Author Interviews, Breast Cancer, JAMA, MD Anderson / 08.10.2013

Kelly K. Hunt, MD F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TXMedicalResearch.com Interview with: Kelly K. Hunt, MD F.A.C.S. Professor, Department of Surgical Oncology, Division of Surgery Chief, Breast Surgical Oncology Section, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX MedicalResearch.com: What are the main findings of the study? Dr. Hunt: We found that 40% of women who had node positive disease at initial presentation (confirmed by needle biopsy) had no evidence of residual cancer in the lymph nodes after chemotherapy. We performed sentinel lymph node (SLN) surgery followed by axillary lymph node dissection in all of the patients and found a false negative rate of 12.6% with the SLN procedure. The false negative rate was lower when surgeons used two mapping agents (blue dye and radioisotope) to identify the sentinel nodes and when they removed more than 2 sentinel nodes. (more…)
Author Interviews, Biomarkers, Cancer Research / 03.10.2013

MedicalResearch.com Interview with: Dr. Muy-Teck Teh BSc, PhD Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry Barts & The London School of Medicine and Dentistry Queen Mary University of London, England, United Kingdom MedicalResearch.com: What are the main findings of the study? Answer: We found unique DNA markings (epigenetic methylation) on certain genes that may “predict” the risk of developing head and neck cancer. We identified certain DNA methylation marks unique to cancer cells and not found in normal healthy cells. DNA methylation marks act as ‘switches’ that regulate the ‘on or off’ statuses of genes. Abnormal DNA methylation is known to precede cancer initiation. Hence, the presence of these abnormal DNA methylation marks in cells may be tell-tale signs of early cancer initiation. The chemically distinctive properties of methylated DNA provide ample opportunities for clinical exploitation as nucleic acid-based biomarkers potentially detectable in non-invasive samples such as blood, buccal scrapes, or even saliva. (more…)
Author Interviews, Lung Cancer / 30.09.2013

MedicalResearch.com: Interview with: Dr. Atul Butte, MD, PhDDr.  Atul Butte, MD, PhD and Julien Sage Ph. DJulien Sage PhD Departments of Pediatrics and Genetics Department of Internal Medicine, University of California Davis Cancer Center University of California Davis School of Medicine Sacramento, California MedicalResearch.com: What are the main findings of the study? Answer: A major finding of the study is the identification of first-generation anti-depressants as possible drugs effective against a lethal subtype of lung cancer, small cell lung cancer. A second important aspect of this work is the use of a bioinformatics-based drug repositioning pipeline developed by the Butte lab, which allowed us, when combined with advanced mouse models of lung cancer developed by the Sage lab, to identify a novel targeted therapy against SCLC and initiate a clinical trial in less than 2 years. (more…)
Author Interviews, Prostate Cancer / 26.09.2013

Robert G Bristow MD, PhD, FRCPC Clinician-Scientist, Ontario Cancer Institute/Princess Margaret Cancer Centre Professor, Depts. of Radiation Oncology and Medical Biophysics, University of Toronto Director, Core I - STTARR Innovation Facility Canadian Cancer Society Research Scientist MedicalResearch.com Interview with: Robert G Bristow MD, PhD, FRCPC Clinician-Scientist, Ontario Cancer Institute/Princess Margaret Cancer Centre Professor, Depts. of Radiation Oncology and Medical Biophysics, University of Toronto Director, Core I - STTARR Innovation Facility Canadian Cancer Society Research Scientist http://www.uhnres.utoronto.ca/researchers/profile.php?lookup=645 MedicalResearch.com: What are the main findings of the study? Dr. Bristow: We studied the more than 7 years of outcome of close to 250 patients with localized (intermediate risk) prostate cancer that received precision radiotherapy or surgery for cure. We found that up to one third of these patients fail initial radiotherapy or prostate surgery. By using a patient’s initial diagnostic core biopsy, we studied the DNA fingerprints of the tumors. We noticed a pattern in which the patients that had failed treatment had abnormal levels of breaks at sites within the chromosomes that are sensitive to DNA damage called, “common fragile sites” (CFS). These CFS break abnormalities have been linked to cancer in general and usually are associated with instability of the cell’s DNA-a phenomenon that is particularly associated with cancer. So patients who have unstable chromosomes are more likely to fail precision radiotherapy or surgery. (more…)
Author Interviews, Cancer Research, Diabetes, NYU, Weight Research / 26.09.2013

