physicians in the context of treating patients.  We found that this approach has the potential to be very effective. (more…)
Author Interviews, JAMA, Macular Degeneration / 28.10.2014

Ronald Klein, MD, MPH, Professor Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health Madison WIMedicalResearch.com Interview with: Ronald Klein, MD, MPH, Professor Department of Ophthalmology and Visual Sciences University of Wisconsin School of Medicine and Public Health Madison WI Medical Research: What are the main findings of the study?  Dr. Klein: We found that more severe age-related macular degeneration (AMD) in 1 eye was associated with increased incidence of age-related macular degeneration [levels 1-2: hazard ratio [HR], 4.90 [95%CI, 4.26-5.63] and accelerated progression [levels 2-3: HR, 2.09 [95%CI, 1.42-3.06]; levels 3-4: HR, 2.38 [95%CI, 1.74-3.25] and incidence of late age-related macular degeneration [levels 4-5: HR, 2.46 [95%CI, 1.65-3.66] in its fellow eye. Less severe AMD in 1 eye was associated with less progression of AMD in its fellow eye. We estimated that 51% of participants who develop any age-related macular degeneration maintained age-related macular degeneration severity states within 1 step of each other between eyes and 90% of participants stay within 2 steps. (more…)
Author Interviews, Memory, Mental Health Research / 28.10.2014

Scott A. Small, MD Boris and Rose Katz Professor of Neurology Division of Aging and Dementia Director, Alzheimer's Disease Research Center Taub Institute for Research on Alzheimer's Disease and the Aging Brain Department of Neurology, Columbia University New York, New YorkMedicalResearch.com Interview with: Scott A. Small, MD Boris and Rose Katz Professor of Neurology Division of Aging and Dementia Director, Alzheimer's Disease Research Center Taub Institute for Research on Alzheimer's Disease and the Aging Brain Department of Neurology, Columbia University New York, NY Medical Research: What is the background for this study? Dr. Small: Previous work, including from my lab, had shown that changes in a specific part of the brain—the dentate gyrus—are associated with age-related memory decline. Until now, however, the evidence in humans showed only a correlational link, not a causal one. To see if the dentate gyrus is the source of age-related memory decline in humans, we tested whether compounds called cocoa flavanols can improve the function of this brain region and improve memory. Flavanols extracted from cocoa beans had previously been found to improve neuronal connections in the dentate gyrus of mice. (more…)
Author Interviews, Ebola, Vaccine Studies / 28.10.2014

Prof. Clive Maurice Gray   Division of Immunology, Institute of Infectious Diseases and Molecular Medicine,National Health Laboratory Services University of Cape Town, Cape Town, South AfricaMedicalResearch.com Interview with: Prof. Clive Maurice Gray   Division of Immunology, Institute of Infectious Diseases and Molecular Medicine,National Health Laboratory Services University of Cape Town, Cape Town, South Africa Medical Research: What is the background for this report? What are the main findings? Prof. Gray: This report is a response on behalf to the International Union of Immunology Societies (IUIS) and is designed to focus a message from the global immunology community to those who are making vaccines and therapies implementing clinical trials and very importantly on Governments and funding bodies. Time is not our side and that vaccine efforts need to be expedited and that production of therapeutics needs to be ramped up. Due to the fact that many people in West Africa are dying, we wish to convey a strong message that to curb this outbreak, therapies and especially vaccines must be rolled out as soon as possible. (more…)
Author Interviews, Heart Disease / 28.10.2014

