Author Interviews, Endocrinology, JAMA, Prostate Cancer / 18.09.2015

MedicalResearch.com Interview with: Sindy Magnan, MD, MSc, FRCPC Division of Radiation Oncology, Department of Medicine CHU de Québe Université Laval Québec City, Québec, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Magnan : Androgen deprivation is the standard therapy for patients with advanced or recurrent prostate cancer. Intermittent administration of this treatment could offer several advantages over the standard continuous administration by delaying the development of castration-resistant disease and by reducing the drugs’ adverse effects. However, this mode of administration remains controversial. We thus conducted a systematic review with meta-analysis of randomized controlled trials to compare the effectiveness and tolerability of intermittent versus continuous androgen deprivation. Intermittent therapy was non-inferior to continuous therapy with respect to overall survival. No major difference in global quality of life was observed between the two interventions, but some quality-of-life criteria, mainly in relation with physical and sexual functioning, seemed improved with intermittent therapy. (more…)
Author Interviews, Endocrinology, JCEM, Menopause, Mineral Metabolism / 01.09.2015

MedicalResearch.com Interview with: Emily Krantz (né Amundson) MD Södra Älvsborgs Hospital Borås, Sweden Medical Research: What is the background for this study? What are the main findings? Response: This study is a 10-year follow up of a double-blind placebo controlled trial in which women with post menopausal osteoporosis received Growth Hormone (GH) for 3 years (Landin-Wilhelmsen JBMR 2003;18:393-404). Positive effects of the treatment on the patients bone mineral density and bone mineral content were seen after another 7 years. Furthermore and most interestingly, fracture incidence decreased dramatically from 56% to 28% (p=.0003) in the osteoporosis patients while fractures increased significantly in the control group, from 8% to 32% (p=.0008). Health Related Quality of Life was also measured throughout the study’s duration and it did not change nor did it differ from the control group. (more…)
Author Interviews, Dermatology, Endocrinology / 27.08.2015

Abdulmaged Traish; Photo by Vernon Doucette for Boston University Photography MedicalResearch.com Interview with: Abdulmaged M. Traish, MBA, Ph.D. Professor of Biochemistry Professor of Urology Boston University School of Medicine Boston, MA 02118   Medical Research: What is the background for this study?  Dr. Traish: This study was undertaken to evaluate the data in the contemporary literature on the use of finasteride and dutasteride for treatment of ( benign prostatic hypertrophy) BPH and androgenetic alopecia (AGA). These drugs were proven effective in management of patients withy BPH andandrogenetic alopecia; however, these drugs inhibit a family of enzymes widely distributed in many tissues and organs and therefore may have undesirable effects. Most importantly, few studies have been undertaken to evaluate the effects of these drugs on the central nervous system. The adverse impact of these drugs on sexual function and well-being in a subset of patients raised the questions that we do not know much about the safety of such drugs. Medical Research: What are the main findings?  Dr. Traish: The main findings of this study is that these agents, while useful in treatment of BPH and androgenetic alopecia, exert undesirable side effects on sexual function and well-being. More importantly, limited data is available on the impact of these agents on the central nervous system. (more…)
Author Interviews, Endocrinology, JAMA, Radiology, Surgical Research, UCSF / 28.07.2015

Quan-Yang Duh MD Endocrine surgeon UCSF Medical CenterMedicalResearch.com Interview with: Quan-Yang Duh MD Chief, Section of Endocrine Surgery UCSF Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Quan-Yang Duh: At UCSF we have a monthly Adrenal Conference (involving surgeons, endocrinologists and radiologists) to discuss patients we are consulted for adrenal tumors. About 30% of these are for incidentally discovered adrenal tumors (versus those found because of specific indications such as clinical suspicion or genetic screening). Of these 15-20% has bilateral adrenal tumors. The evaluation of unilateral incidentaloma has been very well studied and many national guidelines have been published with specific management recommendations. So during our monthly adrenal conference, we have a routine "script" for evaluation and recommendations (rule out metastasis by looking for primary cancer elsewhere, rule out pheochromocytoma and Cushing, resect secreting tumors or large tumors, and if no operation recommended repeat scan in 6 months, etc.). This “script” has worked very well for patients with unilateral incidentaloma. However, we were less certain when we made recommendations about bilateral incidentalomas because there was very little literature or guidelines written about it. We had some gut feelings, but we were not sure that we were recommending the right things. We needed more data. That was the main reason for the study. What we found in our study was that although the possible subclinical diseases were the same – hypercortisolism and pheochromocytoma, the probabilities were different. The patients with bilateral incidentalomas were more likely to have subclinical Cushing’s and less likely to have pheochromocytomas than those with unilateral incidentalomas. (more…)
Author Interviews, CDC, Endocrinology, JCEM / 16.07.2015

MedicalResearch.com Interview with: Hubert W. Vesper, PhD Director, Clinical Standardization Programs in the National Center for Environmental Health, Centers for Disease Control and Prevention Co-author, “Measuring Estrogen Exposure and Metabolism: Workshop Recommendations on Clinical Issues” Co-chair of the PATH Steering Committee Medical Research: What is the background for this study? What are the main findings? Dr. Vesper: Accurate data on estrogen levels are needed to ensure appropriate and effective patient care. Research studies found high inaccuracies among different estrogen tests, especially at low estrogen levels commonly observed in postmenopausal women, men and children. Accurate estrogen measurements can be achieved through standardization. Stakeholders should support standardization efforts of the Centers for Disease Control and Prevention (CDC) or alternative strategies to arrive at estrogen measurement methods that are accuracy-based and reliable. (more…)
Author Interviews, JCEM, Sexual Health, Testosterone / 11.07.2015