Niyati Parekh, PhD, RD Assistant Professor of Nutrition and Public Health, Director of Doctoral Program in Clinical Nutrition, Department of Nutrition, Food Studies and Public Health, Steinhardt School and Department of Population Health, NYU Langone School of Medicine, New York University 411 Lafayette Street NY. NY-10003.MedicalResearch.com Interview with: Niyati Parekh, PhD, RD Assistant Professor of Nutrition and Public Health, Director of Doctoral Program in Clinical Nutrition, Department of Nutrition, Food Studies and Public Health, Steinhardt School and Department of Population Health, NYU Langone School of Medicine, New York University 411 Lafayette Street NY. NY-10003. MedicalResearch.com: What are the main findings of the study? Dr. Parekh: The objective of the study was to investigate disturbances in blood glucose levels in relation to risk of obesity-related cancers. We observed an increased risk of obesity-related cancers, specifically colon cancer among persons with abnormal glucose values. These findings were stronger among persons who had this abnormality for longer duration (>10years). (more…)
Author Interviews, Pancreatic, Radiation Therapy / 26.09.2013

MedicalResearch.com Interview with: Dr. Raphael Yechieli Department of Radiation Oncology at Henry Ford Hospital in Detroit: MedicalResearch.com: What are the main findings of the study? Dr. Yechieli:  The main findings of the study are that elderly patients with pancreatic cancer who also have significant co-morbidities can still be safely and effectively treated with a short course of radiation treatment. Furthermore, the local control and survival data from our study are similar to previously published data, where patients were treated with more intense and longer courses of treatment. (more…)
Author Interviews, Cancer Research, Lancet, Prostate Cancer, Sloan Kettering / 26.09.2013

Dr. Ethan Basch MD Memorial Sloan-Kettering Cancer CenterMedicalResearch.com Interview with Dr. Ethan Basch MD Memorial Sloan-Kettering Cancer Center MedicalResearch.com: What are the main findings of the study? Dr. Basch: The primary clinical finding of this study is that treatment with abiraterone acetate delays the time until pain develops or worsens in men with advanced prostate cancer.  Furthermore, abiraterone delays the time until quality of life and functioning deteriorate, compared to placebo.  There is also a broader research finding of this study, which is that it is feasible to rigorously study the time until symptom progression in cancer clinical trials, which paves the way for future studies to use a similar approach. (more…)
Author Interviews, Breast Cancer, Cancer Research, Lancet / 20.09.2013

Prof Aron Goldhirsch Department of Medicine European Institute of Oncology Via Ripamonti 435, 20141 Milan, ItalyMedicalResearch.com Interview with: Prof Aron Goldhirsch Department of Medicine European Institute of Oncology Via Ripamonti 435, 20141 Milan, Italy MedicalResearch.com: What are the main findings of the study? Prof. Goldhirsch:  Two years of adjuvant trastuzumab after standard chemotherapy is not more effective than is 1 year of treatment with the drug for patients with HER2-positive early breast cancer. (more…)
Author Interviews, Breast Cancer, Lancet / 20.09.2013

Prof John R Yarnold Division of Radiotherapy and Imaging The Royal Marsden NHS Foundation Trust Sutton, Surrey SM2 5PT, UKMedicalResearch.com Interview with: Prof John R Yarnold Division of Radiotherapy and Imaging The Royal Marsden NHS Foundation Trust Sutton, Surrey SM2 5PT, UK   MedicalResearch.com: What are the main findings of the study? Prof. Yarnold: A 3-week schedule of curative post-operative radiotherapy for women with breast cancer involving 15 treatments (fractions) delivered Monday to Friday each week, is at least as safe and effective as historical schedules given over 5 or 6 weeks. In fact the 3-week schedule is gentler on the healthy tissues than earlier standard regimens. (more…)
Author Interviews, General Medicine, Lung Cancer / 19.09.2013