Dr. Andrea M. Isidori, MD, PhD Consultant - Assistant Professor of Endocrinology Department of Experimental Medicine Medical Pathophysiology Sapienza University of RomeMedicalResearch.com Interview with: Dr. Andrea M. Isidori, MD, PhD Consultant - Assistant Professor of Endocrinology Department of Experimental Medicine Medical Pathophysiology Sapienza University of Rome Medical Research: What is the background for this study? What are the main findings? Dr. Isidori : Our meta-analytic research originated to clarify some controversies emerging from the available human studies. We wanted to analyze if chronic PDE5i administration was cardioprotective and safe, and, if so, where the benefits were mainly seen: cardiac muscle, peripheral vessels, or both. In the last sixteen years pre-clinical and clinical research into the extra-urological effects of PDE5i has expanded dramatically, revealing previously unsuspected indications for these drugs. Several animal studies have shown that PDE5i attenuates cardiac remodeling, with an anti-hypertrophic and anti-fibrotic effect, and protects the heart against different types of injury. Some small clinical trials have demonstrated that chronic PDE5 inhibition improves cardiac performance and geometry in various clinical conditions, including heart failure, myocardial infarction and diabetic cardiomyopathy. We showed that continuous administration of Viagra improves cardiac performance (increase of ejection fraction and cardiac index) and has an anti-remodeling effect (decrease of left ventricular mass and increase of end diastolic volume) without a major impact on vascular parameters (blood pressure and vascular resistance) suggesting that it does indeed have a direct effect on the heart. The novelty of this meta-analysis is the identification of subgroups of patients that may benefit more from PDE5i: patients with cardiac hypertrophy and heart failure. Our study is the first to show in a large patient cohort that chronic PDE5i administration improves cardiac output and decreases heart rate. This could result in longer survival, increased exercise tolerance and a better quality of life. Surprisingly, the magnitude of effects was similar to that seen with the drugs currently used to treat these clinical conditions, and was obtained in a relatively brief period (3 to 12 months). Most strikingly, we found that PDE5is are among the very few drugs that are able to improve diastolic relaxation, thus helping the correct refilling of the ventricle after each contraction, a nearly unique feature in drugs used in cardiology, and with incredible potential for future development in the prevention of heart failure. We also demonstrated their high tolerability and safety in a population that included elderly patients with various stages of cardiac disease and numerous comorbidities who were taking multiple pharmacological treatments. This setting resembles what we normally see in real life, supporting that daily administration is safe and involves no increase in the risk of adverse events compared to on-demand use. (more…)
Author Interviews, Biomarkers / 28.10.2014

Dr. Adam Woolley PhD Department of Chemistry and Biochemistry Brigham Young UniversityMedicalResearch.com Interview with: Dr. Adam Woolley PhD Department of Chemistry and Biochemistry Brigham Young University Medical Research: What is the background for this study? What are the main findings? Dr. Woolley: High-performance biomarker analysis methods are usually complex and expensive. In contrast, simple and inexpensive biomarker detection methods typically have low performance. Our study demonstrates a simple nucleic acid measurement system that requires no detection instrumentation. Nucleic acid mimics of microRNA were quantified with sequence specificity down to 10 pg/mL levels. (more…)
Author Interviews, Brain Injury, Cognitive Issues, JAMA, UCSF / 27.10.2014

Raquel C. Gardner, MD, Research Fellow San Francisco VA Medical Center Clinical Instructor Memory and Aging Center, Department of Neurology University of California, San FranciscoMedicalResearch.com Interview with: Raquel C. Gardner, MD, Research Fellow San Francisco VA Medical Center Clinical Instructor Memory and Aging Center, Department of Neurology University of California, San Francisco Medical Research: What are the main findings of the study? Dr. Gardner: We found that people who experience a  traumatic brain injury (TBI )when they are 55 or older have a 26% higher chance of getting dementia over the next 5 to 7 years compared to people who experience bodily trauma. (more…)
Author Interviews, JAMA, Pediatrics / 27.10.2014

MedicalResearch.com Interview with: Ian M. Paul, M.D., M.Sc. Professor of Pediatrics and Public Health Sciences Chief, Division of Academic General Pediatrics Associate Vice Chair for Research, Department of Pediatrics Penn State College of Medicine Hershey, PA 17033-0850 Medical Research: What are the main findings of the study? Dr. Paul: This study highlights that a significant placebo effect exists in the treatment of young children with cough due to colds because agave nectar and placebo both resulted in improvement of child symptoms by parents compared with no treatment. (more…)
Author Interviews / 27.10.2014

