The economic value of extended-release naltrexone, compared to buprenorphine-naloxone, became more attractive after accounting for additional costs to society ...
MedicalResearch.com Interview with:
Daniel J. Lane PhD
Institute of Health Policy, Management and Evaluation
Dalla Lana School of Public Health, University of Toronto
Rescu, Li Ka Shing Knowledge Institute, St Michael’s Hospital
Toronto, Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Early resuscitation and early antibiotics have become the mainstay treatment for patients with sepsis. The time to initiation of these treatments is thought to be an important factor in patients surviving their disease; however, the independent benefits or harms of intravenous fluid resuscitation, in particular a more aggressive versus more conservative approach to this therapy, remains difficult to evaluate given the concurrent use of these therapies in hospital.
To gain a better understanding of this treatment independent of antibiotic use, we assessed intravenous fluid resuscitation by paramedics on the in-hospital mortality of patients with sepsis. By accounting for the interaction between initial systolic blood pressure and the treatment, we found that earlier resuscitation by paramedics was associated with decreased mortality in patients with low initial blood pressures but not associated with mortality for patients with normal or higher initial blood pressures.
MedicalResearch.comInterview with:
Hadi Shafiee, PhD
Harvard Medical School
Assistant Professor of Medicine
Division of Engineering in Medicine
Brigham and Women's Hospital
Harvard Medical School
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Last year we developed a smartphone-based technology for male infertility testing at-home, which was published at Science Translational Medicine. This year, we developed a similar technology for ovulation testing at-home. Here, we developed a 3D printed smartphone-attachment similar to a cellphone case that literally turns the phone to a small microscope.
This low-cost smartphone attachment magnifies the saliva fern structures dried on a reusable device that will be recorded using the smartphone camera. The entire sample-to-answer time is only few minutes (~7 mins). The developed ovulation test is fully automated, simple, and easy-to-use.
MedicalResearch.comInterview with:
Eric J. Belin de Chantemèle, D.Sc.
Associate Professor
Department of Medicine, Cardiology
Vascular Biology Center
Medical College of Georgia at Augusta University
Jessica L Faulkner, PhD
Post-doctoral Fellow
Vascular Biology Center
Medical College of Georgia at Augusta University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is generally accepted in the medical community that women are more salt sensitive than men. By “salt sensitive” we mean that blood pressure increases with increases in salt in the diet.
While we have known for a long time that women are more likely to experience problems with their blood pressure that are associated with the salt that they eat, the reasons why remain largely unknown and, therefore, the best way to treat it is also unknown. With the average American eating roughly twice the salt recommended by the American Heart Association guidelines, the effects of dietary salt on blood pressure are very important. Our latest publication in the journal American Heart Association’s journal Hypertension shows that female mice are more prone to high blood pressure when on a high salt diet than males.
MedicalResearch.com: What should readers take away from your report?
Response: Our report begins to shed some light on why women may have a greater risk of developing high blood pressure due to eating too much salt. We recently found that a hormone, termed “aldosterone” is acting inappropriately in females in response to a lot of salt in the diet. In healthy individuals who are not salt sensitive, aldosterone is decreased by salt in the diet and is protective to the blood vessels. However, in female mice it is less likely that aldosterone will be decreased, and this lack of decrease of aldosterone leads to blood vessel damage and high blood pressure in our study.In contrast, our male mice in our study suppressed aldosterone when given a high salt diet, and did not develop blood vessel damage or high blood pressure.We believe this variation in aldosterone production in women may be a reason why they are clinically more likely to have a blood pressure response to high salt diets.
MedicalResearch.comInterview with:
Tetsuo Shoji, MD, PhD.
Department of Vascular Medicine
Osaka City University Graduate School of Medicine
Osaka Japan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Vitamin D is known to be associated with health and disease of various organs such as bone, heart, brain, and others. Vitamin D is activated by the liver and kidneys to a hormone called 1,25-dihydroxyvitamin D which binds to vitamin D receptor in cells to exert its functions.
Vitamin D activation is severely impaired in patients with kidney disease requiring hemodialysis therapy, leading to mineral and bone disorder(MBD). Therefore, active form of vitamin D is one of the standard choices of treatment for MBD caused by kidney function loss.
Previous observational cohort studies showed that the use of active vitamin D in hemodialysis patients was associated with lower likelihood of all-cause death, cardiovascular death, and incident cardiovascular disease.Potentially cardio-protective effects of active vitamin D were shown by basic studies using cultured cells and animal models. Then, many nephrologists began to believe that active vitamin D is a “longevity hormone” or a “panacea” for kidney patients requiring dialysis therapy, although there was no evidence by randomized clinical trials.