Darius A. Paduch, MD, PhDAssociate Professor of Urology and Reproductive Medicine Director Sexual Health and Medicine Research Director of Male Infertility Fellowship Co-Director Male Infertility Genetics Laboratory Weill Cornell Medical College Dept of Urology New York, NY 10065MedicalResearch.com Interview with: Darius A. Paduch, MD, PhD Associate  Professor of Urology and Reproductive Medicine Director Sexual Health and Medicine Research Director of Male Infertility Fellowship Co-Director Male Infertility Genetics Laboratory Weill Cornell Medical College Dept of Urology New York, NY 10065 Medical Research: What is the background for this study? What are the main findings? Dr. Paduch: Ejaculatory dysfunction, inability to ejaculate or delayed ejaculation affects 10-8% of men. Inability to ejaculate either intravaginally or at all is independent of erectile function. Men with normal erection may take very long time to ejaculate (>30 min) or not able to ejaculate at all. The men in our study had either normal erections or minimal erectile dysfunction. Men of all ages have spontaneous erections but don't ejaculate just from erection, it is progression of arousal and activation of spinal cord motor generator for ejaculation which is necessary for ejaculation. One of important factors in our ability to ejaculate is testosterone (T), testosterone allows for normal function of CNS centers for ejaculation, it is a modulator and is necessary; preadolescent boys don't ejaculate because their spinal cord centers for ejaculations are not mature – process dependent on testosterone. However testosterone is just one of many neurotransmitters and hormones needed of normal ejaculation. Actually our study showed that in men who achieved normal levels of testostosterone the ejaculatory function have improved. As this was first double blinded and randomized clinical trial we had to report our results based on radomization to testosterone treatment or placebo. Unfortunately only 70-80% of men treated with topical testosterone preparation will achieve normal testosterone level , we simply didn’t reach statistical significance based on randomization and  considering relatively low number of patients in each group. But in men who achieved normal testosterone levels the difference was statistically significant. Testosterone should not be used to treat any conditions, including ejaculatory dysfunction, in absence of low testosterone  level. EjD is very common but it bares significant embarrassment stigma, it is difficult for the couple to bear fact that male partner can’t ejaculate, it also creates issues within couple and question about attraction and fidelity. We have previously showed that treatment with tadalafil improves ejaculatory and orgasmic dysfunction and these data has been published. This study was focused on effect of testosterone, but its main significance was it’s design: we developed new tools to assess ejaculatory function and learned a lot about when patients or their partners start to be bothered by EjD. If time to ejaclate takes > 30 min We are now looking into novel and available pharmacotherapy modulating dopaminergic and canabioid signaling and reward mechanisms. I am also very excited about our potential work in direct spinal cord motor generator nano stimulator, this could be very useful for men with spinal cord injuries and diabetic patients. We paved the road for others and I am sure new treatments are just a matter of time. (more…)
Author Interviews, Breast Cancer, Endocrinology, Lancet, Menopause / 08.07.2015

MedicalResearch.com Interview with: Dr. Jürg Bernhard Ph.D. International Breast Cancer Study Group Coordinating Center and Bern University Hospital, Inselspital, Bern, Switzerland Medical Research: What is the background for this study? What are the main findings? Response: In the combined analysis of the SOFT and TEXT trials, the aromatase inhibitor exemestane was more effective than tamoxifen in preventing breast cancer recurrence in young women (premenopausal) who also receive ovarian function suppression (OFS) as adjuvant (post-surgery) treatment for hormone-sensitive early breast cancer, providing a new treatment option for these women. These trials were conducted by the International Breast Cancer Study Group (IBCSG) and involved more than 4700 patients of over 500 centers in 27 countries. Now we present patient-reported quality of life outcomes from these trials. In the TEXT and SOFT trials, patients assigned exemestane+OFS reported more detrimental effects of bone or joint pain, vaginal dryness, greater loss of sexual interest and difficulties becoming aroused, while patients assigned tamoxifen+OFS were more affected by hot flushes and sweats. Global quality of life domains (mood, ability to cope and physical well-being) were similar between the randomized treatment groups. (more…)
Author Interviews, Depression, Sexual Health, Testosterone / 03.07.2015

Michael S. Irwig MD Division of Endocrinology Medical Faculty Associates George Washington UniversityMedicalResearch.com Interview with: Michael S. Irwig MD Division of Endocrinology Medical Faculty Associates George Washington University Medical Research: What is the background for this study? What are the main findings? Response: Many factors are associated with lower testosterone levels and many men who have their testosterone levels checked have non-specific depressive symptoms. The main finding is a remarkably high rate of depression and depressive symptoms (56%) in men who are referred for borderline testosterone levels. Other significant findings include a prevalence of overweight and obesity higher than the general population. (more…)
Author Interviews, Diabetes, Endocrinology, JAMA / 21.06.2015