Brian H. Rowe, MD, MSc, CCFP(EM), FCCP Tier I Canada Research Chair in Evidence-based Emergency Medicine Scientific Director, Emergency Strategic Clinical Network Professor, Department of Emergency Medicine University of AlbertaMedicalResearch.com Interview with: Brian H. Rowe, MD, MSc, CCFP(EM), FCCP Tier I Canada Research Chair in Evidence-based Emergency Medicine Scientific Director, Emergency Strategic Clinical Network Professor, Department of Emergency Medicine University of Alberta Medical Research: What is the background for this study? What are the main findings? Dr. Rowe​: The study was designed to evaluate non-pharmacological issues associated with relapse following discharge from the emergency department with acute asthma. Many years of high-quality research have shown that systemic and inhaled corticosteroids (ICS) in combination are required to reduce relapse. In this study all patients received systemic corticosteroids and the majority received inhaled corticosteroids (either as mono-therapy or in combination with long-acting beta-agonists​ {LABA}). This study ​ design permitted us to evaluate other factors associated with relapse as a guide for clinicians to use in planning discharge. The main findings include identifying the key factors independently associated with relapse: female sex (OR = 1.9; 95% confidence interval [CI]: 1.2, 3.0), symptom duration of > 24 hours prior to emergency department visit (OR = 1.7; 95% CI: 1.3, 2.3), ever using oral corticosteroids (OR = 1.5; 95% CI: 1.1, 2.0), current use of an ICS/LABA combination product (OR = 1.9; 95% CI: 1.1, 3.2), and owning a spacer device (OR = 1.6; 95% CI: 1.3, 1.9). (more…)
Author Interviews, Depression, Gender Differences, NIH / 27.10.2014

Dr. Sunni Mumford PhD Earl Stadtman Investigator in the DESPR Epidemiology Branch Eunice Kennedy Shriver National Institute of Health and Human DevelopmentMedicalResearch.com Interview with: Dr. Sunni Mumford PhD Earl Stadtman Investigator in the DESPR Epidemiology Branch Eunice Kennedy Shriver National Institute of Health and Human Development Medical Research: What are the main findings of the study? Dr. Mumford: Depressive symptoms in healthy women who don’t have diagnosed clinical depression isn’t related to reproductive hormone levels, like estrogen, or impaired ovulation. Medical Research: What was most surprising about the results? Dr. Mumford: Earlier research indicates that changes in estrogen may be associated with depression, for instance during the menopausal transition. Our study identified significant associations between estrogen and depressive symptoms in models that didn’t account for confounding factors, but this relationship was completed eliminated when adjustments were made for common confounding factors like age, race, BMI, and also stress level in these premenopausal women. Another interesting finding was that a score describing mood-related menstrual symptoms indicated that such symptoms are highest in the premenstrual phase, but remain lower throughout the rest of women’s cycles. This tells us that altered mood symptoms are most frequent prior to menstruation. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy / 27.10.2014

MedicalResearch.com Interview with: Shidong Jiang Associate professor of Engineering Thayer School of Engineering at Dartmouth Medical Research: What is the background for this study? What are the main findings? Dr. Jiang: Breast cancer is the most common non-skin cancer in women worldwide, and the second leading cause of women’s cancer mortality in the United States. A common treatment strategy after diagnosis is to shrink breast cancer tumors larger than 3 centimeters with a 6 to 8 month course of Neoadjuvant Chemotherapy prior to surgery. Clinical studies have shown that patients who respond to Neoadjuvant Chemotherapy have longer disease-free survival rates, but only 20 to 30 percent of patients who receive Neoadjuvant Chemotherapy fit this profile. Our work represents the first clinical evidence that tumor total hemoglobin estimated from DOST images differentiates women with locally advanced breast cancer who have a complete pathological response with Neoadjuvant Chemotherapy from those who do not with predictive significance based on image data acquired before the initiation of therapy. The implication of this prognostic information is that certain tumors are pre-disposed to responding to Neoadjuvant Chemotherapy, and that this predisposition should be known prior to choosing the therapy.  The study also demonstrates the potential of dramatically accelerating the validation of optimal Neoadjuvant Chemotherapy regimes through future randomized clinical trials by reducing the number of patients required and the length of time they need to be followed by using a validated imaging surrogate as an outcome measure. (more…)
Author Interviews, Heart Disease / 27.10.2014

