No Magic Age To Stop Performing Screening Mammograms

MedicalResearch.com Interview with:
Cindy S. Lee, MD

Department of Radiology and Biomedical Imaging
University of California, San Francisco, San Francisco
Now with Department of Radiology
NYU Langone Medical Center, Garden City, New York

MedicalResearch.com: What led you and colleagues to conduct this study?

Response: I am a breast imager. I see patients who come in for their screening mammograms and I get asked, a lot, if patients aged 75 years and older should continue screening, because of their age. There is not enough evidence out there to determine how breast cancer screening benefits women older than 75. In fact, all previously randomized trials of screening mammography excluded people older than 75 years.

Unfortunately, age is the biggest risk factor for breast cancer, so as patients get older, they have higher risks of developing breast cancer. It is therefore important to know how well screening mammography works in these patients.

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Radiation Exposure in the Pediatric Patient: What Every Orthopaedist Should Know

MedicalResearch.com Interview with:
Ayesha Rahman, MD

Chief Orthopaedic Surgery Resident
NYU Langone Medical Center.

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

Response: Children are more vulnerable and susceptible to lifetime adverse events from radiation exposure, caused by imaging . We reviewed literature and found certain pediatric orthopaedic patients are at greater risk for radiation exposure, namely those who have surgery for hip dysplasia, scoliosis, and leg length discrepancy, as they are among those most likely to undergo CT imaging. After reviewing all types of imaging studies performed in orthopedics and how much radiation is involved in each test, we developed several recommendations that pediatric orthopaedic surgeons should follow.

Among those recommendations are: utilize low-dose CT protocols or technology that uses less imaging (like EOS), limit CT scans of the spine and pelvis, know that female patients are more susceptible to adverse risk and plan accordingly, and follow the the “as low as reasonably achievable,”principle to limit exposure to parts of the body that are necessary for diagnosis.

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Deep Brain Stimulation Can Be Effective For Severe Tourette Syndrome

MedicalResearch.com Interview with:

Alon Y. Mogilner, M.D., Ph.D. Associate Professor of Neurosurgery and Anesthesiology Director, Center for Neuromodulation Department of Neurosurgery NYU Langone Medical Center New York, NY 10016

Alon Mogilner

Alon Y. Mogilner, M.D., Ph.D.
Associate Professor of Neurosurgery and Anesthesiology
Director, Center for Neuromodulation
Department of Neurosurgery
NYU Langone Medical Center
New York, NY 10016

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

Response: The study was a review of our series of patients with Tourette’s syndrome who had failed all other treatments and who underwent deep brain stimulation (DBS), and the study demonstrated that the procedure was safe and effective in relieving their tics.

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

Response:  Deep brain stimulation can be an effective treatment in patients with severe Tourette’s syndrome.

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

Response: Further studies should be done to confirm which patients are most likely to benefit.

Disclosure: I have received consulting fees from Medtronic, the company who makes the implants.

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

Citation:

Richard S. Dowd, Michael Pourfar, Alon Y. Mogilner. Deep brain stimulation for Tourette syndrome: a single-center series. Journal of Neurosurgery, 2017; 1 DOI: 10.3171/2016.10.JNS161573

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

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Computerized Clinical Decision Support Systems Can Reduce Rate of Venous Thromboembolism

MedicalResearch.com Interview with:
Zachary Borabm, Research fellow

Hansjörg Wyss Department of Plastic Surgery
NYU Langone Medical Center

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

Response: Recent studies have shown that health care providers perform poorly in risk stratifying their patients for venous thromboembolism (VTE) which leads to inadequate VTE prophylaxis delivery, especially in surgical patients. Computerized Clinical Decision Support Systems (CCDSSs) are programs integrated into an electronic health record that have the power to aid health care providers. Using a meta-analysis study technique we were able to pool data from 11 studies, including 156,366 patients that either had CCDSSs intervention or routine care without CCDSSs.

Our main outcome measures were the rate of prophylaxis for VTE and the rate of actual VTE events. We found that CCDSSs increased the rate of VTE prophylaxis (odds ratio 2.35, p<0.001) and decreased the risk of VTE events (risk ratio 0.78, p<0.001).

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Cardiovascular Procedures That Push the Line: High-Risk or Futility of Care?

MedicalResearch.com Interview with:

Adam Skolnick, MD Cardiologist Associate professor of medicine NYU Langone Medical Center

Dr. Adam Skolnick

Adam Skolnick, MD
Cardiologist
Associate professor of medicine
NYU Langone Medical Center  

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

Response: I am privileged to serve on the ACC Program Planning Committee and helped to design this important session that seeks to determine the line between when a cardiovascular procedure is high risk and when it is futile.    I am co-chairing the session with the incoming chair of the section on Geriatric Cardiology for the ACC, Dr. Karen Alexander from Duke.

