Annals Thoracic Surgery, Author Interviews, Diabetes, Duke, Heart Disease, Hepatitis - Liver Disease, Pharmacology / 04.01.2017

MedicalResearch.com Interview with: Matthew J. Crowley, MD, MHS Assistant Professor of Medicine Member in the Duke Clinical Research Institute Duke University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although metformin is widely considered to be the first-line drug for type 2 diabetes, concerns about lactic acidosis have traditionally limited its use in some populations. However, FDA now indicates that metformin may be used safely for patients with mild-moderate chronic kidney disease and other historical contraindications like congestive heart failure. With the lactic acidosis question addressed for these groups, this review asked “what do we know about how metformin affects mortality and other outcomes for patients with historical contraindications and precautions?” The main take-home message is that metformin appears associated with lower mortality in patients with mild-moderate chronic kidney disease, congestive heart failure, and chronic liver disease. (more…)
Alcohol, Author Interviews, Heart Disease, JACC, UCLA / 02.01.2017

MedicalResearch.com Interview with: Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption. In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships. (more…)
Author Interviews, Cannabis, JAMA, Pediatrics, UC Davis / 02.01.2017

MedicalResearch.com Interview with: Magdalena Cerda, DrPH, MPH Vice Chancellor's Chair in Violence Prevention Associate Director, Violence Prevention Research Program UC Davis Violence Prevention Research Program MedicalResearch.com: What is the background for this study? What are the main findings? Response: The potential effect of legalizing marijuana for recreational use has been a topic of considerable debate since Washington and Colorado first legalized its use for adults in 2012. Alaska, Oregon and Washington, D.C., followed suit in 2014, and voters in California, Massachusetts and Nevada approved recreational use this past November. In our study, we examined changes in perceived risk of marijuana use, and in use of marijuana among school-attending adolescents, in Washington and Colorado, following legalization of recreational marijuana use, and compared pre- to post-legalization changes in these two states to changes in the 45 contiguous US states that had not legalized recreational marijuana use. Marijuana use significantly increased and its perceived harm decreased among eighth- and 10th-graders in Washington state following enactment of recreational marijuana laws. There was no change in use or perceived harm among 12th graders or among similar grades in Colorado. In particular, the data showed that legalization of recreational marijuana use significantly reduced perceptions of marijuana’s harmfulness by 14 percent and 16 percent among eighth and 10th graders and increased their past-month marijuana use by 2 percent and 4 percent in Washington state but not in Colorado. Among states without legalized marijuana use, the perceived harmfulness also decreased by 5 percent and 7 percent for students in the two grades, but marijuana use decreased by 1.3 percent and .9 percent. Among older adolescents in Washington state and all adolescents surveyed in Colorado, there were no changes in perceived harmfulness or marijuana use in the month after legalization. (more…)
Author Interviews, Dermatology, Infections, Transplantation, UT Southwestern / 02.01.2017

MedicalResearch.com Interview with: Richard Wang, M.D., Ph.D. Assistant Professor UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Currently, there are 13 polyomaviruses known to infect humans. Several members of this family of double-stranded DNA viruses—including Merkel Cell Polyomavirus, Trichodysplasia Spinulosa Polyomavirus, Human Polyomavirus 6 (HPyV6), and Human Polyomavirus 7 (HPyV7)—can be shed from skin of healthy individuals. While most polyomavirus infections are common and subclinical, several polyomaviruses have been associated with debilitating diseases in immunocompromised individuals. Most recently, HPyV7 was discovered in a pruritic and dyskeratotic eruption in two immunosuppressed transplant patients. A closely related polyomavirus, Human Polyomavirus 6, has not yet been strongly linked to any infectious diseases. Using the previously described, characteristic histologic pattern, we identify 3 additional cases of skin eruptions associated with infections of HPyV6 and HPyV7. The association of the dermatoses with highly active infections were confirmed through electron microscopy, immunohistochemistry, quantitative PCR, and complete sequencing. HPyV7 infects keratinocytes and affects their normal differentiation. In addition, next generation sequencing revealed that HPyV6 could persist in a latent state in the skin of a previously infected patient. (more…)
Author Interviews, Brigham & Women's - Harvard, Hepatitis - Liver Disease, Technology / 01.01.2017

