Hair Cortisol in the Evaluation of Cushing Syndrome

MedicalResearch.com Interview with:
Mihail Zilbermint, M.D.
Endocrinologist, Office of the Scientific Director

Mihail Zilbermint, M.D. Endocrinologist, Office of the Scientific Director Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health

Eunice Kennedy Shriver
National Institute of Child Health and Human Development
National Institutes of Health 

MedicalResearch.com: What is the background for this study?

Response: Diagnosing Cushing Syndrome is often difficult and challenging.  Diagnosing hypercortisolemia, could require the use of a combination of any of these tests: 24-hour free urine cortisol monitoring, an overnight dexamethasone suppression test, and measurement of late night salivary cortisol.  Cortisol levels may change daily, requiring that testing be repeated.  Undiagnosed and untreated Cushing Syndrome greatly increases morbidity and mortality risk.

Cortisol levels can be detected in hair samples.  Much like hemoglobin A1C is a long-term indicator of blood glucose levels, efforts have been made to determine if hair cortisol could serve as a long-term measure of the body’s glucocorticoid levels.  We sought to compare the results of cortisol levels for Cushing Syndrome patients with data from data on cortisol in hair segments, to gain further information on the role of sampling hair cortisol as an initial or supportive method for diagnosing Cushing Syndrome.

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Smaller and More Stable Than Stem Cells, Exosomes Can Preserve Retinal Cell Function

MedicalResearch.com Interview with:

Ben Mead, BSc, MRes, PhD Section of Retinal Ganglion Cell Biology Laboratory of Retinal Cell and Molecular Biology National Eye Institute, National Institutes of Health Bethesda, Maryland 20892

Dr. Ben Mead

Ben Mead, BSc, MRes, PhD
Section of Retinal Ganglion Cell Biology
Laboratory of Retinal Cell and Molecular Biology
National Eye Institute, National Institutes of Health
Bethesda, Maryland 20892

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Retinal ganglion cells (RGC) in the back of the eye transmit visual information to the brain, via long thread-like extensions called axons, which make up the optic nerve. Loss of these cells is the leading cause of irreversible blindness and can occur through trauma or degenerative diseases, such as glaucoma or optic neuritis. While no treatment yet exists to directly protect RGC from death, mesenchymal stem cells, a type of stem cell isolated from adult bone marrow, have shown therapeutic efficacy in various animal models and are currently undergoing clinical trials.

In this study, we aimed to isolate exosomes, which are small, membrane-enclosed vesicles secreted by bone marrow stem cells (BMSC) and that we believe are associated with the therapeutic effect of BMSCs. Injecting these exosomes into the eyes of animals following an optic nerve injury, was associated with significant neuroprotection of RGC, as well as preservation of RGC function. The protective effects of exosomes appeared to be through their delivery of microRNA, molecules that interfere with or silence gene expression.

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Therapeutic Hypothermia After In-Hospital Cardiac Arrest in Children

MedicalResearch.com Interview with:

Victoria Pemberton, RNC, MS, CCRC Program Officer Division of Cardiovascular Sciences National Heart, Lung, and Blood Institute, NIH Bethesda, Maryland

Victoria Pemberton

Victoria Pemberton, RNC, MS, CCRC
Program Officer
Division of Cardiovascular Sciences
National Heart, Lung, and Blood Institute, NIH
Bethesda, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

  • Previous studies have examined cardiac arrest when it occurs outside of the hospital in both children and adults, with current guidelines recommending hypothermia (body cooling) or normothermia (maintenance of normal body temperature) after such an arrest.   This trial addresses pediatric cardiac arrest in a hospital setting, for which no previous data existed. Because children who experience an in-hospital cardiac arrest differ significantly from children who arrest outside of the hospital, it is important to test these treatments in this population.
  • The trial found no significant differences in survival and neurobehavioral functioning a year after cardiac arrest between children assigned to the hypothermia arm and those assigned to normothermia.

