MedicalResearch.com Interview with:
Dr. John K. DiBaise MD
Gastroenterology and Hepatology
Mayo Clinic, Scottsdale Arizona
Medical Research:What is the background for this study? What are the main findings?Dr. DiBaise: Despite nearly 25 years of safe and effective use of proton pump inhibitors (PPI), in recent years there have been an increasing number of reports suggesting potentially harmful effects and harmful associations with their use. One such association with PPI use has been Clostridium difficile infection (CDI) which can cause severe and recurrent episodes of diarrhea. Previous reports evaluating the microbes present within the gastrointestinal tract (ie, gut microbiome) of individuals with CDI have shown a reduction in overall microbial community diversity. We studied the gut microbiome in healthy individuals both before and after using a proton pump inhibitors for one month and found a similar reduction in microbial diversity while taking the PPI that did not entirely revert back to the ‘normal’ baseline after being off the medication for a month. While this does not demonstrate a causal association between proton pump inhibitors use and CDI, it demonstrates that PPI use creates a situation in the gut microbial environment that may increase the individual’s susceptibility to CDI.
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Medical Research.com Interview with:
Surakit Pungpapong, M.D.
Transplant Hepatologist
Associate Professor of Medicine
Mayo Clinic, Jacksonville, Fla.
Medical Research: What is the background for this study? What are the main findings?Dr. Pungpapong: This study reports our multicenter experience from Mayo Clinic’s three sites using sofosbuvir and simeprevir with/without ribavirin for 12 weeks to treat hepatitis C genotype 1 recurrence after liver transplantation. We found that this all-oral interferon-free antiviral regimen was very well tolerated with minimal to mild side effects. It required minimal dose adjustment of immunosuppression and no episode of acute rejection occurred. Overall, sustained virologic response rate was very high, more than 90 percent.
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MedicalResearch.com Interview with:Edith A. Perez, MD
Mayo Clinic
Jacksonville, FL 32224
Medical Research: What are the main findings of the study?Dr. Perez: Our joint analysis of two large prospective trials showed that adding one year of Trastuzumab to otherwise standard adjuvant chemotherapy significantly improved long term survival in women with resected HER2+ breast cancer.
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MedicalResearch.com Interview with: Shadi Rashtak, MD
Department of Dermatology
Mayo Clinic College of Medicine
Rochester, Minnesota
Medical Research: What are the main findings of the study?Dr. Rashtak:We found that among a population of mainly acne patients those who received isotretinoin had a lower risk of inflammatory bowel disease as compared to those who did not take this medication. We carefully reviewed the medical records of patients to ensure that this finding was not simply because the drug was avoided in patients with a previous personal or family history of IBD.
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MedicalResearch.com Interview with:
Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn
Medical Research: What are the main findings of the study?
Dr. Bingener:Other investigators have shown that preoperative quality of life is a predictor for postoperative survival in colon and pancreas cancer surgery. In this study we looked as preoperative quality of life as a predictor for postoperative complications. The main findings of the study were that patients who had a deficit in their quality of life before surgery had a 3 times higher risk of a serious complication before leaving the hospital than patients who had normal quality of life (16% vs 6 %), independent of gender, race, tumor stage or laparoscopic or open colectomy. Patients with serious complications before leaving the hospital also were older and had more other medical problems than patients without complications. Further, patients who had a complication stayed in the hospital longer and their postoperative quality of life was worse (more…)
MedicalResearch.com Interview with:Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.
Medical Research: What are the main findings of the study? Dr. Bingener-Casey: “About half of patients seeking emergency care for gallbladder problems were immediately admitted and underwent urgent cholecystectomy, the other half went home. The half that went home was younger and had lower WBC counts, lower neutrophils and less people with elevated temperature than the patients immediately admitted. Of the half that went home, 31% returned at least once to the ED within 30 days and 20% were admitted to undergo urgent cholecystectomy after the return visit, 55% percent of those within 7 days of the initial ED visit. Patients who failed the elective treatment plan had similar WBC counts but were more likely to have an ASA >3, slightly higher creatinine and higher average maximum VAS pain score. Patients who were less than 40 years old or older than 60 years were more likely to fail the elective pathway.”