MedicalResearch.com Interview with: Jie He, PhD, MD Director, Laboratory of Thoracic Surgery President, Cancer Institute & Hospital, Chinese Academy of Medical Sciences Chaoyang District, Beijing, 100021 MedicalResearch.com: What are the main findings of the study? Dr. Jie He:  The main findings of the study is that we have identified IDH1 as an effective plasma biomarker for the diagnosis of NSCLCs, particularly with high sensitivity and specificity in the diagnosis of lung adenocarcinoma. (more…)
Author Interviews, BMJ, Cancer Research, CMAJ / 19.09.2013

MedicalResearch.com Interview with: Bruno Heleno, PhD fellow Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark MedicalResearch.com: What are the main findings of the study? Answer: In a literature review of cancer screening trials of a wide range of screening interventions, we found that trials seldom report the information necessary to weigh benefits against harms. (more…)
Author Interviews, CMAJ, Colon Cancer, NEJM / 19.09.2013

Aasma Shaukat, M.D., M.P.H. Dept. of Medicine GI Division, MMC 36 University of Minnesota Minneapolis, MN 55455MedicalResearch.com Interview with: Aasma Shaukat, M.D., M.P.H. Dept. of Medicine GI Division, MMC 36 University of Minnesota Minneapolis, MN 55455 MedicalResearch.com: What are the main findings of the study? Dr. Shaukat: The study showed that screening for colon cancer using stool cards consistently reduces risk of death from colon cancer by one-third through thirty years. The benefit of screening in larger in men compared to women, and for women the benefit seems to start at age 60. However, screening did not make people live longer. (more…)
Author Interviews, CMAJ, Melanoma / 17.09.2013

Ze'ev Ronai, Ph.D., Professor and scientific director of Sanford-Burnham Medical Research Institute La Jolla San Diego, Calif.MedicalResearch.com Interview with: Ze'ev Ronai, Ph.D. Professor and scientific director of Sanford-Burnham Medical Research Institute La Jolla San Diego, Calif. MedicalResearch.com: What are the main findings of the study? Answer: This study provides the first direct evidence of the importance of the PDK1 enzyme in the development of melanoma and in the metastasis of this aggressive tumor type. We demonstrate, with a genetic mouse melanoma model (harboring the Braf/Pten mutations commonly seen in human melanomas) and/or pharmacological inhibitors against PDK1, that melanoma requires this enzyme for its development, and more so – for its ability to metastasize. Since PDK1 is key kinase that regulates a number of protein kinases, which are currently being assessed in clinical trials (including AKT), our finding points to a new set of targets that could be more amenable for effective combination therapy in melanoma. (more…)
Author Interviews, Breast Cancer, MRI / 13.09.2013

Nariya Cho, MD Departments of Radiology Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.MedicalResearch.com Interview with: Nariya Cho, MD Departments of Radiology Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.   MedicalResearch.com: What are the main findings of the study? Dr. Cho: Smaller reduction in tumor volume and a smaller reduction in washout component on dynamic contrast agent–enhanced MR imaging assessed by computer-aided evaluation after neoadjuvant chemotherapy were independent parameters of worse recurrence-free survival and overall survival in breast cancer patients who received neoadjuvant chemotherapy. (more…)
Author Interviews, Prostate Cancer / 11.09.2013

David F Jarrard, MD Vice Chair for Clinical Affairs Professor of Urology John Livesey Chair in Urologic OncologyMedicalResearch.com Interview with: David F Jarrard, MD Vice Chair for Clinical Affairs Professor of Urology John Livesey Chair in Urologic Oncology   MedicalResearch.com: What are the main findings of the study? Dr. Jarrard: We have developed and externally validated an accurate nomogram for predicting Gleason score 6 upgrading for use in low-risk prostate cancer patients.  This nomogram incorporates only variables available at the time of diagnosis and is unique in its assessment of clinical as well as pathological factors.  Furthermore, we externally validated this study in patients with Gleason 6 prostate cancer of which 90% met the D’Amico criteria for low-risk cancer at 2 other centers (total 2000 patients).  This nomogram will aid in the decision-making process of patients diagnosed with low-risk prostate cancer. (more…)
Case Western, Esophageal, Gastrointestinal Disease, University of Michigan / 11.09.2013