To show evidence for it, we conducted a randomized clinical trial namedJ-DAVID in which 976 hemodialysis patients were randomly assigned to treatment with oral alfacalcidol or treatment without active vitamin D, and they were followed-up for new cardiovascular events during the four-year period. The risk of cardiovascular events was not significantly different between the two groups. The risk of all-cause death was not significantly different either.
To our surprise, the risk of cardiovascular event tended to be higher in the patients who continued treatment with active vitamin D than those who continued non-use of active vitamin D, although the difference was not statistically significant.
MedicalResearch.comInterview with:
Alexandra Avgustinova PhD
Postdoctoral fellow at the Institute for Research in Biomedicine (IRBBarcelona)
MedicalResearch.com: What is the background for this study?
Response: The basis of this study was the strong association between closed chromatin and high mutation rate reported several years ago. We were surprised to see this observation being widely interpreted as a causal association, as it was largely based on correlative studies without experimental backing. Therefore we decided to experimentally test for the first time whether indeed altering chromatin opening would affect mutation rate or distribution within tumours.
MedicalResearch.com: What are the main findings?
Response: We found that, despite significantly increasing chromatin opening, loss of the histone methyltransferase G9a did not have any major influence on the mutation rate or distribution within cutaneous squamous cell carcinomas. These results demonstrate that chromatin opening does not play a major role in determining the mutation rate within tumours, and we speculate that other, confounded factors (e.g. replication timing or H3K36me3 levels) are likely causal for the observed association. This, however, remains to be proven experimentally.
Another major conclusion of our study was that although tumour initiation was delayed and tumour burden decreased in the absence of G9a, the tumours that did develop were highly aggressive due to selection for more aggressive tumour clones. This finding was contrary to many published reports suggesting G9a as a good candidate for clinical targeting, highlighting the need for long-term follow-up in pre-clinical studies.
(more…)MedicalResearch.comInterview with:
Zhaohui Gu, PhD
Postdoctoral Research Associate
St. Jude Children's Research Hospital, TN
MedicalResearch.com: What is the background for this study? What are the main findings?
Response:B-progenitor acute lymphoblastic leukemia (B-ALL) is the most common pediatric malignancy and the leading cause of childhood cancer death. B-ALL includes multiple subtypes that are defined by distinct genetic alterations and that play an important role in diagnosis, prognosis and therapy of patients. Advances in transcriptome sequencing (RNA-seq)have helped researchers discover additional subtypes and driver mutations inB-ALL and identify possible new therapeutic targets. Still, up to 30% of B-ALL cases do not fit into established subtypes. These patients lack targeted therapeutic approaches and commonly relapse.
Fort his study, we used integrated genomic analysis of 1,988 childhood and adult cases to revise the classification system of B-ALL. The system includes eight new subtypes and a total of 23 B-ALL subtypes. The subtypes are defined by chromosomal rearrangements, sequence mutations, or heterogeneous genomic alterations. Many show a marked variation in prevalence according to age.
The newly identified subtypes included
one (n=18) defined by rearrangements of gene BCL2, MYC and/or BCL6 anda distinctive gene expression profile (GEP). Patients in this
subtype were mostly adults (n=16) with very poor outcomes.
Another
novel subtype was defined by IKZF1
N159Y missense mutation. N159Y is in the DNA-binding domain of IKZF1, and is
known to disrupt IKZF1 function, with distinct nuclear mis-localization and
induction of aberrant intercellular adhesion. There were eight cases in this
subtype that shared highly similar GEPs.
We also
identified two subtypes with distinct GEP and characterized by PAX5 alterations. One, PAX5 altered
(PAX5alt), included 148 cases. PAX5alt was characterized by diverse PAX5 alterations including
rearrangements (n=57), sequence mutations (n=46) and/or focal intragenic
amplifications (n=8). These PAX5
alterations were found in 73.6% of PAX5alt cases. The second distinct subtype
comprised 44 cases, all with PAX5
P80R missense mutations. Bi-allelic PAX5
alterations were commonly seen in this subtype in the form of PAX5 P80R coupled with a second sequence
mutation or deletion of the wild-type PAX5
allele.
Adult PAX5 P80R cases showed better 5-year OS (61.9±13.4%) than those in PAX5alt subtype (42.1±10.2%). In addition, Pax5 P80R heterozygous and homozygous mice developed B lineage leukemia with a median latency of 166 and 87 days, respectively. The heterozygous mice acquired alterations on the second allele, which faithfully recapitulated the condition of the patient leukemia.
MedicalResearch.com: What should readers take away from your report?
Response: Identification of subtypes accurately is very
important for diagnosis, intensity-tailored therapy, and to identify targetable
lesions. In this large scale genomic study, we demonstrated the power of using RNA-seq
to classifying B-ALL and established a revised B-ALL taxonomy with 23 distinct
subtypes. We identified 8 novel subtypes, including two defined by PAX5 alterations. Through in vitro and in vivo experiments, we demonstrated that PAX5 P80R could impair B
cell differentiation and initiate leukemia.