MedicalResearch.com Interview with: Francis de Zegher, MD, PhD Department of Development and Regeneration, University of Leuven Leuven, Belgium & Lourdes Ibáñez, MD, PhD Hospital Sant Joan de Déu, University of Barcelona Barcelona, Spain Medical Research: What is the background for this study? Response: Hyperinsulinemic androgen excess is the most frequent hormonal disorder of adolescent girls. It seems to be mainly driven by an excessive and/or inappropriate storage of fat due to a chronically positive energy balance. The traditional approach (not approved by FDA or EMA) is to silence the ovaries by giving an oral contraceptive. An alternative approach is to change the storage of fat by giving an insulin-sensitizing combination of generics in low dose. (more…)
Author Interviews, Cost of Health Care, Endocrinology, OBGYNE, Yale / 12.06.2015

Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT 06510MedicalResearch.com Interview with: Aileen Gariepy, MD, MPH Assistant Professor Section of Family Planning Department of Obstetrics, Gynecology, and Reproductive Sciences Yale School of Medicine New Haven, CT Medical Research: What is the background for this study? What are the main findings? Dr. Gariepy: Women who have just given birth are often highly motivated to prevent a rapid, repeat pregnancy.  For women who desire the contraceptive implant, a highly effective reversible form of contraception that is placed in the arm and can last for 3 years, new research shows that it is more cost-effective to place the implant while women are still in the hospital after giving birth, compared to delaying insertion to the postpartum visit 6-8 weeks later which is currently the most common practice. When the costs associated with the implant insertion and the costs of unintended pregnancy are compared in women who receive immediate contraceptive implant insertion (while still in the hospital after giving birth) to women who are asked to come back in 6-8 weeks for the implant insertion (delayed insertion), immediate insertion is expected to save $1,263 per patient.  Based on these estimates, for every 1,000 women using postpartum implant, immediate placement is expected to avert 191 unintended pregnancies and save $1,263,000 compared with delayed insertion in the first year. Cost savings would continue to increase for the second and third year after insertion. In fact, over half of U.S. pregnancies are unintended.  Maternal and infant care costs for unintended pregnancies amount to $11.1 billion annually for public insurance programs alone. The immediate postpartum period (after delivery but before discharge home) provides an ideal opportunity for initiating contraceptives as patients are motivated and timing is convenient. However, the majority of insurance company policies do not provide coverage for insertion of the contraceptive implant when the new mother is still in the hospital.  This lack of reimbursement is the most significant barrier to providing this highly effective contraceptive method for women who have just delivered a baby.  Surprisingly, the reason most insurance companies do not offer reimbursement for immediate insertion is due to an outdated insurance protocol, “the global obstetric fee” which precludes separate reimbursement of individual procedures (like inserting the implant). The main reason that immediate insertion results in cost savings is because more women will get the implant compared to a strategy of delayed insertion.  Women can get pregnant again within 4 weeks of delivering a baby.  Starting contraception as soon as possible after giving birth is important because most women will resume sexual activity before their postpartum office visit and therefore will be at risk of pregnancy. And approximately 35% of women do not return for a postpartum visit. Even for women who want another pregnancy soon, the implant has benefits.  When women conceive and deliver a baby within 2 years of last giving birth, there is a significantly higher risk of poor maternal and neonatal outcomes, including preterm birth, low birth weight, and even early neonatal and maternal death.  Birth spacing is better for moms and babies. (more…)
Author Interviews, Cognitive Issues, Endocrinology, OBGYNE / 03.06.2015

Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, WisconsinMedicalResearch.com Interview with: Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, Wisconsin Dr. Gleason: In this response I refer to hormone therapy (HT), which was formally called hormone "replacement" therapy. In particular, we examined menopausal HT, i.e., the use of HT during the menopausal transition to address menopausal symptoms. Medical Research: What is the background for this study? What are the main findings? Dr. Gleason: The WHI Memory Study (WHIMS) suggested that HT was associated with cognitive harm for women age 65 and older. In contrast, we found that the cognitive performance of women randomized to receive menopausal hormone therapy did not differ from that of women randomized to receive the placebo. On a measure of mood states, women treated with conjugated equine estrogens showed improvements compared to those on placebo. (more…)
Author Interviews, Diabetes, Endocrinology, HIV, Infections, JCEM / 18.05.2015

Kevin Yarasheski, PhD Assistant Director, Biomedical Mass Spectrometry Research Facility Professor of Medicine, Cell Biology & Physiology, Physical Therapy Washington University School of MedicineMedicalResearch.com Interview with: Kevin Yarasheski, PhD Assistant Director, Biomedical Mass Spectrometry Research Facility Professor of Medicine, Cell Biology & Physiology, Physical Therapy Washington University School of Medicine Medical Research: What is the background for this study? Dr. Yarasheski:   People living with HIV and taking combination antiretroviral therapy (cART) have successfully reduced the amount of HIV virus in their blood and have partially reconstituted their immune system (CD4+ T-cell count >250 cells/µL).  Despite this, many still experience residual immune cell activation and inflammation that is believed to increase HIV morbidity (non-AIDS conditions e.g., CVD, T2DM, obesity, liver fat, bone loss, dementia) and mortality.  Scientists are seeking safe and effective interventions for residual immune cell activation and inflammation, that have the potential to reduce non-AIDS complications that threaten quality and quantity of life among HIV infected adults. We have been testing the safety and efficacy of sitagliptin in people living with HIV; a dipeptidyl peptidase 4 inhibitor that is FDA approved for treating T2DM, and appears to have favorable anti-inflammatory and immune modulatory properties that might specifically benefit people living with HIV and experiencing cardiometabolic complications associated with residual immune cell activation and inflammation. Medical Research: What are the main findings? Dr. Yarasheski:   In a randomized, double-blinded, placebo controlled 8-wk trial, we found that sitagliptin had beneficial anti-inflammatory, immune regulatory, hematopoietic progenitor cell mobilizing, and glucose lowering effects in cART-treated virally suppressed HIV adults with impaired glucose tolerance.  Sitagliptin improved glucose tolerance (a risk factor for CVD), reduced circulating and adipose-specific inflammatory markers (risk factors for obesity, T2DM, liver fat accumulation, and CVD), and increased the number of blood stem cells that can repair damage and inflammation in the vascular walls. (more…)
Author Interviews, Testosterone, Urology / 18.05.2015