Joel H. Rubenstein, MD, MSc, FACG, FASGE Research Scientist, Veterans Affairs Center for Clinical Management Research Assistant Professor, Division of Gastroenterology, University of Michigan Medical School VA Medical Center 111-D 2215 Fuller Rd. Ann Arbor, MI 48105MedicalResearch.com Interview with: Joel H. Rubenstein, MD, MSc, FACG, FASGE Research Scientist, Veterans Affairs Center for Clinical Management Research Assistant Professor, Division of Gastroenterology, University of Michigan Medical School VA Medical Center Ann Arbor, MI 48105 MedicalResearch.com: What are the main findings of the study? Dr. Rubenstein: In a set of case-control studies within the same population, we found that H. pylori was inversely associated with erosive esophagitis, and with Barrett’s esophagus, but we did not find such a relation with symptoms of gastroesophageal reflux disease (GERD). (more…)
Author Interviews, Colon Cancer / 10.09.2013

Dr. Bettina Scholtka Universität Potsdam Institut für Ernährungswissenschaft Abt. Ernährungstoxikologie Arthur-Scheunert-Allee 114-116 14558 Nuthetal, Germany.Dr. Bettina Scholtka Universität Potsdam Institut für Ernährungswissenschaft Abt. Ernährungstoxikologie Arthur-Scheunert-Allee 114-116 14558 Nuthetal, Germany. MedicalResearch.com: What are the main findings of the study? Answer: The extremely high sensitivity of the WTB-HRM technique allows to find very low amounts of different types of colon cancer initiating gene mutations even in stool samples of patients. The method is able to find the expected mutations as well as unknown mutations. So, by applying WTB-HRM to a panel of especially selected marker genes, it is possible to detect cancer precursors in feces before they progress into a malignant stage. (more…)
Alcohol, Author Interviews, Breast Cancer, JNCI, OBGYNE / 30.08.2013

MedicalResearch.com Interview with: Ying Liu, MD, PhD Instructor, Division of Public Health Sciences Department of Surgery Washington University School of Medicine 660 South Euclid Ave Campus Box 8100 St. Louis, MO 63110 MedicalResearch.com: What are the main findings of the study? Answer: Alcohol intake between menarche (first menstrual period) and first pregnancy was consistently associated with increased risks of breast cancer and proliferative benign breast disease. For every 10 gram/day alcohol intake (approximately a drink a day) during this specific time period, the risk for breast cancer increased by 11% and the risk for proliferative benign breast disease increased by 16%. (more…)
Author Interviews, Coffee, Prostate Cancer, Stanford / 28.08.2013

MedicalResearch.com Interview with: Janet L. Stanford, MPH, PhD Full Member, Research Professor Co-Head, Program in Prostate Cancer Research Fred Hutchinson Cancer Research Center 1100 Fairview Ave. N. M4-B874 Seattle, WA 98109-1024Janet L. Stanford, MPH, PhD Full Member, Research Professor Co-Head, Program in Prostate Cancer Research Fred Hutchinson Cancer Research Center 1100 Fairview Ave. N. M4-B874 Seattle, WA 98109-1024   MedicalResearch.com: What are the main findings of the study? Dr. Stanford: The main finding from our research is that one or more cups of coffee per day is associated with a 56% to 59% reduction in the risk of prostate cancer recurrence or progression in men diagnosed with this common disease.  In our cohort of prostate cancer patients, 61% reported drinking at least one cup of coffee per day, with 14% reporting drinking 4 or more cups per day.  The lower risk for prostate cancer recurrence/progression observed in coffee drinkers, however, was seen even for those who consumed only one cup per day, suggesting that even modest intake of coffee may offer health benefits for prostate cancer patients. (more…)
Author Interviews, Breast Cancer, Cancer Research / 23.08.2013