Together with the subtype defined by IKZF1
N159Y mutation, we showed for the first time that transcription factor missense
mutations could be a subtype defining genetic lesions.
MedicalResearch.comInterview with:
Zhen Gu, Ph.D.
Professor, Department of Bioengineering
University of California, Los Angeles (UCLA)
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Despite improvements in surgical techniques, local residual tumor micro infiltration and circulating tumor cells continue causing tumor recurrence after resection.
Calcium carbonate nanoparticles could scavenge H+ in the surgical wound, reserving the immunosuppressive tumor microenvironment and promoting the antitumor immuneresponses.
(more…)Acute myeloid leukemia, is a difficult-to-treat disease and these Venclexta combinations represent an important new treatment option for patients....
Our findings suggest a potential therapeutic option to slow down or stop the progression of Parkinson's disease and Dementia with...
MedicalResearch.com Interview with: Dr. Moore Dr. Ainsley Moore MD, CFPC, MSc(HB), MSc(CLinEpi) CandAssociate Professor,McMaster UniversityAssociate Editor,Canadian Medical Education JournalVice-Chair, Canadian Task Force on...
MedicalResearch.com Interview with:
Kirti Magudia, MD, PhD
Diagnostic RadiologyResident, Brigham and Women’s Hospital
Clinical Fellow, Radiology, Harvard University
Debra F. Weinstein, M.D.
Vice President, Graduate Medical Education, Partners Health Care
Associate Professor of Medicine, Harvard Medical School
Christina Mangurian, MD,MAS
Professor and Vice Chair at the UCSF Department of Psychiatry
Weill Institute for Neurosciences
Core Faculty, UCSF Center for Vulnerable Populations
Affiliate Faculty, UCSFPhilip R. Lee Institute for Health Policy Studies
Reshma Jagsi, MD, DPhil
Professor and DeputyChair, Department of Radiation Oncology
Director, Center for Bioethics and Social Sciences in Medicine
University of Michigan
MedicalResearch.com: What is the background for this study?
What are the main findings?
Response: Training lengths for medical specialties are increasing and many people are starting training later. Hence, many more trainees are having children during training, an especially difficult time due to long and inflexible work hours. Given the match system, trainees may not have complete control over where they end up in training and thus may not have an optimal support system nearby. Many of the top training institutions are also in high cost of living areas. Since trainees are essentially temporary employees, changing policies to their benefit is challenging. For all of these reasons, prospective and current trainee parents are especially vulnerable.
Parental leave is important to both male and female trainees. We found that just over half of the 15 top graduate medical education (GME) sponsoring institutions associated with the top 12 medical schools did not have parental leave policies. Without these policies, trainees are at the mercy of their departments and program directors. Those institutions that do have parental leave policies for trainees offer significantly less leave to trainees than to faculty. Even then, trainees may not be encouraged to take leave afforded by policy as, depending on specialty board regulations, the leave may extend training time.
(more…)MedicalResearch.comInterview with:
Jac Dinnes PhD, MSc, MA, PGDip
Senior Researcher
Test Evaluation Research Group
Institute of Applied Health Research
University of Birmingham
MedicalResearch.com: What is thebackground for this study? Would you briefly explain the benefits of dermoscopy?
Response: This systematic review was one of a series of Cochrane Reviews of studies evaluating different tests for diagnosing skin cancer. Within creasing rates of skin cancer and an increasing number of more specialised tests becoming available in both primary care and in specialist settings, a thorough review of all available evidence was timely.
The diagnosis of melanoma and other skin cancers fundamentally relies on clinical examination, including history taking, and visual inspection of the concerning skin lesion (mole or patch of skin) and surrounding skin (and other lesions). A dermatoscope is a handheld device using visible light (such as from incandescent or LED bulbs), that allows more detailed examination of the skin compared to examination by the naked eye alone.
Knowing the diagnostic accuracy of dermoscopy added to visual inspection alone, across a range of observers and settings, is critical to understanding its contribution for the diagnosis of melanoma and to future understanding of the potential role of the growing number of other high-resolution image analysis techniques.
(more…)MedicalResearch.com Interview with:
Virginia J. Howard,PhD, FAHA, FSCT
Professor of Epidemiology
The University of Alabama at Birmingham
MedicalResearch.com: What is the background for this study?
Response: This study comes from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national cohort study of 30,239 non-Hispanic black and white community-dwelling participants aged 45 years and older who lived in the 48 contiguous US states.
REGARDS was designed to study risk factors for the development of stroke, with a focus on black and white comparisons as well as comparisons across geographic regions of the US.