Ranjith Ramasamy MD Assistant Professor of Urology University of MiamiMedicalResearch.com Interview with: Ranjith Ramasamy MD Assistant Professor of Urology University of Miami Medical Research: What is the background for this study? Dr. Ramasamy: The association between testosterone supplementation therapy (TST) and thrombotic risk in elderly men remains controversial. We evaluated the prevalence of thrombotic events and all-cause mortality in men older than 65 years with hypogonadism treated with testosterone therapy. We compared men treated with testosterone to an age and comorbidity matched cohort of hypogonadal men not treated with testosterone supplementation therapy. Medical Research: What are the main findings? Dr. Ramasamy: No man who received testosterone supplementation therapy died, whereas 6 hypogonadal men who did not receive TST died (p=0.007). There were 4 thrombotic events (1 MI - myocardial infarction, 2 CVA/TIA - stroke, 1 PE - pulmonary embolism) in men who received testosterone supplementation therapy compared to 1 event (CVA/TIA) among men who did not receive TST (p = 0.8). All the events (except one death which took place at 6 months of follow–up) occurred 2 years or more after follow–up. Strengths of the study include long follow–up (>3 years), availability of serum testosterone levels before and after therapy and of a control group (hypogonadal men not treated with TST) for comparison. Limitations included retrospective study design, and a small sample size. (more…)
Author Interviews, Endocrinology, Testosterone, University of Michigan / 17.05.2015

MedicalResearch.com Interview with: Jim Dupree, MD, MPH Assistant Professor Department of Urology, Division of Andrology University of MichiganMedicalResearch.com Interview with: Jim Dupree, MD, MPH Assistant Professor Department of Urology, Division of Andrology University of Michigan Medical Research: What is the background for this study? What are the main findings? Dr. Dupree: There are increasing discussions in the United States about testosterone therapy and men with clinical hypogonadism (or low testosterone).  Yet, to date, there have not been any nationally-representative studies of the prevalence of low testosterone in the United States.  Using a validated national health examination program from the CDC, we found that the national prevalence of low testosterone (serum testosterone ≤ 300 ng/dL) in adult males in the US was 28.9%.  Among other factors, men who were older, had a higher body mass index (BMI), or had a larger waist circumference were at risk for having lower testosterone levels. (more…)
Author Interviews, Endocrinology, Nature, NYU, Social Issues / 16.04.2015

Bianca Jones Marlin, PhD Froemke Laboratory New York University Langone School of MedicineMedicalResearch.com Interview with: Bianca Jones Marlin, PhD Froemke Laboratory New York University Langone School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Marlin: Oxytocin is a hormone that plays an important role in the expression of social and parental behaviors, but little is know about how it works in the brain to produce these behaviors. Virgin mice will usually ignore, and sometimes cannibalize newborn mouse pups. Our study has shown that oxytocin works in the auditory cortex of virgin mice to change both their neural responses, and eventually their behaviors, to mirror the maternal response. (more…)
Author Interviews, Depression, Endocrinology, Testosterone / 09.04.2015

Mohamed Kabbaj, PHD Professor of Biomedical Sciences & Neurosciences College of Medicine Florida State UniversityMedicalResearch.com Interview with: Mohamed Kabbaj, PHD Professor of Biomedical Sciences & Neurosciences College of Medicine Florida State University Medical Research: What is the background for this study? What are the main findings? Dr. Kabbaj: While anxiety and depressive disorders a major public health concern worldwide, so too are the pervasive sex differences that exist within these pathologies. Fluctuations in the predominant female reproductive hormones, estradiol and progesterone, are thought to be a major contributor to the higher prevalence of anxiety and depression in women compared to men. However, many studies in humans and rodents alike have demonstrated that testosterone, the primary male sex hormone, also influences affective status and may yield protective benefits against the development of mood-related disturbances. Indeed, hypogonadal males with low testosterone levels experience increased rates of anxiety and depressive symptoms. In many of these cases, testosterone replacement alone or in addition to antidepressant medication have been shown to effectively improve mood. How this hormone acts in the brain to exert its beneficial effects, however, is much less clear. Interestingly, it is well-known that many of testosterone’s effects in the brain occur via its conversion to estrogen by the enzyme aromatase. What remained unclear was whether or not this conversion to estrogen was critical for testosterone’s protective anxiolytic and antidepressant effects—so Nicole Carrier and Samantha Saland from Dr. Kabbaj’s lab aimed to figure out just that. To do this, Carrier and Saland targeted an area of the hippocampus in the brain involved in mood regulation where testosterone is known to act to carry out some of its anxiolytic and antidepressant effects in male rats. Here, they inhibited the enzyme responsible for the conversion of testosterone into estrogen and investigated performance in mood-related behaviors. In doing so, they discovered that testosterone’s anxiolytic- and antidepressant-like effects were lost unless this hormone was first converted into estrogen. Importantly, they also found that continuous testosterone and estrogen treatments had very similar effects on the expression of genes within this brain region that are highly implicated in the regulation of mood as well as antidepressant treatments. (more…)
Author Interviews, Endocrinology, JCEM, Metabolic Syndrome, Sleep Disorders / 03.04.2015