Solveig Hofvind, PhD Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Majorstua 0403, Oslo, NorwayMedicalResearch.com Interview with: Solveig Hofvind, PhD Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Majorstua 0403, Oslo, Norway MedicalResearch.com: What are the main findings of the study? Dr. Hofvind: We find that if 100 women aged 50 years attend the Norwegian Breast Cancer Screening Program as recommended, every two years until they are 69 years, four women will undergo a needle biopsy with benign outcome (a false positive needle biopsy). In the same group of women, twenty women will be recalled for further examination and have additional imaging, ultrasound, and/or a biopsy with negative outcome (a false positive screening result). (more…)
Author Interviews, Bone Density, Breast Cancer, Mineral Metabolism / 23.08.2013

Richard R. Love, MD MS International Breast Cancer Research Foundation Professor of Medicine and Public Health The Ohio State University Columbus, OHMedicalResearch.com: Interview with: Richard R. Love, MD MS International Breast Cancer Research Foundation Professor of Medicine and Public Health The Ohio State University Columbus, OH MedicalResearch.com: What are the main findings of the study? Answer: Surgical oophorectomy and tamoxifen treatment was associated with no loss of bone mineral density (BMD) in the femoral neck, and loss of BMD in the first year, followed by stabilization in the lumbar spine. (more…)
Author Interviews, Lung Cancer, University of Pennsylvania / 20.08.2013

Sandra Ryeom, PhD, Assistant professor of Cancer Biology, Perelman School of Medicine, University of Pennsylvania MedicalResearch.com Interview with: Sandra Ryeom, PhD, Assistant professor of Cancer Biology, Perelman School of Medicine, University of Pennsylvania MedicalResearch.com: What are the main findings of the study? Answer: We identified an important pathway (calcineurin-NFAT-Angiopoeitin2) in the vasculature of early metastatic lung lesions that is critical for promoting lung metastases. MedicalResearch.com: Were any of the findings unexpected? Answer: Since there is limited understanding of regulation of tumor angiogenesis at metastatic sites, identification of the calcineurin pathway and a newly identified target of calcineurin-NFAT signaling  was all unexpected. (more…)
Author Interviews, Breast Cancer, Genetic Research / 20.08.2013

Steven A. Narod, MD Women’s College Research Institute 790 Bay St, 7th Floor Toronto, ON, M5G 1N8 CanadaMedicalResearch.com Author Interview: Steven A. Narod, MD Women’s College Research Institute 790 Bay St, 7th Floor Toronto, ON, M5G 1N8 Canada MedicalResearch.com: What are the main findings of the study? Answer: We found that the survival of women with breast cancer and a brca1 mutation was similar to that of women with breast cancer and no mutation. (more…)
Biomarkers, Cancer Research / 16.08.2013

MedicalResearch.com Interview with: Martin Köbel M.D. Assistant Professor, Pathology and Lab Medicine
Calgary Laboratory Services 9 3535 Research Road Nw Calgary, Alberta T2L 2K8 Canada MedicalResearch.com: What are the main findings of the study? Answer:  Ovarian carcinomas are now divided into five histological types, which differ with respect to biology and clinical behaviour. However, the histological type assessment varies from center to center. Our study emphasizes the need for a standardized method to identify them. Until such consistent approach is established, histological types from various centers may not comprise the same entities and studies will give inconsistent results. (more…)
Author Interviews, Breast Cancer, Johns Hopkins, Stem Cells / 13.08.2013

Harvard Stem Cell Institute's Kornelia Polyak, MD, PhD, MedicalResearch.com Interview with: Kornelia Polyak, MD, PhD Professor of Medicine Dana-Farber Cancer Institute Harvard Medical School Boston, MA 02215 MedicalResearch.com: What are the main findings of the study? Dr. Polyak: We found that when comparing normal breast tissue of women who have not had children (nulliparous) and those who had children in their early 20s, the largest changes are in breast epithelial progenitors. The frequency of these cells is lower in parous women (women who had children) and the properties are also altered in a way that they are less likely to proliferate. Women with high risk of breast cancer, such as BRCA1 and BRCA2 mutation carriers, have very high frequency of these cells, and also parous women who did get cancer have more than those who did not. These results indicate that the frequency of these cells may predict breast cancer risk. (more…)
Author Interviews, JNCI, Lung Cancer, Sloan Kettering / 09.08.2013