MedicalResearch.com Interview with: Dr. David MacIver Department of Cardiology Musgrove Park Hospital, Taunton Medical Research: What is the background for this study? What are the main findings? Dr. MacIver: The study was prompted by 2 triathletes who presented to our hospital with similar symptoms suggesting they both had had fluid on the lungs whilst swimming. Both athletes were fit and active and had excellent heart function. They were diagnosed with a condition is known as swimming-induced pulmonary oedema or edema (SIPO in the UK and SIPE in the USA). A condition that has been well-documented in Navy seals during training swims in open water. A similar condition has been described in divers sometimes with fatal consequences. Fluid on the lungs or pulmonary oedema more commonly occurs in patients as a complication of severe heart disease such as heart attacks and is called acute heart failure. Pulmonary oedema has also been documented healthy race-horses during competitions. We had recently suggested that acute pulmonary edema in patients with heart disease could be explained by a transient mismatch in the right and left ventricular stroke volumes. We thought it would be interesting to see if a similar mechanism could explain swimming-induced pulmonary edema. We found that factors that might contribute included cold water and high blood pressure. We speculated that cross-training with land based activities (running, cycling) might be relevant. In this study we proposed a possible mechanism for swimming-induced pulmonary edema - fluid from the blood is force into the lung air sacs by the strong right ventricle. In effect, the individual begins drowning in their own lung fluid. (more…)
Author Interviews, Infections / 27.10.2014

Dr. Simon Corrie PhD The University of Queensland, Australian Institute for Bioengineering and Nanotechnology, Delivery of Drugs and Genes Group Australian Infectious Diseases Research Centre, St. Lucia, Queensland, AustraliaMedicalResearch.com: Interview with: Dr. Simon Corrie PhD The University of Queensland, Australian Institute for Bioengineering and Nanotechnology, Delivery of Drugs and Genes Group Australian Infectious Diseases Research Centre, St. Lucia, Queensland, Australia Medical Research: What is the background for this study? What are the main findings? Dr. Corrie: P. falciparum malaria is a major cause of morbidity and mortality around the world, particularly in developing countries. Some estimates also suggest that in developing countries, children under 5 account for ~90% mortality. As malaria is treatable, positive detection is important rule out other causes, avoid over-treatment leading to resistance, and to guide appropriate treatment. Our focus is on developing diagnostic devices for infectious diseases, which do not require needles, lancets or laboratory processing. These devices are “microprojection arrays”, silicon chips that can be applied to the skin to capture circulating protein biomarkers in the interstitial fluid of the skin. In this publication we: (a) developed methods to improve the sensitivity of the devices for capturing HRP2, (b) confirmed that HRP2 protein injected intravenously is detectable in skin fluid and (c) showed that we could capture both HRP2 and total IgG (as a positive control for penetration into skin) at the same time. (more…)
Author Interviews, Diabetes, Infections, OBGYNE / 27.10.2014

Prof. Zvi Laron Professor Emeritus of Pediatric Endocrinology TAU's Sackler Faculty of Medicine, Director of the Endocrinology and Diabetes Research Unit Schneider Children's Medical Center of Israel Head of the WHO Collaborating Center for the Study of Diabetes in YouthMedicalResearch.com Interview with: Prof. Zvi Laron Professor Emeritus of Pediatric Endocrinology TAU's Sackler Faculty of Medicine, Director of the Endocrinology and Diabetes Research Unit Schneider Children's Medical Center of Israel Head WHO Collaborating Center for the Study of Diabetes in Youth Medical Research: What are the main findings of the study? What was most surprising about results? Prof. Laron: The main findings were the finding of specific antibodies to the pancreatic insulin secreting beta cells together with antibodies against rota-virus in both the mother at delivery and in the newborn's cord blood. We were not surprised, but pleased to find proof to our hypothesis that part, if not the majority of childhood onset Type 1 (autoimmune diabetes) starts "in utero". (more…)
Author Interviews, Colon Cancer, Cost of Health Care / 25.10.2014

Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann ArborMedicalResearch.com Interview with: Dr. Christine Marie Veenstra MD Department of Internal Medicine, Division of Hematology/Oncology Division of Colorectal Surgery Center for Healthcare Outcomes and Policy Division of General Medicine Cancer Surveillance and Outcomes Research Team University of Michigan, Ann Arbor Medical Research: What is the background for this study? Dr. Veenstra: Nearly 50,000 patients are diagnosed with stage III colorectal cancer each year. Chemotherapy is known to increase survival by up to 20% and is the standard recommendation for these patients after surgery. However, use of chemotherapy may be associated with financial strain. In order to better understand the financial burden and worry associated with colorectal cancer treatment, we surveyed 956 patients being treated for stage III colorectal cancer. We asked patients to answer questions about financial burden such as whether they had used savings, borrowed money, skipped credit card payments, or cut back on spending for food, clothing or recreational activities because of their cancer treatment. We also asked patients how much they worry about financial problems because of their cancer or its treatment. (more…)
Author Interviews, Genetic Research, Infections / 25.10.2014

Dr R.E.W. (Bob) Hancock, OC, OBC, FRSC {Canada Research Chair and Professor, Department of Microbiology and Immunology,UBC} Director, Centre for Microbial Diseases and Immunity Research University of British Columbia, Vancouver, British Columbia,  CanadaMedicalResearch.com Interview with: Dr R.E.W. (Bob) Hancock, OC, OBC, FRSC {Canada Research Chair and Professor, Department of Microbiology and Immunology,UBC} Director, Centre for Microbial Diseases and Immunity Research University of British Columbia, Vancouver, British Columbia,  Canada MedicalResearch: What is the background for this study? What are the main findings? Dr. Hancock: We wanted to understand how patients transitioned from the hyperinflammatory phase (cytokine storm) of sepsis to the hypoinflammatory (immunosuppressive) phase of sepsis (inability to respond appropriately to infections). About 15% of patients die in this first phase and 20% in the second phase, making sepsis one of the most deadly syndromes (35% overall mortality, 5 million deaths [8.3% of all deaths] annually worldwide). We hypothesized that immunosuppression was characterized by a state termed endotoxin tolerance a cellular amnesia (termed cellular reprogramming) in which cells fail to respond to microbial cues. Overall we found that an Endotoxin Tolerance gene signature is significantly associated with the subsequent development of confirmed sepsis and new organ dysfunction in patients who had suspected sepsis. All 620 sepsis patients in retrospective and new analyses presented with an expression profile strongly associated with the endotoxin tolerance signature (p<0.01; AUC 96.1%). This occurred in fact very early in sepsis and in a new clinical study we found that the signature could be detected already in the emergency ward at first clinical  presentation and 24-48 hours prior to definitive diagnosis. Importantly, this signature further differentiated between suspected sepsis patients who did, or did not, go on to develop confirmed sepsis, and predicted the development of organ dysfunction. (more…)
Author Interviews, CMAJ, Stroke / 25.10.2014

MedicalResearch.com Interview with: Michael Douglas Hill, MD, MSc The Calgary Stroke Program, Department of Clinical Neurosciences Hotchkiss Brain Institute Associate Professor, University of Calgary Calgary, Alta MedicalResearch: What is the background for this study? Dr. Hill:  We conducted an audit of stroke admissions to Canadian hospitals in all provinces.  We examined key metrics of quality stroke care focusing on the acute treatment. Use of thrombolysis for stroke is a key quality metric in the Accreditation Canada standards for stroke care.  We found that the use of thrombolysis, while better than the past review (CMAJ. 2005 May 10;172(10):1307-12) remains low.  This is a marker for the overall quality of acute stroke care in Canada.  As expected, larger academic hospitals perform at a higher level than smaller community hospitals. Overall, this study serves to quantify the gaps in the delivery of acute stroke care to Canadians. (more…)
AHA Journals, Author Interviews, Cost of Health Care, Stroke / 24.10.2014