CDC- sleepMedicalResearch.com Interview with: Nan Hee Kim M.D., Ph.D., Professor Korea University Ansan Hospital, Gojan1-dong, Danwon-gu, Gyunggi-do, Korea MedicalResearch: What is the background for this study? Dr. Nan Hee Kim: Many individuals in modern society experience a discrepancy between social and biological time. Especially during the work or school week, we are often forced to be awake against our preferred time. In addition, the increase of light, TV, computer and internet make people stay up late at night. However, night owls (evening persons) have been reported to have more health and behavioral problems than morning persons. Evening persons experience eating disorders, negative mood and insufficient sleep compared to morning persons. They initiate sleep later in the night but need to wake up earlier than their biologic morning due to social demands. There is abundant evidence that short sleep duration and insomnia are significant risk factors for obesity and diabetes. Therefore, we feel the necessity to reveal whether evening persons are associated with metabolic abnormalities in the general population. MedicalResearch: What are the main findings? Dr. Nan Hee Kim: In middle-aged adults, people who stayed up late had a 1.7-fold increased risk for type 2 diabetes and metabolic syndrome, and a 3.2-fold increase in risk for sarcopenia as compared with morning persons, independent of sleep duration and lifestyle. Evening persons were associated with reduced muscle mass in men and increased fat mass including visceral fat in women. (more…)
Author Interviews, Endocrinology, Weight Research / 11.03.2015

Elizabeth A. Lawson, M.D., M.M.Sc. Assistant Professor of Medicine Harvard Medical School Director, Interdisciplinary Oxytocin Research Program Neuroendocrine Unit Massachusetts General Hospital Boston, MA 02114MedicalResearch.com Interview with: Elizabeth A. Lawson, M.D., M.M.Sc. Assistant Professor of Medicine Harvard Medical School Director, Interdisciplinary Oxytocin Research Program Neuroendocrine Unit Massachusetts General Hospital Boston, MA 02114 Medical Research: What is the background for this study? What are the main findings? Response: Oxytocin is a hormone produced in the brain that has been shown to reduce food intake in animal studies. The role of oxytocin on appetite and food consumption in humans is not well understood. We therefore performed a randomized, placebo controlled cross-over study of single dose administration of intranasal oxytocin (Syntocinon, Novartis) in healthy men. Subjects presented fasting in the early morning and were randomized to receive 24 IU intranasal oxytocin or placebo. They selected breakfast from a menu and were offered double portions. The caloric content of the food they ate was calculated. They returned for a second visit, which was the same except for this time, they received the other treatment (placebo or oxytocin). There was no difference in how much food the men reported eating in the three days leading up to each of the study visits. On average, the men ate 122 fewer calories and about 9 grams less fat after receiving oxytocin compared to placebo. There was also evidence that oxytocin resulted in greater use of fat as a fuel for the body, and improved insulin sensitivity. (more…)
Author Interviews, Endocrinology, Metabolic Syndrome, Nutrition, Pediatrics, UT Southwestern / 06.03.2015

Dr. Roy Kim, MD Depts. Endocrinology and Pediatrics UT Southwestern Medical CenterMedicalResearch.com Interview with: Dr. Roy Kim, MD Depts. Endocrinology and Pediatrics UT Southwestern Medical Center Medical Research: What was the problem you were focused on? Dr. Kim: We were focused on the problem of adolescent metabolic syndrome, a major public health problem. Our objective was to determine whether nut intake is linked with any difference in odds for metabolic syndrome in US adolescents. Medical Research: How is metabolic syndrome defined? Dr. Kim: In general it is diagnosed when there are 3 or more of the following things: increased belly fat, high blood pressure, high fasting glucose, elevated triglycerides, and low HDL cholesterol. Medical Research: How did you do your study? Dr. Kim: We used data from the National Health and Nutrition Examination Survey (NHANES), years 2003-2010, to examine health status and the diet history for 2,322 US adolescents age 12 to 19 years. Dr. Kim: Our first major finding was that adolescents who ate at least 12.9 grams of nuts per day - this is the equivalent of about 1 ounce of nuts 3 times per week – had a dramatically lower odds for metabolic syndrome compared to adolescents who ate less than that amount. The odds for nut-consumers was only about 43% of the odds for non-consumers. This remained true after controlling for age, gender, race, income, and dietary factors including sugar, fruit, and vegetable intake. Our second major finding was that average nut intake is very low among US adolescents – only about 5 grams per day - and more than 75% of US adolescents eat no nuts at all on a typical day. (more…)
Author Interviews, Endocrinology, JAMA, Thyroid Disease / 05.03.2015

Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma RomaMedicalResearch.com Interview with; Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma Roma MedicalResearch: What is the background for this study? What are the main findings? Dr. Filetti: Thyroid nodule diagnosis is becoming more and more frequent in clinical practice. This trend stems largely from the incidental discovery of small nodules due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Ultrasound studies, for example, are widely used for evaluating other structures in the neck, such as the carotid arteries, parathyroid glands, lymph nodes, and salivary glands. Over 90% of detected thyroid nodules are clinically insignificant, in that they have been cytologically proven to be benign or they have no ultrasound features that raise the suspicion of malignancy. However, consensus is lacking regarding the best way to follow these nodules, mainly because little is known about the actual frequency and magnitude of their growth. The results of our study suggest that most benign nodules exhibit no significant size changes over time, and some actually decrease in size. Only a small subgroup of nodules can be expected to grow, about 15% in our series. However, the growth is slow and limited in magnitude. Most important, the occurrence of cancer is very rare in nodules like this, that appear to be benign. (more…)
Author Interviews, Endocrinology, Pediatrics, Sleep Disorders, Vanderbilt / 28.02.2015

Dave Kennaway, PhD Professor, Lloyd Cox Senior Research Fellow, Head Circadian Physiology Laboratory School of Paediatrics and Reproductive Health Robinson Research Institute, Faculty of Health Sciences, Medical School, University of Adelaide AustraliaMedicalResearch.com Interview with: Dave Kennaway, PhD Professor Lloyd Cox Senior Research Fellow, Head Circadian Physiology Laboratory School of Paediatrics and Reproductive Health Robinson Research Institute, Faculty of Health Sciences, Medical School, University of Adelaide Australia MedicalResearch: What is the background for this review? What are the main findings? Dr. Kennaway: There is evidence that melatonin is being prescribed to for sleep disorders in children and adolescents who are developing normally despite the fact that there have been no properly designed studies on the effects of prolonged administration to children. In countries where melatonin has been registered, it is for use as a monotherapy for the short term treatment of primary insomnia, characterised by poor quality of sleep in patients who are aged 55 years and over. Use in Paediatrics is always “off-label”. After more than 50 years of melatonin research in animals there is overwhelming evidence that melatonin administration affects many organ systems. These include important effects on the reproductive organs of rodents, cats, ruminants and primates and melatonin is in fact registered as a veterinary drug for this purpose. The effects of melatonin, however, go beyond the potential reproductive consequences, including effects on cardiovascular, immune and metabolic systems. It is clear that many paediatricians, practitioners and parents are unaware of this. MedicalResearch: What should clinicians and patients take away from your report? Dr. Kennaway: Clinicians and patients need to recognise that melatonin is a hormone and not a drug developed for a specific purpose or illness. There have been no appropriate trials in children addressing the effects of prolonged administration of melatonin in children. Given the extensive literature on the role of the hormone in normal physiology it is unlikely that such trials would ever be approved. Should endocrine or other abnormalities appear in the future in children previously treated with melatonin it will not be tenable to argue that we were surprised. (more…)
Author Interviews, BMJ, Endocrinology, Thyroid Disease / 25.02.2015

Professor Stephen Peckham Director, Centre for Health Services Studies Professor of Health Policy Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine Director, Policy Research Unit in Commissioning and the Healthcare System University of KentMedicalResearch.com Interview with: Professor Stephen Peckham Director, Centre for Health Services Studies Professor of Health Policy Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine Director, Policy Research Unit in Commissioning and the Healthcare System University of Kent   Medical Research: What is the background for this study? What are the main findings? Response: Community water fluoridation remains a controversial public health measure. There have been continued debates about both its effectiveness in the prevention of dental caries and also its safety. Previous studies have suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism few population level studies have been undertaken. In April 2014 Public Health England published a monitoring report that used secondary analysis of routine health statistics to identify whether water fluoridation in England was associated with any adverse health outcomes. While hypothyroidism data is available this was not included in their monitoring report.  In England approximately 10% of the population lives in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. Tt examine whether there is a relationship – as suggested in smaller studies – we used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/13 Quality Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner (GP) registered patient numbers, and 2012 practice level Index of Multiple Deprivation scores. We found a positive association between fluoride levels and hypothyroidism. High hypothyroidism prevalence was found to be at least 30% more likely in practices located in areas with fluoride levels in excess of 0.3mg/L. This population study supports earlier hypotheses that fluoride is associated with hypothyroidism. In the UK water is fluoridated at 1ppm (1mg/L) and in areas where water is fluoridated the model predicts that after controlling for other factors, practice populations are significantly more likely to have higher levels of hypothyroidism than those in non-fluoridated areas. Higher levels of fluoride in drinking water, therefore, provide a useful contribution for predicting prevalence of hypothyroidism. For example in contrasting two urban areas we found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area). (more…)
Author Interviews, Hormone Therapy, Lancet, Prostate Cancer, Radiation Therapy / 22.02.2015