MedicalResearch.com Interview with: Prof. David A. Weitz Mallinckrodt Professor of Physics and Applied Physics School of Engineering and Applied Sciences Harvard University MedicalResearch.com: What is the background for this technology study? What are the main findings? Response: Currently, it is very time-consuming and expensive to develop new drugs. One reason is that many drugs fail in clinical trials after animal studies, simply because animals are very different from humans. One promising means of solving this problem is to replace animal experiments with artificial human tissues that can be used to directly screen a drug. However, it is a challenge to construct artificial human tissues, as almost all human tissues are composed of multiple types of cells and extracellular matrices in 3D structures. In our studies, we have successfully developed a droplet-based microfluidic technique to fabricate large numbers of monodisperse, portable microtissues. We spatially assemble different types of cells in a 3D core-shell structure and construct an artificial human microtissue in each individual drop. The specific structures we create in the microdoplets are designed to mimic the behavior of the liver, and hence we call these structures a ‘liver in a drop.’  (more…)
Author Interviews, Gender Differences, Sexual Health, University of Michigan / 31.12.2016

MedicalResearch.com Interview with: Halley Crissman, MD, MPH University of Michigan Resident Physician Department of Obstetrics and Gynecology University of Michigan Ann Arbor, Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been very little data on the epidemiology of the transgender population in the U.S., including basic information regarding the proportion of adults that identify as transgender. Transgender is an identity term for individuals whose gender expression and gender identity does not align with culture expectations and gender norms associated with sex assigned at birth. Our study used data from the Centers for Disease Control and Prevention 2014 Behavioral Risk Factor Surveillance System to estimate the demographic characteristics of the U.S. adult transgender population compared to the non-transgender population. We found that 0.53% of U.S. adults identified as transgender. Transgender individuals were more likely to be non-white and below the poverty line, were less likely to attend college, and were as likely to be married, living in a rural area, and employed, compared to non-transgender individuals. (more…)
Author Interviews, Kaiser Permanente, Lancet, Pediatrics, Weight Research / 29.12.2016

MedicalResearch.com Interview with: De-Kun Li, MD, PhD Senior Research Scientist Division of Research Kaiser Foundation Research Institute Kaiser Permanente Oakland, CA 94612 MedicalResearch.com: What is the background for this study? Response: The composition of gut microbia (microbiome) has emerged as a key contributor to human disease risk. The external influence on the composition of microbiome in early childhood, especially in infancy, has been linked to increased risk of childhood obesity. Several studies have examined use of antibiotics in infancy and reported an association between use of antibiotics and increased risk of childhood obesity. This has caused a great uncertainty among both pediatricians and parents regarding treatment of infant infections. However, the previous studies failed to separate the effect of underlying infections for which antibiotics were used from the effect of the antibiotics itself. The contribution of our study was to examine the effects of infections and antibiotic use separately. (more…)
Author Interviews, Cost of Health Care, JACC, UCLA / 28.12.2016

MedicalResearch.com Interview with: Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Four million stable patients in the US undergo testing for suspected ischemic heart disease (IHD) annually. There is substantial variation in how these patients are managed by physicians, and both clinical and economic factors have been used to explain this variation. However, it is unknown whether patients’ beliefs and preferences influence management decisions, and we aimed to answer this question. Based on interviews of 351 stable patients at Geisinger Health System newly referred for cardiac stress testing/coronary computed tomographic angiography (CTA) for suspected IHD, we found that patients with an accurate understanding of their initial test result were less likely to undergo follow-up tests/procedures if the initial test was negative and more likely to undergo follow-up tests/procedures if the initial test was positive. (more…)
Author Interviews, Cancer Research, Immunotherapy, Nature, Technology, University of Michigan / 27.12.2016

MedicalResearch.com Interview with: James Moon, PhD John Gideon Searle Assistant Professor University of Michigan Dept. of Pharmaceutical Sciences and Biomedical Engineering Biointerfaces Institute Ann Arbor, MI, 48109 MedicalResearch.com: What is the background for this study? Response: The field of cancer immunotherapy has recently made a breakthrough with the clinical success of immune checkpoint inhibitors, which work by removing the brakes on immunosuppressed T-cells. However, these approaches generally work by augmenting pre-existing T-cell immunity and benefit only a subset of patients. In addition, because the majority of somatic mutations in cancer cells are unique to each patient, cancer immunotherapy may benefit from a personalized approach. (more…)
Author Interviews, Hospital Readmissions, JAMA, Yale / 27.12.2016

