ASCO, Author Interviews, Cancer Research, NEJM, Prostate Cancer / 25.02.2019

MedicalResearch.com Interview with: Prof. Karim Fizazi, MD, PhD Head of the Department of Cancer Medicine Institute Gustave Roussy MedicalResearch.com: What is the background for this study? How does darolutamide differ from other medications for prostate cancer? Response: Despite recent treatment advances, there is still significant unmet need for new therapeutic options for men with non-metastatic castration-resistant prostate cancer (nmCRPC). In laymen’s terms, nmCRPC is cancer that has not spread beyond the prostate region; PSA levels are elevated, despite treatment with hormone therapy, and men with nmCRPC generally feel well and do not have symptoms. The unmet medical need is for treatments that achieve disease control and delay the spread of the cancer without impacting their daily lives or increasing the burden of disease with treatment side effects. While the current treatments in this space are effective in delaying onset of metastases, the side effects can be unpleasant and disruptive to men’s lives; particularly cognitive issues, seizures, impact on balance which may lead to falls and bone fractures, rash and hypertension. Furthermore, new treatment options that have limited interactions with medications typically used in this patient population are also important.  (more…)
Author Interviews, Opiods / 25.02.2019

MedicalResearch.com Interview with: Mathew Vinhhoa Kiang, PhD Postdoctoral Research Fellow Primary Care and Outcomes Research Stanford University School of Medicine Stanford, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nationally, opioid-related mortality has continued to climb for decades and resulted in over 42,000 deaths in 2016 — more than the number of deaths from car accidents or firearms. However, there are substantial differences across states and by opioid type. We sought to systematically describe these differences by examining state-level opioid mortality by opioid type. Deaths from synthetic opioids, such as fentanyl, are rapidly increasing in the eastern half of the US. Specifically, 28 states have synthetic opioid mortality rates that are more than doubling every two years. Twelve of those states already have high levels of synthetic opioid mortality — above 10 deaths per 100,000. Lastly, the opioid epidemic has reached our nation's capital — Washington DC has the fastest rate of increase, more than tripling every year, and a high opioid mortality rate. (more…)
Aging, Author Interviews, Exercise - Fitness, JAMA / 25.02.2019

MedicalResearch.com Interview with: Fuzhong Li, Ph.D. Senior Scientist Oregon Research Institute MedicalResearch.com: What is the background for this study? What are the main findings? Response: Injurious falls among community-dwelling older adults are a serious public health and cost-bearing problem worldwide.Exercise has been shown to reduce falls and injurious falls among older adults. However, evidence is limited with regard to the type of exercise interventions that are most effective, without exacerbating the risk in some individuals, in reducing injurious falls. This study addresses this knowledge gap in the field of falls prevention. Findings from this study showed that a six-month Tai Ji Quan program reduced the incidence of injurious falls among frail elderly by 53% compared to a regular (multimodal) exercise intervention. The effect of the Tai Ji Quan intervention was shown to be robust, and still evident at follow-up examinations six months after the study. (more…)
Author Interviews, BMJ, Exercise - Fitness, Weight Research / 25.02.2019

MedicalResearch.com Interview with: "Colnago M10 Campagnolo Record Custom Bike 067" by Glory Cycles is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0 Dr Paul Gentil Faculty of Physical Education and Dance Federal University of Goias Goiania, Brazil  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although being overweight and/or obese are associated with numerous health risks, the prevalence of both are continuing to increase worldwide. The treatment would include anything that results in an increase in energy expenditure (exercise) or a decrease in energy intake (diet). However, our metabolism seems to adapt to variations in physical activity to maintain total energy expenditure. Although lower-than-expected weight loss is often attributed to incomplete adherence to prescribed  interventions, there are other factors that might influence the results, such as, metabolic downregulation. So, instead of making people spend more calories, maybe we have to think on how to promote metabolic changes in order to overcome these physiological adaptations above-mentioned. In this regard, high intensity training might be particularly interesting as a strategy to promote fat loss. Irrespective the amount of calories spent during training, higher intensity exercise seems to promote many physiological changes that might favor long-term weight loss. For example, previous studies have shown that interval training is able to promote upregulation of important enzymes associated with glycolysis and beta oxidation pathways, which occurs in a greater extent than with moderate intensity continuous exercise. Our findings suggest that interval training might be an important tool to promote weigh loss. However, I t might be performed adequately and under direct supervision in order to get better results. (more…)
Accidents & Violence, Author Interviews, JAMA / 25.02.2019