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Premature Midlife Deaths Increase in US Whites and Native Americans

Dr. Meredith Shiels

Dr. Meredith Shiels

MedicalResearch.com Interview with:
Dr Meredith S Shiels

Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, MD

MedicalResearch.com: What is the background for this study?

Response: In most high-income countries, premature death rates have been declining, due to the overwhelming successes of public health efforts to prevent and treat chronic disease. The US is a major outlier, where death rates overall have plateaued, or even increased, as reported recently by our sister agency, the Centers for Disease Control and Prevention. Of particular concern are recent reports of increasing death rates among Americans during mid-life.

To expand upon prior findings, we focused on premature death, which we defined as death occurring between the ages of 25 and 64. We examined finely detailed death certificate data for the entire U.S. population and described changes in death rates during 1999-2014 by cause of death, sex, race, ethnicity, and geography. To provide context to our findings, we compared trends in death rates in the U.S. to England and Wales and Canada.

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Government Endorsed DASH Diet Voted Best Overall

MedicalResearch.com Interview with:

Janet M. de Jesus, M.S., R.D. Program Officer, Implementation Science Center for Translation Research and Implementation Science (CTRIS) National Heart, Lung, and Blood Institute

Janet de Jesus

Janet M. de Jesus, M.S., R.D.
Program Officer, Implementation Science
Center for Translation Research and Implementation Science (CTRIS)
National Heart, Lung, and Blood Institute

MedicalResearch.com: What is the background for the DASH diet? What are the main components?

Response: The DASH eating plan was created for a clinical trial funded by the National Heart, Lung, and Blood Institute (NHLBI). DASH stands for Dietary Approaches to Stop Hypertension. The goal of the original DASH trial was to test the eating plan compared to a typical American diet (at the time in the 1990s) on the effect of blood pressure.

The DASH eating plan is rich in fruits, vegetables, and whole grains. It includes low-fat dairy products, poultry, fish, legumes, vegetable oils, and nuts; and limits intake of sweets and sugar-sweetened beverages and high-fat meats. The eating plan is a good source of potassium, magnesium, and calcium. The DASH eating plan was shown to reduce blood pressure and improve lipid profiles.

A second DASH trial, “DASH-sodium,” showed that adding sodium reduction to the DASH eating plan reduced blood pressure even more.

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Conflicts of Interest In Medical Guideline Committees Underreported

MedicalResearch.com Interview with:

Akilah Jefferson, MD, MSc Postdoctoral Fellow, Clinical Center, Department of Bioethics Clinical Fellow, Allergy and Immunology National Institute of Allergy and Infectious Diseases National Institutes of Health

Dr. Akilah Jefferson

Akilah Jefferson, MD, MSc
Postdoctoral Fellow, Clinical Center, Department of Bioethics
Clinical Fellow, Allergy and Immunology
National Institute of Allergy and Infectious Diseases
National Institutes of Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The guidelines that we looked at in this study were two that resulted in large paradigm shifts. Given their impact, we thought the question of conflicts of interest, which has been problematic among specialty societies in the past, be looked into.

We found that the levels of conflicts of interest among both guideline committees was problematic, and that conflict of interest disclosures often did not match contemporaneous conflict of interest disclosures in published articles.

MedicalResearch.com: What should readers take away from your report?

Response: We want to highlight the need for broader and more explicit adoption of Institute of Medicine (IOM)  standards for conflict of interest management.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We recommend further research into how specialty societies are adopting Institute of Medicine standards, and barriers to adoption. Some work has highlighted how some specialty societies are successfully avoiding conflicts of interest among their guideline writing groups.

MedicalResearch.com: Is there anything else you would like to add?