MedicalResearch.com Interview with: Nihar R. Desai, MD, MPH Assistant Professor of Medicine Section of Cardiovascular Medicine, Yale School of Medicine Center for Outcomes Research and Evaluation Yale New Haven Health System MedicalResearch.com: What is the background for this study? Response: Reducing rates of readmissions after hospitalization has been a major focus for patients, providers, payers, and policymakers because they reflect, at least partially, the quality of care and care transitions, and account for substantial costs. The Hospital Readmission Reduction Program (HRRP) was enacted under Section 3025 of the Patient Protection and Affordable Care Act (ACA) in March 2010 and imposed financial penalties beginning in October 2012 for hospitals with higher than expected readmissions for acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia among their fee-for-service Medicare beneficiaries. In recent years, readmission rates have fallen nationally, and for both target (AMI, HF, pneumonia) and non-target conditions. We were interested in determining whether the Hospital Readmission Reduction Program (HRRP) associated with different changes in readmission rates for targeted and non-targeted conditions for penalized vs non-penalized hospitals? (more…)
Author Interviews, Cancer Research, Columbia, Genetic Research, Personalized Medicine / 23.12.2016

MedicalResearch.com Interview with: Dr. Kai Wang Zilkha Neurogenetic Institute, University of Southern California Institute for Genomic Medicine, Columbia University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cancer is a genetic disease caused by a small number of “driver mutations” in the cancer genome that drive disease initiation and progression. To understand such mechanism, there are increasing community efforts in interrogating cancer genomes, transcriptomes and proteomes by high-throughput technologies, generating huge amounts of data. For example, The Cancer Genome Atlas (TCGA) project has already made public 2.5 petabytes of data describing tumor and normal tissues from more than 11,000 patients. We were interested in using such publicly available genomics data to predict cancer driver genes/variants for individual patients, and design an "electronic brain” called iCAGES that learns from such information to provide personalized cancer diagnosis and treatment. iCAGES is composed of three consecutive layers, to infer driver variants, driver genes and drug treatment, respectively. Unlike most other existing tools that infer driver genes from a cohort of patients with similar cancer, iCAGES attempts to predict drivers for individual patient based on his/her genomic profile. What we have found is that iCAGES outperforms other tools in identifying driver variants and driver genes for individual patients. More importantly, a retrospective analysis on TCGA data shows that iCAGES predicts whether patients respond to drug treatment and predicts long-term survival. For example, we analyzed two groups of patients and found that using iCAGES recommend drugs can increase patients’ survival probability by 66%. These results suggest that whole-genome information, together with transcriptome and proteome information, may benefit patients in getting optimal and precise treatment. (more…)
Aging, Author Interviews, Neurological Disorders, Yale / 22.12.2016

MedicalResearch.com Interview with: Ifat Levy, PhD Associate Professor Comparative Med and Neuroscience Yale School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The proportion of older adults in the population is rapidly rising. These older adults need to make many important decisions, including medical and financial ones, and therefore understanding age-related changes in decision making is of high importance. Prior research has shown that older adults tend to be more risk averse than their younger counterparts when making choices between sure gains and lotteries. For example, asked to choose between receiving $5 for sure and playing a lottery with 50% of gaining $12 (but also 50% of gaining nothing), older adults are more likely than young adults to prefer the safe $5. We were interested in understanding the neurobiological mechanisms that are involved in these age-related shifts in preferences. An earlier study that we have conducted in young adults provided a clue. In that study, we measured the risk preference of each participant (based on a series of choices they made between safe and risky options), and also used MRI to obtain a 3D image of their brain. Comparing the behavioral and anatomical measures, we found an association between individual risk preferences and the gray-matter volume of a particular brain area, known as “right posterior parietal cortex” (rPPC), which is located at the back of the right side of the brain. Participants with more gray matter in that brain area were, on average, more tolerant of risk (or less risk averse). This suggested a very interesting possibility – that perhaps the increase in risk aversion observed in older adults is linked to the thinning of gray matter which is also observed in elders. In the current study we set out to test this hypothesis, by measuring risk preference and gray matter density in a group of 52 participants between the ages of 18 and 88. We found that, as expected, older participants were more risk averse than younger ones, and also had less gray matter in their rPPC. We also replicated our previous finding - that less gray matter was associated with higher risk aversion. The critical finding, however, was that the gray matter volume was a better predictor of increased risk aversion than age itself.  Essentially, if both age and the gray matter volume of rPPC were used in the same statistical model, rPPC volume predicted risk preferences, while age did not. Moreover, the predictive power was specific to the rPPC – when we added the total gray matter volume to the model, it did not show such predictive power. (more…)
Author Interviews, Immunotherapy, Multiple Sclerosis, NEJM, University Texas / 22.12.2016