Prasad Adusumilli MD, FACS Associate Member, Thoracic Surgery Memorial Sloan-Kettering Cancer Center New YorkMedicalResearch.com Interview with: Prasad Adusumilli MD, FACS Associate Member, Thoracic Surgery Memorial Sloan-Kettering Cancer Center New York MedicalResearch.com: What are the main findings of the study? Answer: The current standard of care of for early-stage lung adenocarcinoma, the common form of lung cancer is curative-intent surgery either by limited resection, LR (removal of tumor with clear margins) or lobectomy, LO (removal of one-third to one-half of the lung harboring the tumor). Although lung-sparing LR is preferable, there is a reported incidence of 30-40% of recurrences within the same lung. The causative factor/s for these local recurrences is not known. In our study, we analyzed recurrence patterns and pathological features in patients who underwent 476 LO and 258 LR performed at the Memorial Sloan-Kettering Cancer Center, New York. We investigated the morphological patterns in pathology specimens utilizing the recently proposed International Association for the Study of Lung Cancer / European Respiratory Society / American Thoracic Society (IASLC/ERS/ATS) classification. We noticed that presence of micropapillary morphology was associated with three times higher recurrences in patients undergoing LR compared to LO, these recurrences were lower when there is an adequate margin (2 cm) resected beyond the tumor. In patients undergoing LO, the recurrences were 75% less. (more…)
Author Interviews, HIV, Infections, JNCI, Lymphoma / 08.08.2013

MedicalResearch.com Interview with: Satish Gopal, MD, MPH Program in Global Oncology, Lineberger Comprehensive Cancer Center UNC Project-Malawi, Tidziwe Center, Private Bag A-104, Lilongwe, Malawi MedicalResearch.com: What is the primary message our physician readers should take away from the piece?” Answer: Lymphoma is one of the leading causes of HIV-associated death in the modern ART era. In our analyses of a large multicenter US cohort, survival for HIV-associated lymphoma patients receiving routine care has not clearly improved since the modern ART era began, and remains significantly worse than SEER outcomes for the same lymphoma subtypes in the general population. This was somewhat surprising in an era of normalizing life expectancy for HIV-infected patients on ART, and quite different from the outstanding results achieved for this population in recent clinical trials conducted by AMC and NCI. (more…)
Author Interviews, Breast Cancer, Race/Ethnic Diversity / 07.08.2013

MedicalResearch.com Interview with: Lindsey Enewold PhD, MPH Division of Military Epidemiology and Population Sciences John P. Murtha Cancer Center Walter Reed National Military Medical Center Rockville, Maryland MedicalResearch.com: What are the main findings of the study?
 Answer: With increasing time since breast cancer diagnosis women were less likely to receive surveillance mammography. Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within an equal access healthcare system. (more…)
Author Interviews, Colon Cancer, JAMA / 07.08.2013

MedicalResearch.com: Interview with: Samir Gupta, MD, MSCS San Diego Veterans Affairs Healthcare System Associate Professor of Clinical Medicine Division of Gastroenterology, Department of Internal Medicine Moores Cancer Center University of California San Diego MedicalResearch.com: What are the main findings? Dr. Gupta: In a randomized, comparative effectiveness study among uninsured individuals not up to date with screening, we found that mailed outreach invitations to complete colonoscopy outreach, and mailed outreach to complete a non-invasive fecal immunochemical test (FIT) tripled screening rates compared to usual care. Additionally, we found that outreach was almost twice as effective with offers for FIT versus colonoscopy screening. (more…)
Author Interviews, Cancer Research, Pediatrics / 07.08.2013

Kirsten Ness, PT, PhD 
 Epidemiology and Cancer Control MS 735, Room S-6013 St. Jude Children's Research Hospital 262 Danny Thomas Place Memphis, TN 38105-3678MedicalResearch.com Interview with: Kirsten Ness, PT, PhD Epidemiology and Cancer Control MS 735, Room S-6013 St. Jude Children's Research Hospital 262 Danny Thomas Place Memphis, TN 38105-3678 MedicalResearch.com: What are the main findings of the study?  Answer: Even though they report similar levels of physical activity, children who were treated for cancer and who survive at least five years, on average, do not perform as well as their siblings on tests of physical performance.  They have muscle weakness and decreased cardiopulmonary fitness. (more…)