Author Interviews, End of Life Care, JAMA, Mental Health Research, NIH / 11.02.2016

MedicalResearch.com Interview with: Scott Y. H. Kim, MD, PhD Department of Bioethics, National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? Dr. Kim: Euthanasia and/or physician assisted suicide (EAS) of persons suffering from psychiatric disorders is increasingly practiced in some jurisdictions such as Belgium and the Netherlands but very little is known about the practice.  There is an active debate over whether to legalize such a practice in Canada, after a Supreme Court ruling last year that struck down laws banning physician assisted death.  Medical Research: What are the main findings? Dr. Kim: The main findings are that:
  1. Most patients who receive psychiatric euthanasia and/or physician assisted suicide are women, of diverse ages, with a variety of chronic psychiatric conditions accompanied by personality disorders, significant physical problems, and social isolation/loneliness, often in the context of refusals of treatment.  A minority who are initially refused EAS ultimately receive euthanasia and/or physician assisted suicide through a mobile euthanasia clinic.
  2. Given that the patients have chronic, complicated histories requiring considerable physician judgment, extensive consultations are common. But independent psychiatric input does not always occur; disagreement among physicians occurred in one in four cases; and the euthanasia review committees generally defer to the judgments of the physicians performing euthanasia and/or physician assisted suicide.
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Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Lung Cancer, Radiology / 10.02.2016

MedicalResearch.com Interview with: Phillip M. Boiselle, MD Professor of Radiology and Associate Dean for Academic and Clinical Affairs Harvard Medical School Beth Israel Deaconess Medical Center Boston, Massachusetts Medical Research: What is the background for this study? Dr. Boiselle: We surveyed leading academic medical centers in 2013 and found considerable variability in their practice patterns as well as a relatively small number of patients being screened for lung cancer at these sites. Considering landmark developments since that time, including favorable policy and payment decisions by USPSTF  and CMS  and development of radiology-specific nodule guidelines by the American College of Radiology, we were curious to see whether there would be greater conformity of practice patterns and increased patient volumes in response to these developments. Medical Research: What are the main findings? Dr. Boiselle: First, our finding of greater conformity of lung cancer screening practices at present compared to 2013 confirmed our hypothesis that the development of radiology-specific guidelines by ACR would contribute to greater uniformity. Second, we were surprised by the very modest level of increase in patient volumes for CT screening over time despite the favorable USPSTF and CMS decisions. We emphasize, however, that the timing of our survey occurred too early to determine the full impact of CMS coverage on patient volumes (more…)
Author Interviews, HIV, Social Issues, Yale / 10.02.2016

MedicalResearch.com Interview with: Kristina Marie Talbert-Slagle, PhD Lecturer in Epidemiology (Microbial Diseases) and in Public Health (Health Policy); Senior Scientific Officer, Yale Global Health Leadership Institute Yale School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Talbert-Slagle: The interest for this study originally came as a result of work done by Elizabeth Bradley, PhD, co-author of The American Health Care Paradox.  In the book, Dr. Bradley compared spending rates of social services to health care services between the U.S. and other countries and found that while the U.S. invested more money in health care services than any other country we had worse health outcomes.  By contrast, countries that spent more on social services per dollar spent on health care had better outcomes. We applied that same idea to AIDS.  There are still more than 50,000 cases of HIV/AIDS diagnosed in the U.S. each year.  Although many medical advances have been made in treatment and prevention of this infection, we were curious as to why rates of HIV/AIDS have remained stagnate.  We wanted to explore how spending relates to differences in case rates among the states and found a significant difference among states regarding social service and public health spending related to HIV/AIDS.  We looked at all 50 states’ spending habits over the past 10 years and discovered that states that invested more money in social services such as education, housing, and nutrition per person in poverty had significantly lower rates of HIV/AIDS deaths. (more…)
Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Psychological Science, Technology / 06.02.2016

MedicalResearch.com Interview with: Dr. Jesper Enander Department of Clinical Neuroscience Karolinska Institutet MedicalResearch: What is the background for this study? Dr. Enander: Body dysmorphic disorder (BDD) is a common anxiety disorder affecting about 2% of the general population, and is associated with hospitalization, substance dependence and suicidality. The disorder is characterized by a intense preoccupation with perceived defects in physical appearance, despite looking perfectly normal. It is common for people with BDD to seek non-psychiatric care, such as dermatological treatment or plastic surgery, however, such treatments rarely work, and can even lead to a deterioration of symptoms. The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that patients with Body dysmorphic disorder should be offered cognitive behavior therapy (CBT), however, there is a gap between supply and demand of CBT. One way of increasing access to CBT is to deliver it using the Internet. In this randomized clinical trial we tested the efficacy of a Internet based CBT program for Body dysmorphic disorder called BDD-NET and compared it to supportive therapy. MedicalResearch: What are the main findings? Dr. Enander: Our study shows that BDD-NET was associated with large and significant improvements in  Body dysmorphic disorder symptom severity. 56% of those receiving BDD-NET were responders (defined as at least a 30% reduction in symptoms), compared to 13% of those receiving supportive therapy. At the six months follow-up, 39% of those who received BDD-NET no longer met diagnostic criteria for Body dysmorphic disorder. No serious adverse events were reported, and most participants were satisfied with BDD-NET, despite no face-to-face contact with a therapist, and deemed the treatment as highly acceptable. (more…)
Author Interviews, Education, NYU, Pediatrics, Pediatrics, Social Issues / 05.02.2016