MedicalResearch.com Interview with: Jerry S. Wolinsky, MD Emeritus Professor in Neurology McGovern Medical School The University of Texas Health Science Center at Houston Houston’s Health University Department of Neurology Houston, Texas 77030 MedicalResearch.com: What is the background for this study? Response: Multiple sclerosis (MS) clinically is a very heterogeneous disease. It presents in considerably different ways and has a very poorly predictable clinical course. In an attempt to better communicate between experts in the field, there have been multiple attempts to categorize “typical” courses of the disease. How we think about the disease is in part driven by these somewhat artificial categories that lump our patients into those with relapsing forms of the disease (relapsing remitting with or without accumulating clinical disability, and secondary progressive with accumulating disability eventually occurring even in the absence of apparent clinical episodes of the disease), and primary progressive MS, where patients are slowly or sometimes rather rapidly accumulating disability in the absence of prior clinical relapses. However, the distinctions between multiple sclerosis patients are not always as clear as the definitions would suggest, and it is certain that patients with primary progressive multiple sclerosis sometimes have clinical relapses after years of never having had relapses, and show MRI evidence of having accumulated many lesions in the brain over the course of their disease. Until now, none of the drugs that have shown benefit for relapsing disease have been able to convincingly show clinical benefit for patients with primary progressive disease, and for that matter have shown variable results when attempted in patients categorized as having secondary progressive courses. While some of our currently approved drugs have shown hints of benefit when tried in major clinical trials in primary progressive MS, the results were not been robust enough to seek regulatory approval. The Oratorio study design was based on lessons learned from prior trials in primary progressive and relapsing forms of MS, as well as the recognition that B cells might play an important role in the immunopathogenesis of disease based on a considerable amount of preclinical work and observations in patients with multiple sclerosis. (more…)
Annals Internal Medicine, Author Interviews, Hematology, Karolinski Institute / 21.12.2016

MedicalResearch.com Interview with: Märit Halmin, MD, PhD student Department of Medical Epidemiology and Biostatistics, Karolinska Institutet,  Stockholm, Sweden MedicalResearch.com: What is the background for this study? Response: During recent years the possible negative effects among recipients of stored red blood cells have been investigated.  Despite a large number of studies, including four randomized trials, no consensus exists. We therefore performed the hitherto largest register based cohort study of transfused patients, assessing the association between length of storage of red blood cells and mortality. Our design allowed for detection of small but still clinically significant effect, if such exists. (more…)
Author Interviews, Heart Disease, NIH / 20.12.2016

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, Brigham & Women's - Harvard, Gender Differences, Hospital Readmissions, JAMA / 20.12.2016

MedicalResearch.com Interview with: Yusuke Tsugawa, MD, MPH, PhD Department of Health Policy and Management Harvard T. H. Chan School of Public Health, Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts  MedicalResearch.com: What is the background for this study? What are the main findings? Response: We analyzed a 20% sample of Medicare beneficiaries hospitalized with a medical condition in 2011-2014, and found that patients treated by female doctors have lower mortality and readmission rates than those cared for by male doctors. (more…)
Author Interviews, Cancer Research, Nature, Wistar / 20.12.2016