MedicalResearch.com Interview with: Hannah Decker MD Candidate, Class of 2019 Emory School of Medicine Jeremiah Schuur, MD, MHS FACEP Physician-in-chief for emergency medicine at Lifespan and Chair of the department of Emergency Medicine Brown MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Firearm injury is a leading cause of injury and death in the United States. Many physician groups advocate for evidence-based policies, such as universal background checks, to reduce this morbidity and mortality. We studied contributions of the 25 largest political action committees (PACs) affiliated with physician professional groups during the 2016 election cycle and found that almost all gave more money to political candidates who voted against universal background checks and were endorsed by the NRA. These PACs contributed to more than twice as many incumbent US Senate candidates who voted against an amendment to expand firearm background checks than those who voted for the amendment. In the US House of Representatives, the pattern of giving was similar. These PACs gave $2.8 million more to candidates who did not sponsor a bill to expand background checks than to those who did. Finally, these physician PACs were more than twice as likely to contribute to and gave almost $1.5 million dollars more to candidates rated A by the NRA. (more…)
Allergies, Author Interviews, Immunotherapy / 25.02.2019

MedicalResearch.com Interview with: Dr Paul Turner FRACP PhD MRC Clinician Scientist and Clinical Senior Lecturer, Imperial College London Honorary Consultant in Paediatric Allergy & Immunology Imperial College Healthcare NHS Trust Hon Consultant, Royal Free Hospital / Royal Brompton & Harefield NHS Foundation Trust Clinical trials specialist (Paediatrics), Public Health England Clinical Associate Professor in Paediatrics, University of Sydney, Australia Dr. Nandinee Patel, MD Section of Paediatrics Imperial College London London, United Kingdom MRC & Asthma UK Centre in Allergic Mechanisms of Asthma London, United Kingdom MedicalResearch.com: What is the background for this study? Response: Current desensitisation protocols for peanut allergy use defatted roasted peanut flour, which can be difficult to accurately measure in very low doses needed for desensitisation (and thus has resulted in the development of AR101 by Aimmune which is likely cost many thousands of dollars for a course of treatment). We have previously observed that some children with food allergy to roasted peanut (such as peanut butter) are nonetheless able to tolerate boiled peanuts without reacting. We performed in vitro protein analysis studies which demonstrated that boiling peanuts resulted in around 50% of protein leaching out of the peanut into the cooking water. Furthermore, we found evidence for preferential leaching of allergen epitopes such as Ara h 2 as well aggregation of proteins resulting in a hypoallergenic peanut product. We therefore sought to assess whether boiled peanuts could be as effective and safe to induce desensitisation. (more…)
Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Chemotherapy, NEJM / 24.02.2019

MedicalResearch.com Interview with: Aditya Bardia, MBBS, MPH Director, Precision Medicine, Center for Breast Cancer, Attending Physician Massachusetts General Hospital Cancer Center Harvard Medical School Boston, MA 02114 MedicalResearch.com: What is the background for this study? Response: Metastatic triple negative breast cancer is associated with aggressive tumor biology, and tends to affect younger patients and African Amerians. The response rate with standard chemotherapy regimens in patients with pre-treated metastatic TNBC ranges from 10-15%, and median progression-free survival ranges from 3-4 months. The median survival of metastatic TNBC is around 12 months and has not changed in the past 20 years. Thus, treatment of metastatic triple negative breast cancer represents an unmet clinical need.   (more…)
Author Interviews, Opiods / 24.02.2019