We are practicing medicine at one of the most extraordinary times when there are so many devices and procedures to prolong and improve quality of life.    It is critical to assess a patient’s goals of care for a given intervention.   In some patients, particularly those who are multiple degenerative chronic conditions, are frail and/or have cognitive impairment it is difficult to know when a given procedure multiple medical conditions will achieve a patient’s goals.   When is a procedure high risk, and when is it simply futile?    This is the fine line upon which many cardiologists often find themselves.

The speakers present case examples of high risk patients considering TAVI, high risk PCI or CABG and mechanical support devices and with interaction from the audience work through when each procedure is high risk and when it is unlikely to achieve a patient’s goals of care.   We also have a dedicated talk on high risk procedures in patients with cognitive impairment, such as advanced dementia.

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Patients Who Quit Smoking Had Fewer Adverse Events After Knee Replacement

MedicalResearch.com Interview with:
Amy Wasterlain, MD

Fourth-year orthopaedic surgery resident
NYU Langone Medical Center who led the study with Dr. Richard Iorio 

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

Response:  We looked at smoking habits and outcomes for 539 smokers undergoing primary total hip or knee arthroplasty, 73 of whom participated in a pre-operative smoking cessation program. Patients who participated in program were 4.3 times more likely to quit than smokers who tried to quit on their own. Program participants also reduced their tobacco intake dramatically (10.6 fewer cigarettes/day) compared to smokers who didn’t participate (2.3 fewer cigarettes/day), even if they weren’t able to quit completely. Patients who completed the program before undergoing total knee arthroplasty had about 24% fewer adverse events (readmission, venous thromboembolism, stroke, urinary tract infection, pneumonia, and surgical site infection) than smokers who didn’t participate in the program.

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How Does Spinal Deformity Impact Hip Stability?

MedicalResearch.com Interview with:

Dr Aaron J. Buckland Spinal and scoliosis surgeon and assistant professor Orthopedic surgery NYU Langone Medical Center

Dr. Aaron Buckland

Dr Aaron J. Buckland
Spinal and scoliosis surgeon and
Assistant professor
Orthopedic surgery
NYU Langone Medical Center

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

Response: For decades, surgeons performing hip replacements have placed the acetabular component adjacent to the pelvis in a “safe zone” which has been shown to reduce dislocation risk. However, beginning in residency, I would notice that several of my patients with spinal deformities or lumbar fusions, would experience dislocations despite the safe zone placement of these implants. Our initial research demonstrated that there was an increased dislocation risk in patients with lumbar fusions, particularly if they underwent spinal realignment. We investigated this phenomenon further by retrospectively reviewing 107 patients who met the criteria for sagittal spinal deformity, including 139 hip replacements collectively.

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Taking Testosterone Doesn’t Increase Prostate Cancer Risk

MedicalResearch.com Interview with:

Dr. Stacy Loeb, MD, MScDepartment of Urology, Population Health, and Laura and Isaac Perlmutter Cancer CenterNew York University, New York

Dr. Stacy Loeb

Dr. Stacy Loeb MD Msc
Assistant Professor of Urology and Population Health
New York University Langone Medical Center

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

Response: The association between exposure to testosterone replacement therapy and prostate cancer risk is controversial.  The purpose of our study was to examine this issue using national registries from Sweden, with complete records on prescription medications and prostate cancer diagnoses.  Overall, we found no association between testosterone use and overall prostate cancer risk. There was an early increase in favorable cancers which is likely due to a detection bias, but long-term users actually had a significantly reduced risk of aggressive disease.

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Diabetes Raises Risk of Death From Cancer in Asians

MedicalResearch.com Interview with:

Yu Chen</strong> Associate Professor, Department of Population Health Associate Professor, Department of Environmental Medicine Associate Professor, Department of Medicine NYU Langone School of Medicine

Dr. Yu Chen

Yu Chen PhD MPH
Associate Professor, Department of Population Health
Associate Professor, Department of Environmental Medicine
Associate Professor, Department of Medicine
NYU Langone School of Medicine

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

Response There is increasing evidence of an association between type 2 diabetes and cancer risk. However, previous studies in Asian only considered one or a few cancer types, included only a small number of patients with diabetes, or didn’t control for other important risk factors such as obesity.
We conducted pooled analyses of 19 prospective population-based cohorts included in the Asia Cohort Consortium (ACC), comprising data from over 771,000 individuals in the Asia.

Diabetes was associated with a 26% increased risk of death from any cancer in Asians.
Significant positive associations with diabetes were observed for the risk of death from cancers of the colorectum, liver, bile duct , gallbladder, pancreas, breast, endometrium, ovary, prostate, kidney, thyroid, as well as lymphoma. Diabetes was not statistically significantly associated with the risk of death from cancers of the bladder, cervix, esophagus, stomach, and lung or with leukemia.

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

Response: Influence of diabetes on the risk of death from overall cancer, digestive cancers and breast cancer is largely similar in Asians and in developed Western countries

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

Response: The findings indicate a potential need for appropriate cancer screening among individuals with diabetes, and a greater emphasis on lifestyle modifications to prevent diabetes and reduce cancer mortality, not only in Western populations, but also in Asians

No disclosures

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

Citation:

 Chen Y, et al “Association between type 2 diabetes and risk of cancer mortality: a pooled analysis of over 771,000 individuals in the Asia Cohort Consortium” Diabetologia 2017; DOI:10.1007/s00125-017-4229-z.