MedicalResearch.com Interview with: Cecilia Caino, Ph.D. The Wistar Institute 3601 Spruce Street Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mitochondria have recently experienced a resurgence of interest in the field of cellular biology. Traditionally known for their role in energy production and in programmed cell death, mitochondria are more broadly recognized as signaling hubs and biosynthetic factories. Not surprisingly, mitochondria have been linked to several hallmarks of cancer, including evasion of apoptosis, tissue invasion and metastasis and abnormal metabolic pathways. It has become clear that mitochondria quality control and metabolism-regulated shape changes are dysregulated in cancer. Recent studies identified a novel therapy-resistance mechanism that involves mitochondrial subcellular re-localization and is responsible for enhanced metastatic potential of cancer cells. In this context, the molecular regulators of mitochondrial trafficking in cancer are largely unknown. Through analysis of shRNA screening results, we identified Syntaphilin (SNPH), which is considered to moderate mitochondrial trafficking in neurons, as a non-neuronal tissue specific factor to suppress cancer cell invasion. Using multi-disciplinary cell biological, real time imaging, in vivo studies and human clinical studies, SNPH was revealed to block cell motility and tumor metastasis by regulation of reprogramming of mitochondrial dynamics. We provided evidence from public databases and clinical samples that SNPH levels are decreased in different types of human tumors and low SNPH levels correlate with worse patient prognosis. Overall this study demonstrated a new mechanism by which tumor cell invasion is regulated by a SNPH-mediated pathway. (more…)
Author Interviews, OBGYNE, UCLA, Zika / 20.12.2016

MedicalResearch.com Interview with: Karin Nielsen, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases David Geffen School of Medicine at UCLA Director, Center for Brazilian Studies MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our research was a prospective study in which pregnant women in Rio de Janeiro who developed a rash in the last 5 days between the end of 2015 to mid 2016 were screened for possible infection with Zika virus by a special molecular test (PCR) which looked for the virus in blood or urine. Women who were found to have Zika virus in either blood, urine or both were followed throughout time to look for pregnancy and infant outcomes. We also followed women who had a negative PCR test for Zika as a comparison group. By July 2016, we had outcomes known for 125 Zika affected pregnancies, of these 58 had abnormal outcomes, with 9 fetal losses and 49 babies who had abnormal findings on physical exam or brain imaging, all consistent with neurologic abnormalities. This meant 46% of the pregnant women in our study had an abnormal pregnancy outcome, and 42% of live birth infants were found to have an abnormality in the first few months of life. (more…)
AHA Journals, Author Interviews, Duke, Social Issues, Stroke / 19.12.2016

MedicalResearch.com Interview with: Matthew E. Dupre, Ph.D. Associate Professor Department of Community and Family Medicine & Duke Clinical Research Institute (DCRI) Duke University MedicalResearch.com: What is the background for this study? What are the main findings? Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke. We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses. (more…)
Author Interviews, Brigham & Women's - Harvard, Endocrinology, Infections / 18.12.2016

MedicalResearch.com Interview with: Flaminia Catteruccia PhD Associate Professor of Immunology and Infectious Diseases Department of Immunology and Infectious Diseases Boston, Massachusetts 02115 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Mosquito control via lethal insecticides is a key method for reduction of malaria transmission. As insecticide resistance is spreading, new intervention methods are urgent. Our study demonstrates that studies on mosquito biology can provide novel, much needed tools for malaria control. We show how key aspects of mosquito physiology and Plasmodium development can be significantly disrupted in the female Anopheles mosquito by agonists of the insect steroid hormone 20-hydroxyecdysone (20E). Modeling of the data predicts that the integration of 20E agonists in malaria control programs would significantly reduce malaria prevalence to a similar extent as insecticides, but without imposing severe costs to mosquito populations (more…)
Author Interviews, Brigham & Women's - Harvard, Dental Research, Infections, Rheumatology, Science / 17.12.2016

MedicalResearch.com Interview with: Maximilian F. Konig, MD Division of Rheumatology, Johns Hopkins University School of Medicine Current affiliation: Department of Medicine Massachusetts General Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? Response:The idea that rheumatoid arthritis (RA), an autoimmune disease that leads to chronic joint inflammation and destruction, may be initiated by a bacterial infection is not novel, but has been posited for more than a century. Based on the clinical observation that patients with RA frequently have severe periodontal disease (gum disease), gum inflammation has long been thought to contribute to disease development in RA. However, limited understanding of the mechanisms that fuel and sustain the autoimmune attack in RA made it difficult to pinpoint a specific bacterial trigger. In recent years, our understanding of the abnormal immune response that attacks the joints in patients with RA has grown exponentially, and we now know that disease-specific autoantibodies (ACPAs) target modified self-proteins (this modification is known as citrullination). It is this abnormal immune response against citrullinated proteins that appears to drive the joint (and sometimes lung) inflammation seen in rheumatoid arthritis. Recent studies from our laboratory at The Johns Hopkins University (led by principle investigator Felipe Andrade, MD, PhD) suggested that an immune cell called the neutrophil, which normally protects us from infection at sites like the oral cavity or anywhere else in the body, also appears to be the source of the proteins attacked in RA. We were therefore interested to understand what drives the association of gum disease, an inflammation commonly triggered by bacteria, with RA. (more…)
Abuse and Neglect, Author Interviews, Pediatrics, University of Pennsylvania / 16.12.2016