MedicalResearch.com Interview with: Brian J. Piper, PhD, MS Assistant Professor of Neuroscience Geisinger Commonwealth School of Medicine MedicalResearch.com: What is the background for this study? Response: Fentanyl is an important opioid for pain management but also has exceptional potential for misuse. Illicitly manufactured fentanyl accounts for a large portion of opioid overdoses. Seven states including Maine, Connecticut, Massachusetts, New York, Rhode Island, and Vermont have recently implemented opioid prescribing laws. The objectives of this study were to:
  • 1) characterize how medical use of fentanyl, fentanyl analogues like sufentanil, alfentanil, and remifentanil, and other opioid use changed over the past decade, and
  • 2) determine whether opioid prescribing laws impacted fentanyl use in the US. The Drug Enforcement Administration’s Automation of Reports and Consolidated Ordering System (ARCOS) is the gold-standard for pharmacoepidemiology research of controlled substances in the US for its comprehensiveness. 
(more…)
Author Interviews, JAMA, Karolinski Institute, Pharmacology, Schizophrenia / 24.02.2019

MedicalResearch.com Interview with: Jari Tiihonen, MD, PhD Professor, Department of Clinical Neuroscience Karolinska Institutet Stockholm, Sweden  MedicalResearch.com: What is the background for this study? Response: The effectiveness of antipsychotic combination therapy in schizophrenia relapse prevention is controversial, and use of multiple agents is generally believed to impair physical well-being. But the evidence for this are weak and antipsychotic polypharmacy is widely used. (more…)
Author Interviews, Genetic Research, JAMA, Prostate Cancer / 24.02.2019

MedicalResearch.com Interview with: Masaki Shiota MD, PhD Department of Urology Graduate School of Medical Sciences Kyushu University Fukuoka , Japan MedicalResearch.com: What is the background for this study? What are the main findings? Response:  3β-hydroxysteroid dehydrogenase-1 encoded by HSD3B1 is a rate-limiting enzyme required for all pathways of dihydrotestosterone synthesis, as well as converts abiraterone into Δ4-abiraterone (D4A), which blocks multiple steroidogenic enzymes and antagonizes the androgen receptor. A mutation (1245A>C) in HSD3B1 is shown to be resistant to proteasomal degradation, causing substantial accumulation of this enzyme and gain-of-function. Although the HSD3B1 (1245C) allele can be acquired by mutation, germ-line single nucleotide polymorphism (SNP; rs1047303) is also known to exist. Then, in this study, we investigated the significance of missense polymorphism in HSD3B1 gene among men treated with primary ADT or abiraterone. The results showed men carrying variant allele showed higher risk of progression in primary androgen-deprivation therapy, but vulnerable to abiraterone treatment. (more…)
Author Interviews, Exercise - Fitness, Kidney Disease, Nutrition, UT Southwestern / 24.02.2019

MedicalResearch.com Interview with: Dr. Wanpen Vongpatanasin, M.D. Professor of Medicine Norman & Audrey Kaplan Chair in Hypertension Fredric L. Coe Professorship in Nephrolithiasis and Mineral Metabolism Research Director, Hypertension Section, Cardiology Division, UT Southwestern Medical Center    MedicalResearch.com: What is the background for this study? Response: Increased sedentary activity is commonly seen in people who regularly consume fast food but previously studies have not identified potential mechanisms beyond increased obesity and lack of motivation. Our study seeks to determine if inorganic phosphate, a commonly used food additives that are present in up to 70% of foods in the American diet, maybe the culprit. These food additives (which may come in the form of monocalcium phosphate, phosphoric acid, or tetrasodium phosphate, etc. are used to make the food taste better and/or last longer. It is found mostly in prepackaged foods, cola drinks, and bakery items (cookies, cake, and bread). This is very different from organic phosphates that are found naturally in many healthful foods, such as fruits and vegetables, which are not not readily absorbed from the GI tract. In the Dallas Heart Study, a multiethnic population-based study, we found that serum phosphate is significantly associated with sedentary time and increased time spent in moderate-to-vigorous physical activity which was measured by wrist actigraphy device. This is not explained by reduce cardiac function as ejection fraction remains normal at higher serum phosphate. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA, Surgical Research, Weight Research / 24.02.2019