Response: We hope that our study leads to positive discussions about this topic, and adoption of more standard and transparent methods of conflict of interest disclosure among specialty societies.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Jefferson AA, Pearson SD. Conflict of Interest in Seminal Hepatitis C Virus and Cholesterol Management Guidelines. JAMA Intern Med. Published online January 17, 2017. doi:10.1001/jamainternmed.2016.8439

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

When Should Babies Eat Peanut-Containing Foods?

MedicalResearch.com Interview with:

Anna Nowak-Wegrzyn, MD Associate Professor of Pediatrics Icahn School of Medicine at Mount Sinai Jaffe Food Allergy Institute New York, NY 10029

Dr. Anna Nowak-Wegrzyn

Anna Nowak-Wegrzyn, MD
Associate Professor of Pediatrics
Icahn School of Medicine at Mount Sinai
Jaffe Food Allergy Institute
New York, NY 10029

MedicalResearch.com: What is the background for this study?

Response: Peanut allergy can be fatal, is usually life-long and has no cure. Considering a dramatic increase in prevalence of peanut allergy over the past decades, affecting estimated 2-3% of infants and young children in the US, there is a dire need for prevention. Prior studies determined that risk of peanut allergy is highest in the infants with severe eczema, those with mutations in filaggrin gene resulting in an impaired skin barrier function and those not eating peanut but exposed to peanut in the household dust. In addition, the prevalence of peanut allergy was 10-fold higher among Jewish children in the United Kingdom compared with Israeli children of similar ancestry. In Israel, peanut-containing foods are usually introduced in the diet when infants are approximately 7 months of age and consumed in substantial amounts, whereas in the United Kingdom children do not typically consume any peanut-containing foods during their first year of life.

Based on these observations, a landmark clinical trial (Learning Early about Peanut Allergy, LEAP) has been designed to evaluate whether early introduction of peanut into the diet of infant considered at high risk for peanut allergy can reduce the risk of peanut allergy compared to avoidance of peanut. LEAP and other studies suggested that peanut allergy can be prevented by introduction of peanut-containing foods in infancy. The overall reduction in peanut allergy among the infants in the LEAP trial randomized to an early introduction group compared to those who avoided peanut until age 5 years was 81%.

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Genetic Calcification Disorder May Lead To Better Treatment of Atherosclerosis

MedicalResearch.com Interview with:

Manfred Boehm M.D. Senior Investigator Laboratory of Cardiovascular Regenerative Medicine Center for Molecular Medicine NHLBI-NIH Bethesda, MD 20892

Dr. Manfred Boehm

Manfred Boehm M.D.
Senior Investigator
Laboratory of Cardiovascular Regenerative Medicine
Center for Molecular Medicine
NHLBI-NIH
Bethesda, MD 20892

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Common atherosclerosis (hardening of blood vessels) is the leading cause for vascular diseases worldwide. Vascular calcification is a critical component of atherosclerosis and an indicator of negative outcomes. This process is highly regulated and dynamic. However, the underlying mechanism is poorly understood and no direct treatment is available to stop or reverse this devastating buildup of calcium crystals in the vessel wall. Arterial calcification due to deficiency of CD73 is a rare inherited vascular disease characterized by extensive calcification of blood vessels caused by mutation in a gene encoding an enzyme that generates a compound called Adenosine outside of cells. The lack of this important enzyme, CD73, activates a compensatory mechanism to generated Adenosine by an alternative enzyme. Unfortunately, increased activity of this other enzyme is causing accelerated vascular calcification. By using the patient’s own cells, this study characterized the compensatory signaling pathway and discovered several new treatment strategies.

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Genes Linked To Ectopic Fat Deposition Identified

MedicalResearch.com Interview with:

Audrey Chu, Ph.D. Division of Intramural Research of the National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health

Dr. Audrey Chu

Audrey Chu, Ph.D.
Division of Intramural Research
National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Body shape reflects the underlying adipose tissue distributed throughout different compartments of the body (ectopic fat). Variation in ectopic fat is associated with diabetes, hypertension and heart disease. This is mostly independent of overall adiposity. Ectopic fat can be measured using special x-rays procedures such as CT (“CAT scans”) or MRI and can give more information about fat distribution. Fat distribution characteristics can run in families, suggesting that a person’s genes can help determine the amount of fat that can accumulate in different parts of the body. Identifying genes that are associated with ectopic fat can provide insight into the biological mechanisms leading to differences in cardiometabolic disease risk.