MedicalResearch.com Interview with: Joanne N. Wood, MD, MSHP Assistant Professor of Pediatrics Perelman School of Medicine at the University of Pennsylvania Research Director, SafePlace Faculty, PolicyLab The Children’s Hospital of Philadelphia  MedicalResearch.com: What is the background for this study? Response: Each year the U.S. Army Family Advocacy program (FAP) investigates between 6000 to 9000 reports of alleged abuse or neglect involving children of Army service members.   In approximately 48% of reported cases FAP determines a child was a victim of maltreatment, substantiates the report, and collaborates with local civilian child protection service (CPS) agencies in providing services and ensuring safety. Thus, FAP plays a key role in supporting Army families and protecting children.  But FAP can only investigate and respond to cases of child abuse and neglect about which they are aware. (more…)
Author Interviews, Cost of Health Care, Johns Hopkins, Weight Research / 16.12.2016

MedicalResearch.com Interview with: Ruchi Doshi, MPH MD Candidate 2017 | Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend that physicians collaborate with non-physician health professionals to deliver weight management care. While several studies have looked at barriers physicians face in providing these services, few studies have looked at the barriers that the non-physician health professionals face. Ultimately, we found that one quarter of these health professionals found insurance coverage to be a current challenge to providing weight management care, and that over half of them felt improved coverage would help facilitate weight loss. These findings were consistent regardless of the income level of the patient populations. (more…)
Author Interviews, Leukemia, Nature, Pediatrics, UT Southwestern, Weight Research / 13.12.2016

MedicalResearch.com Interview with: Chengcheng (Alec) Zhang, Ph.D. Associate Professor Hortense L. and Morton H. Sanger Professorship in Oncology Michael L. Rosenberg Scholar for Medical Research Department of Physiology UT Southwestern Medical Center MedicalResearch.com: What is the background for this study? Response: New therapeutic targets and approaches are needed to effectively treat leukemia. Acute myeloid leukemia (AML) is the most common form of adult acute leukemia whereas acute lymphoblastic leukemia (ALL) is the most common form of cancer in children; ALL also occurs in adults. Although treatment of pediatric ALL is highly effective, a sizeable number of patients are non-responders who succumb to this disease. The outcome of ALL in adults is significantly worse than for pediatric ALL. Additionally, some types of ALL have a much poorer prognosis than others. Dietary restriction, including fasting, delays aging and has prolonged effects in a wide range of organisms and has been considered for cancer prevention. In certain types of solid tumor,_ENREF_1 dietary restriction regimens are able to promote T cell-mediated tumor cytotoxicity and enhance anticancer immunosurveillance, and coordinate with chemotherapy to promote the anti-cancer effects. However, the responsiveness of hematopoietic malignancies to dietary restriction, including fasting, remains unknown. Furthermore, whether dietary restriction alone can inhibit cancer development is not clear. (more…)
Alzheimer's - Dementia, Annals Internal Medicine, Author Interviews, Critical Care - Intensive Care - ICUs, Health Care Systems, University of Pittsburgh / 12.12.2016

MedicalResearch.com Interview with: Joshua M. Thorpe, PhD, MPH From the Center for Health Equity Research and Promotion Veterans Affairs Pittsburgh Healthcare System Pittsburgh Pennsylvania, and Center for Health Services Research in Primary Care Department of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy MedicalResearch.com: What is the background for this study? Response: Care coordination for persons with dementia is challenging for health care systems under the best of circumstances. These coordination challenges are exacerbated in Medicare-eligible veterans who receive care through both Medicare and the Department of Veterans Affairs (VA). Recent Medicare and VA policy changes (e.g., Medicare Part D, Veteran’s Choice Act) expand veterans’ access to providers outside the VA. While access to care may be improved, seeking care across multiple health systems may disrupt care coordination and increase the risk of unsafe prescribing - particularly in veterans with dementia. To see how expanded access to care outside the VA might influence medication safety for veterans with dementia, we studied prescribing safety in Veterans who qualified for prescriptions through the VA as well as through the Medicare Part D drug benefit. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Mammograms, MD Anderson, Surgical Research / 12.12.2016