MedicalResearch.com Interview with: Jagpreet Chhatwal PhD Assistant Professor, Harvard Medical School Senior Scientist, Institute for Technology Assessment Massachusetts General Hospital Chin Hur, MD Associate Professor of Medicine Harvard Medical School       MedicalResearch.com: What is the background for this study? Response: Nonalcoholic steatohepatitis (NASH), a severe form of nonalcoholic fatty liver disease, is one of the leading causes of liver transplantation. Because of increasing prevalence of obesity in the United States, NASH-related cirrhosis cases are expected to increase in the near future. Unfortunately, there are few pharmacological treatments for NASH, and none with proven long-term benefit. Weight loss can be effective in managing NASH but not many patients can lose the sufficient weight necessary to impact NASH and/or maintain long-term weight loss. In contrast, bariatric surgery can provide long-term weight loss and thus potentially reverse liver damage in cirrhosis. However, bariatric surgery is associated with mortality and morbidity associated with the procedure. (more…)
Author Interviews, Colon Cancer, Gastrointestinal Disease / 23.02.2019

MedicalResearch.com Interview with: Dr. Michael Epstein MD Dr. Epstein has over 30 years of experience in the field of Gastroenterology with extensive medical training as a practicing clinician, including treating patients with a range of gastroenterological conditions, such as Inflammatory Bowel Disease (IBD), Crohn’s disease, Ulcerative Colitis, Hepatology and Liver diseases. Dr. Epstein is also the founder and principle physician at Digestive Disorders Associates and is the president of the Maryland Diagnostic and Therapeutic Endo Center, both in Annapolis, Maryland. He is board certified by the American Board of Internal Medicine with a sub-specialty in Gastroenterology. He is a fellow of the American Gastroenterology Association and the American College of Gastroenterology, and a member of the Society of Gastrointestinal Surgeons.  MedicalResearch.com: What is the importance of colonoscopy?  Response: We lose more people to colon cancer each year than who have died in the Vietnam War. I believe that colon cancer has become a public health issue and there is a great need to increase public awareness around screening. It is so important for patients to take part in routine screenings as the symptoms of colon cancer are often silent. Sadly, often times people do not know they have colon cancer until the cancer is in an advanced state. A colonoscopy is important because it is the only test that can currently detect and treat this type of cancer that is also one of the leading killers in the United States. Not only can we often detect pre-cancerous polyps, but we can often remove these polyps during the procedure.  (more…)
Author Interviews, Cancer Research, Dermatology, Radiation Therapy / 23.02.2019

MedicalResearch.com Interview with: William I. Roth MD Dermatology and Dermatological Surgery Boynton Beach, FL MedicalResearch.com: What is the background for this study?
  • This retrospective study reviewed medical records of patients with biopsy-proven, primary cutaneous basal and squamous cell carcinoma (BCC and SCC) lesions on the lower extremities. These patients were treated with the Sensus Healthcare’s Superficial Radiation Therapy SRT-100 Unit between 2011 and 2014. The SRT-100 is most amenable for treating non-melanoma skin cancer (NMSC) in patients aged 65 and older although many younger patients are treated as well when a non-scarring method is desired.
  • The types of skin cancers treated included superficial, well differentiated and moderately differentiated squamous cell carcinomas, squamous cell carcinoma in situ and basal cell carcinomas including infiltrative basal cell carcinomas. Higher energy linear accelerator radiation units have been reported to have a high incidence of healing problems. With the SRT-100 the radiation is concentrated primarily in the higher layers of the skin where the skin cancer is located and thus the treatments are well tolerated.
(more…)
Author Interviews, Health Care Systems, JAMA, Outcomes & Safety, Surgical Research / 22.02.2019

MedicalResearch.com Interview with: Alexis G. Antunez MS University of Michigan Medical School, Ann Arbor Center for Healthcare Outcomes and Policy University of Michigan, Ann Arbor MedicalResearch.com: What is the background for this study? Response: The American College of Surgeons Commission on Cancer is implementing a National Accreditation Program for Rectal Cancer (NAPRC), aiming to improve and standardize the quality of rectal cancer care in the United States. While this is a commendable goal, previous accreditation programs in other specialties have faced controversy around their uncertain impact on access to care. Furthermore, it is well established that the quality of rectal cancer care is associated with patients’ socioeconomic position. So, the NAPRC could have the unintended consequence of widening disparities and limiting access to high quality rectal cancer care for certain patient populations.  (more…)
Author Interviews, Genetic Research, Smoking, Tobacco / 22.02.2019