Almudena Zapatero MD PhD Senior Consultant Dpt Radiation Oncology Instituto Investigación Sanitaria IIS-IP Hospital Universitario de la Princesa MadridMedicalResearch.com Interview with: Almudena Zapatero MD PhD Senior Consultant Dpt Radiation Oncology Instituto Investigación Sanitaria IIS-IP Hospital Universitario de la Princesa Madrid Medical Research: What is the background for this study? What are the main findings? Dr. Zapatero: There is a significant body of evidence from randomized trials showing a significant improvement in clinical outcome with the combination of androgen deprivation and conventional-dose radiotherapy (≤70 Gy) in patients with high-risk and intermediate-risk prostate cancer. However, the optimal duration the optimum duration of androgen deprivation in the setting of high-dose radiotherapy remained to be determined. The results of our trial (DART01/05) show that 2 years of adjuvant androgen deprivation is superior to 4 months androgen deprivation when combined with plus high-dose radiotherapy  in terms of biochemical control, freedom from metastasis and overall survival, particularly in patients with high-risk prostate cancer. (more…)
Author Interviews, Endocrinology, Sexual Health / 15.02.2015

Joshua D. Safer MD, FACP Director, Endocrinology Fellowship Training and Endocrinology Education Boston University Medical Center Associate Professor of Medicine and Molecular Medicine Boston University School of Medicine MedicalResearch.com Interview with: Joshua D. Safer MD, FACP Director, Endocrinology Fellowship Training and Endocrinology Education Boston University Medical Center Associate Professor of Medicine and Molecular Medicine Boston University School of Medicine   Medical Research: What is the background for this study? What are the main findings? Dr. Safer: This is a review of the current medical literature in favor of the biologic nature of gender identity.  The main barrier to medical care for transgender patients is lack of physicians with the knowledge and willingness to provide that care. A major concern of physicians is that this is a mental health issue, meaning that transgender hormone therapy and surgery may be too drastic a response to an individual who should be counseled instead.  The review lays out the evidence to make it clear that a major component of gender identity is biologic even if we don’t have the exact details worked out.  Therefore, counseling alone cannot address the disconnect between transgender individuals’ gender identity and their physical bodies. (more…)
Author Interviews, Endocrinology, Toxin Research / 05.02.2015

Dr. Andrea Gore PhD Gustavus & Louise Pfeiffer Professor University of Texas Austin/Div of Pharmacology/ToxicoMedicalResearch.com Interview with: Dr. Andrea Gore PhD Gustavus & Louise Pfeiffer Professor University of Texas Austin/Div of Pharmacology/Toxicology MedicalResearch.com Editor’s Note: Dr. Gore, Editor-in-Chief of the Journal Endocrinology, has graciously answered several questions regarding the recent concerns of environmental chemicals linked to both early puberty and early menopause. Medical Research: How can chemicals found inside the home impact onset of menopause? Dr. Gore: It is important to clarify that the cause-and-effect relationship between chemicals and menopause is not established. The timing of menopause in women is due to a variety of factors including genetic traits, nutritional status, and general health or chronic disease. Some research on humans, including the recent study by Grindler et al., also suggests that environmental chemicals may contribute to the timing of earlier menopause. Animal models also suggest an advance in the timing of reproductive failure following earlier life exposures to endocrine-disrupting chemicals (EDCs). [See references below]. The question of exactly how chemicals may change the timing of menopause is therefore unresolved, but based on animal studies it is likely that the mechanisms include effects of endocrine-disrupting chemicals on the expression of genes and proteins involved in ovarian function that may lead to premature loss of follicles (eggs). Because the control of reproduction involves the brain and the pituitary gland, as well as the ovary, it is possible that endocrine-disrupting chemicals also impair how these organs regulate reproductive hormones.
  1. Gore AC, Walker DM, Zama AM, Armenti AE, Uzumcu M. Early life exposure to endocrine-disrupting chemicals causes lifelong molecular reprogramming of the hypothalamus and premature reproductive aging. Mol Endocrinol. 2011;25:2157–2168.
  2. Shi Z, Valdez KE, Ting AY, Franczak A,GumSL, Petroff BK. Ovarian endocrine disruption underlies premature reproductive senescence following environmentally relevant chronic exposure to the aryl hydrocarbon receptor agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin. Biol Reprod. 2007;76:198–202.
  3. Akkina J, Reif J, Keefe T, Bachand A. Age at natural menopause and exposure to organochlorine pesticides in Hispanic women. J Toxicol Environ Health A. 2004;67:1407–1422.
  4. Cooper GS, Savitz DA, Millikan R, Chiu Kit T. Organochlorine exposure and age at natural menopause. Epidemiology. 2002;13: 729–733.
  5. Hatch EE, Troisi R, Wise LA, et al. Age at natural menopause in women exposed to diethylstilbestrol in utero. Am J Epidemiol. 2006;164:682–688.
  6. KnoxSS, Jackson T, Javins B, Frisbee SJ, Shankar A, DucatmanAM. Implications of early menopause in women exposed to perfluorocarbons. J Clin Endocrinol Metab. 2011;96:1747–1753.
  7. Farr SL, Cai J, Savitz DA, Sandler DP, Hoppin JA, Cooper GS. Pesticide exposure and timing of menopause: the Agricultural Health Study. Am J Epidemiol. 2006;163:731–742.
Medical Research: What are the primary sources of exposure to these chemicals? Dr. Gore: Endocrine-disrupting chemicals exposures come from a variety of sources, including plastic containers (e.g. water bottles) and other products, certain foods, personal care products, pesticides, and many others. (more…)
Author Interviews, Endocrinology, JCEM, OBGYNE / 28.01.2015