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MedicalResearch.com Interview with Dr. John C. Lieske, MD
Mayo Clinic, Rochester, MN
Medical Research: What are the main findings of the study?Dr. Lieske:We followed 11 women before, 6 and 12 months after Roux en Y gastric bypass surgery. The patients successfully lost weight as mean BMI fell from 46 kg/m2 preoperatively to 28 kg/m2 postoperatively. Mean serum creatinine did not significantly change from baseline (0.8 mg/dl) to 12 months (0.7 mg/dl). Hence mean GFR estimated by the CKD-EPI equation (eGFR) did not significantly change from 84 ml/min/1.73 m2 (baseline) to 90 ml/min/1.73 m2 (12 months). However, GFR measured by iothalamate clearance (mGFR) significantly decreased from 108 ml/min/1.73m2 (121 ml/min) to 85 ml/min/1.73 m2 (90 ml/min).
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MedicalResearch.com Interview Invitation Dr. Bryan K. Woodruff
Assistant Professor of Neurology
Mayo Clinic, Arizona
Medical Research: What are the main findings of the study?Dr. Woodruff: There is evidence in the medical literature supporting a negative impact of losing a spouse for health conditions such as cancer or cardiovascular disease, but this has not been evaluated in terms of the impact of widowhood on the development of dementia. We used the National Alzheimer’s Disease Coordinating Center (NACC) database, which pools data gathered by multiple federally-funded Alzheimer’s disease research centers to try to answer this question. Specifically, we looked at the age at which individuals ultimately developed dementia in both individuals who lost their spouse and in those who remained married over the course of the study. Surprisingly, the data we analyzed did not support a negative impact of losing a spouse in individuals who had no cognitive difficulties when they entered the study, and we saw a paradoxical effect of widowhood in those with mild cognitive impairment (MCI).
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MedicalResearch.com Interview with:Stephanie Faubion, M.D
Director of the Women’s Health Clinic
Mayo Clinic in Rochester
Medical Research: What are the main findings of the study?Dr. Faubion:In this study that included over 1800 women, we found that caffeine intake was associated with more bothersome hot flashes and night sweats in postmenopausal women.
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MedicalResearch.com Interview with: Dr. Robert Foote MD
Chair, Department of Radiation Oncology
Mayo Clinic, Rochester, MN
MedicalResearch: What are the main findings of the study?Dr. Foote: Charged particle therapy (mainly protons and carbon ions) provide superior overall survival, disease-free survival and tumor control when compared to conventional photon therapy. In particular, it appears that proton beam therapy provides superior disease-free survival and tumor control when compared to the state of the art intensity modulated radiation therapy using photons.
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MedicalResearch.com Interview with: Dr. John A. Copland, PhD
Associate Professor of Biochemistry/Molecular Biology
Professor of Cancer Biology
Cancer Basic Science
Mayo Clinic, Jacksonville, Florida
MedicalResearch: What are the main findings of the study?Dr. Copland: In our study we identified a pro-cancerous role for a novel protein- neuronal pentraxin 2 (NPTX2). This protein, normally found expressed in brain and nervous system tissues, is highly overexpressed in kidney tumors at all stages of disease. It has never previously been associated with kidney cancer, nor has it been associated with an oncogenic function in any other cancer. NPTX2 appears to play a significant role in not only tumor cell survival, but it also promotes tumor cell migration through activation of the ionotropic glutamate receptor 4 (GluR4). GluR4, also commonly associated with nervous system tissues, appears to be manipulating the flow of calcium into the tumor cell. Both NPTX2 and GluR4 are not components of normal kidney cell function. Because calcium is an important co-factor for many signaling pathways controlling cell growth, survival, and mobility, unconstrained calcium levels in a cell can promote malignancy. We show that calcium calmodulin kinase and AKT, two oncogenic signaling pathways are activated by NPTX2 via calcium influx.