MedicalResearch.com Interview with: Dennis Drayna, PhD Chief of the Laboratory of Communication Disorders and the Section on Genetics of Communication Disorders National Institute on Deafness and Other Communication Disorders Part of the National Institutes of Health MedicalResearch.com: What is the background for this study? Response: In the United States, there are striking racial differences in the rate of menthol cigarette use.  Tobacco use is a major preventable source of morbidity and mortality in the population, and menthol cigarette use by African Americans represents an important issue for attempts to address minority health disparities. There have been many studies that have documented the role of inherited factors that contribute to smoking or tobacco use.  However, no studies have examined the role of genetic factors specifically in menthol tobacco use.  The preference for menthol cigarettes among African Americans has previously been attributed to cultural factors or industry advertising practices directed at this group. In our study, we asked whether genetic factors could explain why African-American smokers choose menthol cigarettes over non-menthol cigarettes. Our initial hypothesis was that variation in genes that encode the known menthol receptors was important in this difference, although we designed our study to look at all 21,000 protein-coding genes in the genome. (more…)
Accidents & Violence, Author Interviews, Cannabis / 22.02.2019

MedicalResearch.com Interview with: Lonnie M. Schaible PhD Associate Professor School of Public Affairs University of Colorado Denver, CO MedicalResearch.com: What is the background for this study? Response: Following legalization of recreational marijuana use in Colorado, strong -- but unsubstantiated -- claims were being made about crime surrounding marijuana dispensaries.  We wanted to know what the data would show.  We were especially interested in determining whether the addition of recreational facilities had any effects above and beyond those which might exist for medical dispensaries.  To better capture the dynamic landscape of marijuana legalization, this is the first study to control for the prior existence of medical dispensaries and assess how effects of both of these types of establishments changed over time. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Exercise - Fitness / 22.02.2019

MedicalResearch.com Interview with: Michael J. Wheeler Baker Heart and Diabetes Institute Melbourne, Victoria, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: We conducted this study because separate lines of inquiry have determined that a bout of exercise can acutely lower blood pressure, and more recently that prolonged sitting can increase blood pressure over the space of a day. We wanted to know whether the blood pressure lowering effects of an exercise bout would be diminished by a subsequent period of prolonged sitting or enhanced by a subsequent period of sitting that is regularly interrupted with short walking breaks. We found an additive blood pressure lowering effect when exercise was combined with breaks in sitting as opposed to exercise plus prolonged sitting. However, this was only true for women. Men had equal blood pressure lowering effects following exercise regardless of whether-or-not subsequent sitting was interrupted (more…)
ASCO, Author Interviews, Prostate Cancer / 22.02.2019

MedicalResearch.com Interview with: Kim Nguyen Chi, MD FRCPC Professor of Medicine, University of British Columbia Regional Medical Director, BC Cancer - Vancouver MedicalResearch.com: What is the background for this study? What are the main findings? Response: For over 70 years, androgen deprivation therapy (ADT) has been the main treatment therapy for metastatic prostate cancer patients. This Phase 3 final analysis study looked at adding abiraterone acetate and prednisone to ADT for patients with metastatic prostate cancer, with the primary objectives being to assess improvements in overall survival and radiographic progression-free survival. At the first interim analysis reported in 2017, both primary endpoints were met, and the study was unblinded and patients on the ADT and placebos arm crossed over to receive ADT with abiraterone and prednisone. This study is the final analysis reporting on overall survival. The study findings found abiraterone acetate and prednisone plus ADT continued to demonstrate an improvement in overall survival, hazard ratio (HR) = 0.66, meaning a 34% decrease in the risk of death associated with the use of ADT with abiraterone and prednisone. The median overall survival, which had not been reached before in the ADT with abiraterone and prednisone arm, was 53.3 months compared to 36.5 months for ADT plus placebo, prolonging median overall survival by 16.8 months. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Hepatitis - Liver Disease, JAMA / 22.02.2019