A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, AustraliaMedicalResearch.com Interview with: A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, Australia Medical Research: What are the main findings of the study? Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH). 243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on. The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]). The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event. (more…)
Author Interviews, Genetic Research / 24.10.2014

Dr. Toomas Kivsild PhD Department of Archaeology and Anthropology University of Cambridge, CambridgeMedicalResearch.com Interview with: Dr. Toomas Kivsild PhD Department of Archaeology and Anthropology University of Cambridge, Cambridge Medical Research: What is the background for this study? What are the main findings? Dr. Kivsild: Native populations of Siberia are known to have certain physiological characteristics such as high basal metabolic rate, and high blood pressure and low levels of serum lipids, that have been explained as traits that have evolved as a consequence of the adaptation of Siberians to their cold environment. Genetic basis of cold adaptation is still poorly understood. In our previous study using genome-wide genotyping scans we detected a 3 Mbp region of high haplotype homozygosity in chromosome 11 as a candidate of strong positive selection in Northeast Siberians. There were 79 protein coding genes mapping to this homozygosity region but we could not determine which of the genes was driving the signal we observed. In this forthcoming paper we have used high coverage whole genome sequences from 25 individuals from Northeast Siberia and we were able to determine the most likely SNP that is responsible for the high haplotype homozygosity in the chromosome 11 in Northeast Siberians maps to CPT1A gene which is a key regulator of long-chain fatty-acid oxidation in mitochondria. What makes this finding most interesting is that the same SNP had previously been found in Greenland and Canadian Inuits in association with high infant mortality and hypoketotic hypoglycemia. There are only a few other similar cases, like the sickle cell and APOL1 alleles, where disease associated genetic variants may have risen to high frequency in modern day populations due to the adaptive advantage they have presented in the past populations. (more…)
Author Interviews, Depression, Heart Disease / 24.10.2014

  MedicalResearch.com Interview with: Professor Pranas Serpytis Vilnius University Hospital Santariskiu Clinic Vilnius, Lithuania  Medical Research: What are the main findings of the study?  Professor Serpytis: The main findings of the study were that women are more likely to develop anxiety and depression after acute myocardial infarction. In our study depression was assessed by HADS scale: no depression (0-7 score), possible depression (8-10 score), definite depression (11+ score). The mean score of assessing depression were 6.87 (± 4.6) among men and 8.66 (± 3.7) among women (p <.05). Cardiovascular disease risk factors such as smoking increases patients anxiety levels, and low physical activity is associated with an increased risk to suffer from depression.  Medical Research: What was most surprising about the results?  Professor Serpytis: Most surprising about the results were that for women it is indeed more difficult to cope with the disease rather than for men. Women’s anxiety and depression rates are higher.  Medical Research: What should clinicians and patients take away from your report?  Professor Serpytis: Clinicians and patients should look after the possible symptoms and if needed refer the patients for psychologist or psychiatrist consultation in order get proper timely treatment. This could possibly improve the long-term treatment results.  Medical Research: What recommendations do you have for future research as a result of this study?  Professor Serpytis: Most definitely more research is needed in this field. Most importantly it is crucial to look for the impact of depression on the long-term effects on survival and general well-being.   Citation:   Women more likely to develop anxiety and depression after heart attack Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC) and takes place 18-20 October in Geneva, Switzerland.MedicalResearch.com Interview with: Professor Pranas Serpytis Vilnius University Hospital Santariskiu Clinic Vilnius, Lithuania Medical Research: What are the main findings of the study? Professor Serpytis: The main findings of the study were that women are more likely to develop anxiety and depression after acute myocardial infarction. In our study depression was assessed by HADS scale: no depression (0-7 score), possible depression (8-10 score), definite depression (11+ score). The mean score of assessing depression were 6.87 (± 4.6) among men and 8.66 (± 3.7) among women (p <.05). Cardiovascular disease risk factors such as smoking increases patients anxiety levels, and low physical activity is associated with an increased risk to suffer from depression. (more…)
Author Interviews, Cancer, Pancreatic / 24.10.2014