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MedicalResearch.com Interview with: Xuemei Sui, MD, MPH, PhD
Assistant Professor, Department of Exercise Science
Division of Health Aspects of Physical Activity
Arnold School of Public Health
University of South Carolina
Columbia, SC 29208
MedicalResearch: What are the main findings of the study?Dr. Sui: In the present study, cancer survivors who reported performing resistance exercise (RE) at least 1 day of the week had a 33% lower risk of all-cause mortality compared with individuals who did not report participation in resistance exercise. Further, there was an inverse relationship between resistance exercise and all-cause mortality in those who were physically active, but not in those who were physically inactive. Although leisure-time physical activity was not associated with a lower risk of all-cause mortality, the present results support the benefits of resistance exercise and physical activity was during cancer survival.
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MedicalResearch.com Interview with: Prashanthi Vemur, Ph.D.
Mayo Clinic
Rochester, Minnesota
MedicalResearch: What are the main findings of the study?Dr. Vemuri: Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic. We studied two non-overlapping components of lifetime intellectual enrichment: education/occupation-score and mid/late-life cognitive activity measure based on self-report questionnaires. Both were helpful in delaying the onset of cognitive impairment but the contribution of higher education/occupation was larger.
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MedicalResearch.com Interview with:Stephanie F. Polites, MD
Department of Surgery and
Michael B. Ishitani, MD
Department of Pediatric Surgery
Mayo Clinic, Rochester, Minnesota
MedicalResearch: What are the main findings of the study?Answer: Though most injuries were in boys, 20% of the injuries occurred in girls. Extremity fractures and head injuries were the most common injuries with older children and boys more likely to sustain extremity fractures while younger children and girls were more likely to have head injuries or concussions. Life threatening injuries were rare, which is reassuring.
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MedicalResearch.com Interview with:Dr. Anders Nykjaer MD, PhD
Mayo Clinic in Florida and
Aarhus University in Denmark
MedicalResearch: What are the main findings of the study?Dr. Nykjaer: It is well known that ADHD is a complex condition caused by a number of factors including genetic and environment. However, approximately 75% etiology is considered to be genetic and a large body of investigations suggests that it is multiple genes each with a moderate effect that is responsible for conferring susceptibility to ADHD. We have here found one single gene the dysfunction of which is sufficient to trigger the disease. The gene encodes a receptor, SorCS2, which ensures correct wiring our reward system during embryonic development. Malfunction of the receptor causes ADHD-like symptoms in mice. It is well accepted that ADHD predisposes to psychiatric disorders and genetic reports have linked variations in the SorCS2 gene with schizophrenia. Studies are currently ongoing to evaluate if mutations disrupting the function of SorCS2 may also result in schizophrenia. If this is the case we have come closer to an explanation for the link between ADHD and psychiatric disorders. In the future when prenatal genetic screening becomes established, non-sense mutations in the SorCS2 gene can be used to predict that the child will develop ADHD with 100% certainty. (more…)
MedicalResearch.com Interview InvitationDr. Barbara Pockaj, MD
Professor of Surgery
Mayo Clinic, Arizona
MedicalResearch: What are the main findings of the study?Dr. Pockaj: The study analyzed 515 triple negative breast cancer samples using a multi-platform approach including whole genome mRNA expression, protein expression, gene copy number changes and gene sequencing for immune markers. The study found that a cohort of the triple negative breast cancer patients had high expression of PD-L1 (program death ligand) and other immune regulators such as CTLA-4 (Cytotoxic T-lymphocyte Antigen) and IDO-1 (indoleamine 2,3-dioxygenase). High PD-L1 expression was found in patients whose tumors were triple negative and androgen receptor negative. High PD-L1 expression was related to DNA repair gene abnormalities including BRCA1.
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MedicalResearch.com Interview with Dr. Derek Radisky PhD
Associate Professor and Consultant
Mayo Clinic Cancer Center
MedicalResearch: What are the main findings of the study? Dr. Radisky: The study used human tissue biopsies to find that production of matrix metalloproteinse-3 (MMP3) in pancreatic cancer biopsies was associated with poorer patient prognosis, and showed through transgenic animal and cell culture experiments that this was due to activation of the oncogenic protein Rac1b. The study thus identifies an MMP3-Rac1b signaling axis that drives pancreatic cancer progression.