MedicalResearch.com Interview with: Xuehong Zhang, MD, ScD Assistant Professor in Medicine Harvard Medical School Associate Epidemiologist Brigham and Women's Hospital Boston, MA MedicalResearch.com: What is the background for this study? Response: In the United States., liver cancer incidence is rapidly increasing and over 42,200 new cases were projected to be diagnosed in 2018. The majority of individuals with liver cancer are diagnosed at a late stage, are not eligible for curative therapy, and die within 1 year of diagnosis. Established risk factors for liver cancer are limited to hepatitis B and C virus (HBV/HCV) infections, metabolic disorders, and smoking. Clearly, identification of novel risk factors, particularly those that are modifiable, is urgently needed. Dietary factors have been suspected as important, but only excessive alcohol use and aflatoxin-contaminated foods are considered to be established dietary risk factors for hepatocellular carcinoma (HCC). Consumption of whole grains and dietary fiber, especially cereal fiber, have been associated with lower risk of obesity, type 2 diabetes, and nonalcoholic fatty liver disease, which are known predisposing factors for HCC. We thus hypothesized that long-term intake of whole grains and dietary fiber may lower the risk of developing hepatocellular carcinoma (HCC) and tested this hypothesis using data from two large prospective cohort studies, the Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). (more…)
AHA Journals, Artificial Sweeteners, Author Interviews, Stroke / 21.02.2019

MedicalResearch.com Interview with: Yasmin Mossavar-Rahmani, Ph.D., RD Associate Professor Division of Health Promotion & Nutrition Research Dept. of Epidemiology & Population Health Albert Einstein College of Medicine Bronx, NY 10461 MedicalResearch.com: What is the background for this study? Response: This is the largest study of the effects of artificially sweetened beverages (ASB) in older women from the Women's Health Initiative Observational Study which started in 1993 and still continues to follow the women. A prior paper indicated excess risk of cardiovascular disease with high consumption of ASBs, but cardiovascular disease was a composite endpoint combining stroke, coronary heart disease, heart failure, revascularization and peripheral arterial disease.  Our study focusses on stroke by itself and with different subtypes of stroke. We define high consumption as two or more 12 fl oz. of diet drinks (diet soda or fruit drinks) per day and low consumption as no or less than one drink per week. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmacology / 21.02.2019

MedicalResearch.com Interview with: Jennifer N. Goldstein, MD, MSc Assistant  program Director of Internal Medicine Christiana Care Health System Newark, Delaware MedicalResearch.com: What is the background for this study? Response: Human synthetic insulins have been available over-the-counter for nearly a century, and at relatively low cost for around a decade under a Walmart brand name. However, little is known about  the frequency of sale of over-the-counter insulin or the reasons why patients use it. While prescription insulins (insulin analogues) are considered by many to be easier to use and more predictable than the over-the-counter versions, the cost of these insulins has skyrocketed. Our study examined the frequency of sale of over-the-counter insulins and whether patients potentially use over-the-counter insulin as a substitute for expensive prescription insulins. (more…)
Author Interviews, Columbia, Depression, JAMA, OBGYNE, USPSTF / 21.02.2019

MedicalResearch.com Interview with: Dr. Karina Davidson, PhD Professor of Behavioral Medicine (in Medicine and Psychiatry) Executive Director, Center for Behavioral Cardiovascular Health Columbia University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Perinatal depression, which includes depression that develops during pregnancy or after childbirth, is one of the most common complications of pregnancy and the postpartum period, affecting as many as 1 in 7 pregnant women. The Task Force found that counseling can help those who are at increased risk of developing perinatal depression, and clinicians should provide or refer pregnant and postpartum individuals who are at increased risk to counseling. Clinicians can determine who might be at increased risk of perinatal depression by looking at someone’s history of depression, current depressive symptoms, socioeconomic risk factors, recent intimate partner violence, and other mental-health related factors. (more…)
Author Interviews, McGill, PNAS / 20.02.2019

MedicalResearch.com Interview with: Ben Gold, a PhD candidate Lab of Robert Zatorre The Neuro (Montreal Neurological Institute and Hospital) McGill University MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Music is just sound in air, but it carries considerable power. It captivates our brain’s reward system, we devote an enormous amount of time and money to it, and we're just beginning to tap its therapeutic potential. We wanted to explore how something so abstract could have such an impact, and since music is so well suited to establishing and manipulating patterns of sound as it unfolds, we focused on how it manipulates expectations. Previous research has shown that surprises are often the most emotional and pleasurable moments in music listening, but whether and how this engaged the brain's reward system was unclear. So we adapted an experimental protocol designed for studying learning and surprise about more concrete rewards like food or money, and applied it to a musical context during brain imaging. This protocol relies on participants making decisions from which we could infer their expectations, allowing us to estimate how surprised they were by each outcome whenever it occurred. In our case, we asked participants to make choices about colors and directions that were associated with different musical outcomes, but we didn't tell them what those associations were so that they they started with no expectations and learned as they went. We found that our participants could learn about music just like they would learn about how to find food or win money, and that the same neural process was involved. Specifically, we saw that the activity of the nucleus accumbens -- a central hub of the reward system -- reflected both how pleasant and how surprising each musical outcome was: a computation known as a reward prediction error. Across individuals, those who better represented these reward prediction errors in their nucleus accumbens also learned better about the music in the experiment, making more decisions over time to find the music they preferred.  (more…)
Author Interviews, Stroke / 19.02.2019