MedicalResearch.com Interview with: Jeremy L. Humphris MBBS The Kinghorn Cancer Center, Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia and Andrew V. Biankin Regius Professor of Surgery Director, Wolfson Wohl Cancer Research Centre, University of Glasgow Garscube Estate, Switchback Road, Bearsden, Glasgow Scotland United Kingdom Medical Research: What are the main findings of the study? Response: Familial pancreatic cancer (FPC) is a family with at least 2 first degree (parent-child or siblings) with pancreatic cancer. We found these patients represent nearly 9% of our cohort. In addition we found those with familial pancreatic cancer were more likely to have other first degree relatives with a history of extra-pancreatic cancer, in particular melanoma and endometrial cancer. Patients with familial pancreatic cancer had more high grade precursor lesions in the pancreas adjacent to the tumour but the outcome was similar. Smoking was more prevalent in sporadic pancreatic cancer and active smoking was associated with significantly younger age at diagnosis in both groups. Long-standing diabetes mellitus (> 2 years duration) was associated with poorer survival in both groups. (more…)
Author Interviews, Pediatrics, Vaccine Studies / 24.10.2014

MedicalResearch.com Interview with: Louise-Anne McNutt, PhD Associate Director, Institute for Health and the Environment University at Albany, State University of New YorkLouise-Anne McNutt, PhD Associate Director, Institute for Health and the Environment University at Albany, State University of New York Jessica Nadeau, PhD Epidemiologist, University at Albany, State University of New YorkJessica Nadeau, PhD Epidemiologist, University at Albany, State University of New York Medical Research: What are the main findings of the study? Response: The study found that about 25% of infants consistently deviated from the routine vaccine schedule recommended by the American Academy of Pediatrics (AAP).  Alterations included either consistently refusing a recommended vaccine or reducing the number of vaccines given at each visit. These deviations are generally associated with intent to use an alternative vaccination schedule. Infants who did not follow the AAP recommended schedule were more likely to be unprotected against vaccine preventable diseases for a longer period of time. Only 1 in10 infants vaccinated on an alternative schedule were up-to-date at 9 months of age. (more…)
Author Interviews, Health Care Systems / 23.10.2014

Dr. Steffie Woolhandler MD MPH Professor of Public Health and City University of New York, Lecturer (formerly Professor of Medicine) at Harvard Medical School Primary Care Physician Practicing in the South BronxMedicalResearch.com Interview with: Dr. Steffie Woolhandler MD MPH Professor of Public Health and City University of New York, Lecturer (formerly Professor of Medicine) at Harvard Medical School Primary Care Physician Practicing in the South Bronx Medical Research: What is the background for this study? Dr. Woolhandler: Physicians like myself are extremely frustrated by the administrative burdens of medical practice. Many hours of physicians’ time each week go to administrative work completely unrelated to good patient care, but mandated by private insurers and other payers. Colleagues often tell me that they love seeing patients but are getting burned out by the paperwork. (more…)
Author Interviews, Bipolar Disorder, JAMA, Schizophrenia / 23.10.2014

Glenn T. Konopaske, MD McLean Hospital, Belmont, Massachusetts Department of Psychiatry, Harvard Medical School Boston, MassachusettsMedicalResearch.com Interview with: Glenn T. Konopaske, MD McLean Hospital, Belmont, Massachusetts Department of Psychiatry, Harvard Medical School Boston, Massachusetts Medical Research: What are the main findings of the study? Dr. Konopaske: Using postmortem human brain tissue this study did reconstructions of basilar dendrites localized to pyramidal cells in the deep layer III of the dorsolateral prefrontal cortex. Tissue from individuals with schizophrenia, bipolar disorder or controls was examined. Dendritic spine density (number of spines per μm dendrite) was significantly reduced in bipolar disorder and also reduced in schizophrenia at a trend level. The number of dendritic spines per dendrite and dendrite length were significantly reduced in subjects with schizophrenia and bipolar disorder. (more…)