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

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Multiple Sclerosis Patients Show Cognitive Benefit From Remotely Supervised Transcranial Direct Current Stimulation

MedicalResearch.com Interview with:

Leigh E. Charvet, PhD Associate Professor, Department of Neurology Department of Neurology New York University Langone Medical Center New York, NY

Dr. Charvet

Leigh E. Charvet, PhD
Associate Professor, Department of Neurology
Department of Neurology
New York University Langone Medical Center
New York, NY

MedicalResearch.com: What is the background for transcranial direct current stimulation? What are the main findings of this study in multiple sclerosis patients?

Response: The application of tDCS is a relatively recent therapeutic development that utilizes low amplitude direct currents to induce changes in cortical excitability. When paired with a rehabilitation activity, it may improve learning rates and outcomes.

Multiple repeated sessions are needed for both tDCS and cognitive training sessions to see a benefit. Because it is not feasible to have participants come to clinic daily for treatments, we developed a method to deliver tDCS paired with cognitive training (using computer-based training games) to patients at home. Our protocol uses a telemedicine platform with videoconferencing to assist study participants with all the procedures and to ensure safety and consistency across treatment sessions.

When testing our methods, we enrolled 25 participants with multiple sclerosis (MS) completed 10 sessions of tDCS (2.0 mA x 20 minutes, dorsolateral prefrontal cortex, left anodal) using the remotely-supervised telerehabilitation protocol. This group was compared to n=20 MS participants who completed 10 sessions of cognitive training only (also through remote supervision).

We administered cognitive testing measures at baseline and study end. We found that both the tDCS and cognitive training only group had similar and slight improvements on composites of standard neuropsychological measures and basic attention. However, the tDCS group had a significantly greater gain on computer-based measures of complex attention and on a measure of intra-individual variability in response times.

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Hip vs Lumbar Spine Pain Can Be Difficult to Differentiate

MedicalResearch.com Interview with:

Afshin E. Razi MD</strong> Clinical Assistant Professor NYU Hospital for Joint Diseases Department of Orthopaedic Surgery New York, N.Y. 1001

Dr. Afshin Razi

Afshin E. Razi MD
Clinical Assistant Professor
NYU Hospital for Joint Diseases
Department of Orthopaedic Surgery
New York, N.Y. 10016

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

Response: We did an extensive literature search and through our two previous seminars on this topic we were able to gather information to aid our colleagues on best ways of differentiating causes of hip and back pain. As an orthopaedic surgeon specializing in spine surgery I encounter many patients who present with concomitant back and hip pain. Many of these patients are also referred to me by surgeons who solely take care of hip problems such as total hip replacement or sport medicine specialist who treat younger patients with hip pain. It can be very difficult to properly diagnose the main issue and as such some patients go on to have unnecessary treatments, including surgery, because of their persistent symptoms. It was our goal to try to educate physicians, including orthopaedic surgeons, on the common differential diagnoses, appropriate clinical history and physical examination, diagnostic tools and their evaluations appropriately, as well as treatment options and priorities of which one to be treated first. More recently, it has been noted that some patients who have undergone total hip replacement with significant curvature of the spine had postoperative dislocation of the hip after reconstruction of the spinal malalignment. This article also talks about this newly seen problem.

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Novel Relapse Markers Identified in Pediatric ALL

MedicalResearch.com Interview with:
Jason Saliba PhD

Perlmutter Cancer Center
New York University Langone Medical Center
New York, NY

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

Response: The outcome for children with acute lymphoblastic leukemia (ALL) has improved dramatically over the last four decades, but the prognosis for those who relapse remains dismal, especially for those who relapse while on therapy. In fact, relapsed disease remains a leading cause of cancer related mortality in children. To date, various studies have discovered a number of somatic alterations that contribute to driving relapse and have provided profound insight into the selective forces that lead to clonal outgrowth of drug resistant populations. However, the timing of the initial emergence of the driving mutations along with the speed of clonal outgrowth is unknown.

Whole exome sequencing (WES) was run on available diagnosis, germline (remission), and relapse samples collected from thirteen pediatric ALL patients treated according to Nordic NOPHO ALL protocols. Analyses were then performed to find somatic missense mutations enriched in the relapse samples versus their patient matched diagnosis and/or germline samples. Candidate relapse driving missense mutations were identified as present at high levels (>20%) in the relapse sample, but were undetectable in germline or low to absent in the diagnosis sample. Eight of the thirteen patients contained mutations in genes previously reported to be enriched at relapse. Interestingly, a majority of the patients contained novel candidate relapse specific genes involved in a wide array of cellular processes such as cell adhesion/migration, RNA polymerase II/transcription, circadian rhythm, the unfolded protein response, RNA transport, epigenetic regulation, DNA methylation, and kinases.

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