Roger Hart MD FRANZCOG MRCOG CREI Winthrop Professor of Reproductive MedicineSchool of Women's and Infants Health Director of Fertility Specialists of Western Australia The University of Western Australia Perth Western Australia 6008MedicalResearch.com Interview with: Roger Hart MD  FRANZCOG MRCOG CREI Winthrop Professor of Reproductive MedicineSchool of Women's and Infants Health Director of Fertility Specialists of Western Australia The University of Western Australia Perth Western Australia 6008 Medical Research: What is the background for this study? What are the main findings? Dr. Hart: PCOS is a very common condition affecting approximately 1 in 12 women and has an estimated annual impact upon the health system in the USA of up to $4.36 billion per year. PCOS is a condition that often manifests itself early in girls life with menstrual problems in adolescence and may lead to reduced fertility in later life due to problems with ovulation. Previous studies have suggested that women with this condition may have other problems in later life, however they have generally been small studies over a short duration. We studied women from 15 years of age, who were admitted to a hospital in Western Australia where a diagnosis of PCOS was recorded on admission. We compared them to women who did not have a PCOS diagnosis recorded on admission using our state-wide hospital database system data linkage. The medical records of 2,566 women with a PCOS diagnosis were followed from 1980 onwards until an average of almost 36 years, and these women were matched to 25,660 women without PCOS. Women with PCOS on average had twice as many hospital admissions and unfortunately were twice as likely to die during the study period. As expected women with PCOS women had a higher rate of menstrual problems and infertility, and require IVF treatment, have a miscarriage or an ectopic pregnancy, and ultimately require surgical intervention for heavy periods and a hysterectomy. In pregnancy women with PCOS were more likely to deliver preterm or have a stillbirth. In addition women with PCOS were four times more likely to develop late onset diabetes, even after taking into consideration obesity. These women wore more likely to have problems with blood pressure and ischemic heart disease, despite being relatively young. They were more likely to develop a deep vein thrombosis and have a diagnosis of asthma. With regard to mental health women with PCOS were twice as likely to have a diagnosis of stress and anxiety and depression. They were more likely to be a victim of self-harm and be involved with a land transport accidents. With regard to cancer; cervical cancer was diagnosed less frequently in women with PCOS, but they had an increased risk of cancer of the womb. The incidence of breast and skin cancers was no different between the groups. (more…)
Author Interviews, Heart Disease, Mayo Clinic, Testosterone / 27.01.2015

Abraham Morgentaler, MD Director and Founder Men’s Health BostonMedicalResearch.com Interview with: Abraham Morgentaler, MD Director and Founder Men’s Health Boston Medical Research: What is the background for this study? What are the main findings? Response: There has been  tremendous media attention over the last 15 months to two retrospective studies that reported increased cardiovascular risks with testosterone. Those reports anchored a variety of stories critical of testosterone therapy for non-scientific reasons, such as alleged dangers of direct-to-consumer advertising.  In this review we investigated the two recent studies in depth, as well as the broader literature regarding testosterone and cardiovascular issues. One primary finding was that the studies alleging risk were remarkably weak and flawed- one reported low rates of MI and had no control group, and the other had such large data errors (nearly 10% of the all-male population turned out to be female!) that 29 medical societies have called for its retraction. In contrast, there is substantial literature suggesting that testosterone therapy, or naturally occurring higher levels of testosterone, is protective against atherosclerosis, and mortality.  Several small randomized controlled trials in men with known heart disease- angina and congestive heart failure- have even shown benefits for men that received testosterone compared with placebo. (more…)
Author Interviews, Endocrinology, Toxin Research, University of Michigan / 21.01.2015

Vasantha Padmanabhan, MS, PhD Professor, Departments of Pediatrics, Obstetrics and Gynecology, Molecular and Integrative Physiology, and Environmental Health Sciences University of Michigan Ann Arbor, Mi 48109MedicalResearch.com Interview with: Vasantha Padmanabhan, MS, PhD Professor, Departments of Pediatrics, Obstetrics and Gynecology, Molecular and Integrative Physiology, and Environmental Health Sciences University of Michigan Ann Arbor, Mi 48109 Medical Research: What is the background for this study? What are the main findings? Response: Controversy exists regarding the human health effects of bisphenol A (BPA), an endocrine-disrupting industrial chemical, present in plastic products, baby bottles, food can liners, and wide array of paper products including cash receipts. BPA has been linked to adverse metabolic effects, including obesity, diabetes and cardiac disease.  This study examined if exposure to bisphenol A during pregnancy, at levels humans are exposed to, induces oxidative stress, a major contributor to the development of insulin resistance, type 2 diabetes, metabolic syndrome, and cardiovascular disease. Findings from this multi species study show an association between higher maternal- and cord-blood BPA levels and 3-nitrotyrosine Y (NY), a marker of oxidative stress, in 24 pregnant women. Similar effect on oxidative stress was also found when human-comparable BPA doses were given to pregnant sheep and rats. Similarity of findings between BPA exposure and oxidative stress in the human association study and animals testing study raises concern about potential risk of BPA later in life. (more…)