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MedicalResearch.com Interview with: Daniel S. Elliott, M.D
MAYO Clinic, Associate Professor
Department of Urology
Section of Pelvic and Reconstructive Surgery
Rochester, Minnesota
MedicalResearch: What are the main findings of the study? Dr. Elliott:The biggest issue is that we were able to devise a new procedure that is a simple outpatient anti-incontinence surgery for women that does NOT use any synthetic meshes. The importance of this is that all traditional (meaning NON-mesh) surgeries for female incontinence have been large surgeries with fairly significant risks such as pain, bleeding and prolonged recovery. When the meshes came out in the late ‘90’s, their big benefit was that they were outpatient and quick procedures. But now that we are discovering all the long term complications from meshes such as chronic pain, scarring, painful intercourse, vaginal extrusion of the meshes, and organ injury, patients have become VERY reluctant and fearful to undergo any mesh type surgery. Therefore, we devised a new procedure that used a very small piece of the patient’s own tissue (from the rectus fascia) and placed this via the “transobturator route.” In the process, we melded together the “best” of both worlds---a NON-mesh, outpatient anti-incontinence procedure that is safe (no long term problems as seen with meshes) .
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MedicalResearch.com Interview with: Sarah P. Psutka, MD
Fellow in Urologic Oncology
Department of Urology, Mayo Clinic
MedicalResearch: What are the main findings of each study? Dr. Psutka: In this study, we analyzed 1335 patients who underwent radical cystectomy at the Mayo clinic between 1996 and 2006. We categorized patients who stayed in the hospital longer than 10 days, putting them in the top 25th percentile of the length of stay, as having a prolonged hospital stay. We noted that prolonged hospital stay was associated with adverse postoperative outcomes, including serious complications and early postoperative death. Patients who had a prolonged length of stay had a higher burden of comorbidities, American Society of Anesthesiologist score, and their Eastern Cooperative Oncology Group Score. A multivariable analysis, holding these factors and other clinically relevant potential confounders constant, revealed that only the ECOG performance score independently predicted whether or not a patient had a prolonged hospital course following radical cystectomy.
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MedicalResearch.com Interview with: Aaron L. Leppin, MD
Knowledge and Evaluation Research Unit
Mayo Clinic, Rochester, Minnesota
MedicalResearch.com: What are the main findings of the study?Dr. Leppin: We conducted a systematic review and meta-analysis of randomized trials assessing the effectiveness of hospital discharge interventions on reducing 30-day readmission rates. We identified 47 trials, 42 of which contributed to the primary meta-analysis.
Overall, the interventions that have been tested to reduce early hospital readmissions reduce them by about 20%.
The ones that are most effective, though, reduce them by almost 40% and use a consistent but complex approach. These interventions make a robust effort to fully understand the patient’s post-discharge context, often by visiting the patient’s home. They focus on identifying all the things the patient needs to do to be well—whether that’s organizing medications, getting a ride to the clinic, or paying the electric bill—and they determine whether the patient has the necessary resources and capacity to pull it all off. When limitations are found, these interventions have a strategy in place to support the patient through the post-discharge period.
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MedicalResearch Interview with:Dr. David Cook MD
Professor in the Department of Anesthesiology
Division of Cardiovascular Anesthesiology
Center for the Science of Health Care Delivery
Mayo Clinic College of Medicine
Rochester, Minnesota.
MedicalResearch: What are the main findings of the study?Dr. Cook: The main finding of the study was that segmentation of a population of surgical patients into groups of higher and lower complexity allowed us to apply a standardized practice, focused factory model to surgical care delivery. A standardized care model improved care process measures such as time on mechanical ventilation or duration of a bladder catheter indwelling. The model reduced resource utilization, decreasing patient time in all care environments (operating room, ICU and on ?the floor?). The care model improved outcomes at 30 days and reduced the costs overall and in every care environment. In addition to the absolute improvements in quality and in cost, the standardized care model reduced variation in all measured variables. That reduction in variation may be even more important than the improved outcomes or reduced costs because we now know it is possible to make the health care experience predictable for these patients. That predictability is critically important to patients and providers, but it also has implications for health care metrics and payment models.
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MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Rates of bilateral mastectomy are higher in hospitals with immediate breast reconstruction available. Bilateral mastectomy rates were highest in hospitals with high volumes of immediate breast reconstruction. Large, teaching, urban, and Northeastern hospitals were more likely to have higher immediate breast reconstruction volumes.