In order to understand which genes might be involved, we examined genetic variants across the genome and their association with ectopic fat in the largest study of its kind including over 18,000 individuals of four different ancestral backgrounds.

Several new genetic regions were identified in association with ectopic fat in addition to confirming previously known regions. The association of the new regions was specific to ectopic fat, since the majority of the regions were not associated with overall or central adiposity. Furthermore, most of these regions were not associated with type 2 diabetes, lipids, heart disease or blood pressure. The major exception was the region surrounding the UBE2E2 gene, which was associated with diabetes.

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Protein Found To Enhance Ability To Kill MRSA

MedicalResearch.com Interview with:

Warren Leonard, M.D. NIH Distinguished Investigator Laboratory of Molecular Immunology NHLBI, NIH

Dr. Warren Leonard

Warren Leonard, M.D.
NIH Distinguished Investigator
Laboratory of Molecular Immunology
NHLBI, NIH

MedicalResearch.com: What is the background for this study?

Response: TSLP is a cytokine that has been well studied in the context of T cell helper type 2 (TH2) responses and the promotion of atopic diseases. TSLP is naturally expressed at barrier surfaces, such as the skin; however, its role in skin infections was not previously explored.

In our study, we investigated whether TSLP plays a role in host defense to Staphylococcus aureus skin infections, using the most common strain of methicillin-resistant S. aureus (MRSA) present in the United States.

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ADHD: Heritability of Structural and Functional Brain Connectivity in Families

MedicalResearch.com Interview with:

Gustavo Sudre, PhD Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch National Human Genome Research Institute Bethesda, Maryland

Dr. Gustavo Sudre

Gustavo Sudre, PhD
Section on Neurobehavioral Clinical Research, Social and Behavioral Research Branch
National Human Genome Research Institute
Bethesda, Maryland

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: ADHD is the most common childhood neuropsychiatric disorder, affecting 7-9% of school age children. It is highly heritable (h2=0.7), but few risk genes have been identified. In this study, we aimed to provide quantitative brain-based phenotypes to accelerate gene discovery and understanding.

ADHD is increasingly viewed as resulting from anomalies of the brain’s connectome. The connectome is comprised of the structural connectome (white matter tracts joining different brain regions) and the functional connectome (networks of synchronized functional activity supporting cognition). Here, we identified features of the connectome that are both heritable and associated with ADHD symptoms.

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Dust Mite Allergen Proteins More Abundant Than Non-Allergen Dust Mite Proteins

MedicalResearch.com Interview with:

Geoffrey Mueller, Ph.D. Staff Scientist Genome Integrity and Structural Biology Laboratory National Institute of Environmental Health Sciences National Institutes of Health Research Triangle Park, NC 27709

Dr. Geoffrey Mueller

Geoffrey Mueller, Ph.D.
Staff Scientist
Genome Integrity and Structural Biology Laboratory
National Institute of Environmental Health Sciences
National Institutes of Health
Research Triangle Park, NC 27709

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While allergic disease is a wide spread problem, it is actually a select few proteins, called allergens, that initiate allergy symptoms. This study was focused on looking for fundamental biochemical differences between allergens and non-allergens derived from the house dust mite.

We found that the mite allergens, as a group, are distinctly different from the non-allergens in that they are more highly produced, and more stable. Previous anecdotal evidence suggested that these properties would lead to more allergens surviving the journey from the source (either mites or pollens) to a person. In addition, the greater stability of allergens may influence the decision making of the immune system to target these proteins as dangerous instead of harmless.

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