MedicalResearch.com Interview with: Henry M. Kuerer, MD, PhD, FACS Executive Director, Breast Network Programs MD Anderson Cancer Network PH and Fay Etta Robinson Distinguished Professor in Research Department of Breast Surgical Oncology Director, Breast Surgical Oncology Training Program MedicalResearch.com: What is the background for this study? Response: Worldwide, triple negative and HER2 positive breast cancers, combined, account for about 370,000 women diagnosed annually. With recent advances in neoadjuvant systemic therapy (NST, chemotherapy and targeted therapy given before surgery) for both subsets, the pCR (pathologic complete response- when no residual cancer is found) rates found at the time of surgery in these populations can be as high as 60 percent. This high rate of pCR naturally raises the question of whether surgery is required for all patients, particularly those who will receive adjuvant radiation. We believe surgery may potentially be redundant – at least for these two subtypes of breast cancer – because of such a high chance for no evidence of disease at the time of pathological review. If there’s no cancer left after the patient has received chemotherapy and the patient is going to receive local radiation therapy, is surgery actually needed? The challenge has been that standard breast imaging methods cannot accurately predict residual disease after NST. However, by doing the same image-guided percutaneous needle biopsies after neoadjuvant systemic therapy that we do at time of diagnosis, our preliminary research reveals that we may be able to accurately predict which women will have cancer or not. (more…)
Author Interviews, Education, JAMA, Outcomes & Safety, UCSF / 12.12.2016

MedicalResearch.com Interview with: Charlie M. Wray, DO, MS Assistant Clinical Professor of Medicine University of California, San Francisco Department of Medicine San Francisco VA Medical Center MedicalResearch.com: What is the background for this study? Response: Since the establishment of residency duty hour regulations in 2010, which subsequently lead to increased discontinuity of inpatient care and more resident shift work, educators and researchers have attempted to establish which shift handoff technique(s) or strategies work best. National organizations, such as the ACGME, AHRQ, and the Joint Commission have made specific recommendations that are considered "best practice". In our study, using an annual national survey given to Internal Medicine Program Directors, we examined the degree of implementation of these recommended handoff strategies and the proportion of Program Director satisfaction with each of the respective strategies. (more…)
Author Interviews, Genetic Research, Leukemia, NYU / 11.12.2016

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. (more…)
Author Interviews, BMJ, Imperial College, Nutrition / 10.12.2016

MedicalResearch.com Interview with: Dr. Dagfinn Aune Department of Epidemiology and Biostatistics School of Public Health Imperial College London St. Mary's Campus London  UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a growing body of evidence suggesting that intake of nuts may reduce the risk of coronary heart disease, but the relation between nut intake and other diseases like cancer and stroke, and the relation with mortality and less common causes of death is not clear. Also it is not clear how much nuts are needed to reduce the risk. So our current meta-analysis reviewed the data from 20 studies (29 publications) on nut intake and different health outcomes. We found that a nut intake of approximately one serving per day (28 g/d or a handful) was associated with a reduced risk of coronary heart disease (by 30%), total cancer (15%), all-cause mortality (22%) and mortality from respiratory disease (50%), diabetes (40%), and infections (75%), although there were few studies in the latter three analyses. We found that most of the benefit was observed up to an intake of around 20 grams per day. Similar results were found for total nuts, tree nuts and peanuts (which are botanically defined as legumes), but peanuts were also associated with reduced risk of stroke, while only tree nuts were associated with reduced cancer risk. We also calculated the number of deaths that potentially could be avoided, under the assumption that the observed associations are causal, and arrived at 4.4 million deaths in North and South America, Europe, Southeast Asia and the Western Pacific (unfortunately we did not have data on nut intake from West Asia and Africa so we were not able to include those areas). (more…)