MedicalResearch.com Interview with: Sunil A. Sheth, MD Department of Neurology McGovern Medical School at UTHealth Houston, TX 77030 MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is no country in the world where the absolute number of people living with or died from stroke has declined between 1990 and 2013. In the US, approximately 795,000 people experience a stroke each year with nearly 90% being acute ischemic stroke (AIS), which remains the leading cause of adult disability in the US. In 2015 landmark clinical trials demonstrated that endovascular stroke treatments (EST) for patients with large vessel occlusion (LVO) leads to dramatic improvements in patient outcomes. However, in the wake of these results, stroke systems of care around the globe are now faced with the daunting task of ensuring that patients with AIS have access to appropriate screening and therapy. The evidence of benefit for endovascular stroke that emerged from these trials was derived from treatments rendered almost exclusively at high volume stroke centers, with specialized neuro-imaging, neuro-intensive care, neuro-rehabilitation and neuro-nursing. However, since the publication and adoption of these findings into guidelines, it has become well-established that the likelihood of good neurologic outcome for these patients remains dependent on minimizing delays in treatment. Even 15-minute delays in endovascular reperfusion have been associated with quantifiable decrements in clinical outcomes. As such, there has been an increase in demand for the procedure as well as calls for the dissemination of the treatment away from tertiary-care referral centers into the community, to avoid the costly delays associated with inter-hospital transfer (IHT). On the other hand, transferring endovascular stroke patients to higher volume centers has also been associated with reduced mortality. In the absence of clear data on the relative efficacy of EST in lower volume centers, this lack of clarity on the optimal distribution of endovascular stroke resources had led to considerable confusion, with stroke center certifying agencies such as The Joint Commission initially requiring physician and hospital minimal EST volume requirements for certification, and then very recently revoking and then reinstating that criterion. Given the need to structure stroke systems of care in the modern endovascular stroke era, as well as the poorly characterized effect on EST outcomes away from tertiary-care referral centers, understanding the trends in treatment patterns as well as outcomes in relation to treatment volumes and IHT is of vital importance. The study described here provides for the first time large-scale data on the utilization of the procedure as well as the finding that its outcomes are directly tied to annual volumes. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmacology, University of Pittsburgh / 19.02.2019

MedicalResearch.com Interview with: Alvaro San-Juan-Rodriguez, PharmD Pharmacoeconomics, Outcomes and Pharmacoanalytics Research Fellow Pharmacy and Therapeutics School of Pharmacy University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Before 2009, etanercept (Enbrel®), infliximab (Remicade®), and adalimumab (Humira®) were the only tumor necrosis factor (TNF) inhibitors approved by the FDA for rheumatoid arthritis. Subsequently, 3 therapies gained FDA approval: subcutaneous golimumab (Simponi®) in April 2009, certolizumab pegol (Cimzia®) in May 2009, and intravenous golimumab (Simponi Aria®) in July 2013. All 6 agents are brand-name drugs. Our study aimed to evaluate how the prices of existing TNF inhibitors (Enbrel®, Remicade® and Humira®) changed in response to the market entry of new TNF inhibitors.  (more…)
Author Interviews, CMAJ, OBGYNE / 19.02.2019