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MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Use of paravertebral block (a form of regional anesthesia) in women undergoing mastectomy results in less need for opioid medications and less frequent use of anti-nausea medication after surgery.
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MedicalResearch.com Interview with:Kejal Kantarci, M.D. M.S.
Professor of Radiology
Division of Neuroradiology
Mayo Clinic, Rochester, MN 55905
MedicalResearch: What are the main findings of the study?Dr. Kantarci: Microinfarcts are one of the most common pathologies identified in the brains of older individuals and they impact cognition. However they are invisible lesions on MRI. We demonstrated that presence of microinfarcts in autopsied individuals are associated with the macroinfarcts identified on their MRI scans than they were alive. We also demonstrated that the presence of these invisible lesions are related to greater brain atrophy rates that are localized to watershed zones.
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MedicalResearch.com Interview with: Tina Hieken, M.D.
Associate Professor of Surgery
Mayo Clinic,Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Hieken: Among more than 1,300 newly diagnosed invasive breast cancer patients, 36 percent of whom were obese (BMI ≥ 30), preoperative axillary ultrasound with fine needle aspiration biopsy of suspicious lymph nodes identified metastasis to the lymph nodes in 36 percent of patients found to be node-positive at operation. For all BMI categories (normal, overweight, obese) axillary ultrasound was predictive of pathologic nodal status (p<0.0001). The sensitivity of axillary ultrasound did not differ across BMI categories while specificity and accuracy were better for overweight and obese patients, respectively, than for normal weight patients. Furthermore, patients across all BMI categories who had suspicious axillary lymph nodes on ultrasound and had a positive fine needle aspiration biopsy had significantly more positive lymph nodes at operation, an average of five metastatic nodes, and an overall higher nodal disease burden at operation.
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MedicalResearch.com Interview with:Eric Matteson, M.D.
Chairman of Rheumatology
Mayo Clinic, Rochester, Minn
MedicalResearch.com: What are the main findings of the study?Dr. Matteson: “The main points are that kidney disease is more common in patients with rheumatoid arthritis than in the general population and that moderate reduction in kidney function was more likely to be associated with cardiovascular disease in these patients as well. Patients with more active disease week are also at higher risk for kidney disease. “
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MedicalResearch.com Interview with Dr. Judy C. Boughey MD
Professor of Surgery
Mayo Clinic, Rochester MN
MedicalResearch.com: What are the main findings of the study? Dr. Boughey: This study showed that the rate of reoperation after lumpectomy for breast cancer was significantly lower at Mayo Clinic in Rochester compared to national data. Mayo Clinic in Rochester uses frozen section analysis of margins at time of lumpectomy to direct any margin re-excisions during the surgery and therefore has a significantly lower rate of need for a second operation to ensure clean margins. The rate of reoperation was four times higher in the national data set than in the Mayo Clinic data set. (more…)
MedicalResearch.com Interview with:Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.
MedicalResearch.com: What are the study’s main findings?Dr. Bingener-Casey: “Patient-reported outcomes such as pain and fatigue are sensitive tools to detect how well patients recover from surgery. These patient-reported outcome results are different for men and women and for older versus younger people.”
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MedicalResearch.com Interview with: Tim Bongartz, M.D.
Associate Professor of Medicine
Department of Rheumatology
Mayo Clinic, Minnesota
MedicalResearch.com: What are the main study findings?Dr. Bongartz: Dual-energy computed tomography (DECT) is an imaging methods that has been in use for many years to classify the material of renal stones. Our study demonstrates that this technology can be useful in identifying monosodium urate deposits in and around joint, allowing to diagnose patients with gout with overall high sensitivity and specificity. Importantly, a stratified analysis of patient subgroups revealed that DECT is less accurate in diagnosing patients with a first flare of gout, emphasizing the importance of careful patient selection when using this new technology. In a "diagnostic-yield" substudy, we explored the question how much DECT could contribute to correctly diagnose patients where clinicians did have a high level of suspicion for gout, but synovial fluid aspiration results came back negative. In about a third of these patients with negative routine testing, we could confirm a diagnosis of gout through use of DECT.
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