MedicalResearch.com Interview with: Anick Bérard PhD FISPE Research chair FRQS on Medications and Pregnancy Director, Réseau Québécois de recherche sur le médicament Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy, University of Montrealand Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justin   MedicalResearch.com: What is the background for this study? What are the main findings? Response: Yeast infections are common during pregnancy (10%). Although topical treatments are first-line therapies, yeast infections during gestation are often more severe and are resistant to topical options. Hence, low dose oral fluconazole is often the treatment of choice for pregnant women (1 dose for 1 day). Human and animal studies have shown that high dose of fluconazole is teratogenic.Few studies are available for the risk associated with low dose of fluconazole (the most used during pregnancy). Also, no one has studied the combined effect of low- and high-dose fluconazole use during pregnancy on overall adverse pregnancy outcomes (spontaneous abortions, stillbirths and major malformations).  (more…)
Author Interviews, Dermatology / 19.02.2019

MedicalResearch.com Interview with: Eli Sprecher MD PhD Professor and Chair, Division of Dermatology Deputy Director General for R&D and Innovation Tel Aviv Sourasky Medical Center Frederick Reiss Chair of Dermatology Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel and MedicalResearch.com: What is the background for this study? Response: Central centrifugal cicatricial alopecia (CCCA) is a form of hair loss (alopecia) which is extremely common and affects one in every 20 women of African origin. It starts usually during the fourth decade of life. Because it can be inherited from mothers to their children, it is thought to have a genetic basis. On the other hand, it is known to mainly affect women who use to groom their hair intensively. Thus it was thought that the disease stems from some form of inherited susceptibility to the damage incurred to the hair follicle by grooming habits. In the study we published, we searched for the genetic basis of CCCA. In contrast with the common form of alopecia (androgenetic alopecia or female pattern alopecia), CCCA is associated with scarring of the scalp skin, which means that once hair is lost, it will likely not re-grow. (more…)
Author Interviews, Personalized Medicine, Weight Research / 19.02.2019

MedicalResearch.com Interview with: Ruth Loos, PhD The Charles Bronfman Professor in Personalized Medicine Director, Genetics of Obesity and Related Traits Program Co-Director, Charles Bronfman Institute for Personalized Medicine Icahn School of Medicine at Mount Sinai New York, NY     MedicalResearch.com: What is the background for this study? Which type of body fat distribution carries greater risk of diabetes or other obesity-related health disorders? Response: Obesity broadly consists of two component; [1] there is overall body size (assessed using BMI) and [2] there is fat distribution (assessed using WHR). Both are “heritable”, which mean that they are in part determined by our genome (and the other part is determined by our lifestyle). Over the past 15 years, geneticists have used an approach to screen the whole genome of thousands of people to identify genetic variations that differ between e.g. obese people vs non-obese people. We have applied this approach to both components of obesity and have found so far that genes for “overall body size” seem to act in the brain, likely controlling hunger, satiety, reward, etc., whereas the genes that determine where in the body the excess fat will be stored when you gain weight (i.e. fat distribution) seem to act more “locally” at the fat cell level itself, determining the storage and release of fat.  (more…)
Author Interviews, Fertility / 19.02.2019

MedicalResearch.com Interview with: Dr Simone Immler PhD School of Biological Sciences University of East Anglia  MedicalResearch.com: What is the background for this study? Response: Sperm produced by one male vary substantially both in their genetic content as well as their swimming ability including speed and duration. In a previous study in the zebrafish, we showed that sperm swimming duration is at least partly determined by the underlying haploid genetic content carried by the different sperm within an ejaculate (alavioon et al. 2017 PNAS). If sperm with different swimming ability differ in their genetic content, we expect to see differences among the offspring sired by sperm that vary on their swimming ability. In our new study, we tested how selection on  sperm swimming duration affects offspring fitness. We performed in vitro fertilisation assays mimicking natural conditions in the externally fertilising zebrafish. We split the ejaculate of one male into two halves and in one half we added the sperm straight away to the eggs, allowing all motile sperm to have a go at fertilising an  egg. In the second half, we activated the sperm but delayed the moment of fertilisation by 25 seconds and thus selected for the longer swimming sperm. In this treatment only sperm that were still swimming after this period of time (about 50%) were able to fertilise an egg. We then reared the offspring to adulthood and measured number of offspring produced throughout life and measured lifespan. We found that sperm that were able to swim for longer sired offspring that not only produced more and healthier offspring but also lived for longer than their full siblings sired by sperm with reduced swimming ability. Our previous research (Alavioon et al. 2017 PNAS) suggests that these differences are caused at least partly by genetic differences among sperm. (more…)