MedicalResearch.com Interview with: Alan Mendelsohn, MD Associate professor, Departments of Pediatrics and Population Health Adriana Weisleder, PhD Research scientist, Department of Pediatrics NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Response: In the last decade, scientists have begun to understand the mechanisms by which poverty can cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children. This study shows that pediatric-based programs that promote reading aloud and play can help prevent these problems before they arise. The Video Interaction Project (VIP) – the main program studied in the research – takes place at regular pediatric check-ups starting at birth. A trained parenting coach meets with the family at each visit and records the parent and child playing and reading together with materials provided by the program. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals. The results of the three-year randomized-controlled trial showed notable benefits for children’s social and emotional development. Children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half.  These findings are important because a child’s ability to control or regulate his or her behavior is a critical factor in their learning and success at school. (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Nutrition / 05.02.2016

MedicalResearch.com Interview with: Lea Borgi, MD Joint Fellowship Program in Nephrology Brigham and Women’s/ Massachusetts General Medical Research: What is the background for this study? What are the main findings? Dr. Borgi: Hypertension is one of the most common diseases in the United States and in the world. It is a known risk factor for cardiovascular disease. Even when hypertension is well-controlled with anti-hypertensives, these individuals are at an increased cardiovascular risk. Therefore, a healthy lifestyle is critical for normotensive individuals. This usually includes dietary patterns. However, if we could restrict dietary patterns to specific foods, then we would be able to provide better advice to our patients. In this study, we analyzed the association of fruits and vegetables with the incidence of hypertension. We were also interested in studying the change in consumption of fruits and vegetables over time and the incidence of hypertension. We used data from 3 large prospective cohort studies: the Nurses’ Health Study, the Nurses’ Health Study II and the Health Professional Follow-up study (total of 187,453 participants). Information about health and food intake was updated every 2 and 4 years, respectively. We found that participants who consumed ≥4 servings/day of fruits (not including fruit juice) had a lower risk of developing hypertension (follow-up was more than 20 years), when compared to participants whose consumption was ≤4 servings/weeks (Hazard ratio=0.92; 95%CI= 0.87-0.97). However, the association of vegetable intake with hypertension was different; indeed, we found no significant association with a HR of 0.95(0.86-1.04). To better understand these associations, we further analyzed individual fruits and vegetables with the incidence of hypertension. We found lower risks of developing hypertension when these individual fruits and vegetables were consumed ≥4 servings/week as compared to <1 serving/month: broccoli, carrots, tofu or soybeans, raisins and apples. In contrast, we found that eating more string beans or brussel sprouts was associated with an increased risk of hypertension with HRs of 1.11(1.05-1.17) and 1.23(1.04-1.46), respectively. In all of our analyses, we adjusted for potential cofounders (such as age, gender, body mass index and more). Finally, we also found that increasing total fruit (but not total vegetable) consumption by ≥7servings/week in the preceding 8 years was associated with a lower risk of hypertension with a pooled HR 0.94(0.90-0.97). (more…)
Author Interviews, Brain Cancer - Brain Tumors, Genetic Research, Pediatrics, University of Pennsylvania / 04.02.2016

MedicalResearch.com Interview with: Dr. Adam C. Resnick, Ph.D Assistant Professor of Neurosurgery Faculty, Abramson Cancer Center Director of Children's Brain Tumor Tissue Consortium Division of Neurosurgery Director, CHOP/PENN Department of Neurosurgery Brain Tumor Tissue BiorepositoryDirector for Neurosurgical Translational Research, Division of Neurosurgery Children's Hospital of Philadelphia   Payal Jain, PhD Candidate Division of Neurosurgery, Children's Hospital of Philadelphia Department of Neurosurgery Cell and Molecular Biology Graduate Group Gene Therapy and Vaccines Program Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania   Medical Research: What is the background for this study? What are the main findings? Response: This study originates from our long-standing interest in studying pediatric low-grade gliomas (PLGGs), which are the most commonly diagnosed brain tumor in children. While several PLGGs have been found to harbor mutations/gene fusions driving the mitogen-associated protein kinase (MAPK) pathway leading to clinical trials testing MAPK inhibitors, these tumors remain poorly categorized and not enough is known about specific genetic mutations driving different tumor sub-types and the potential for specific targeted therapeutics. Our current study encompasses analysis of the largest combined genomic dataset of pediatric low-grade gliomas samples.  In doing this we, identified the MYB-QKI gene fusion, a non-MAPK related event, as the common genetic event driving a rare PLGG sub-type, called angiocentric gliomas. We have reported a novel tri-partite mechanism by which MYB-QKI mediates its oncogenic effect, this being the first report of a single gene rearrangement utilizing three different paths to cause cancer.
  • First, this gene rearrangement activates MYB, which is a proto-oncogene that is normally not expressed in the developed brain.
  • Second, we found that the rearrangement leads to translocation of QKI-related enhancers close to MYB’s promoters, thereby driving MYB-QKI expression in these tumors. Furthermore, MYB-QKI can also regulate its expression in a positive feedback loop.
  • Third, the tumor suppressor activities of QKI are disrupted in MYB-QKI. Such collaboration of genetic and epigenetic dysregulation in a single genetic rearrangement has previously not been reported.
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Author Interviews, OBGYNE, Rheumatology, Stanford / 03.02.2016

MedicalResearch.com Interview with: Dr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of MedicineDr. Julia Fridman Simard ScD Assistant Professor Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden Division of Epidemiology, Department of Health Research & Policy Division of Immunology & Rheumatology, Department of Medicine Stanford School of Medicine  Medical Research: What is the background for this study? What are the main findings? Dr. Simard: A number of studies have shown that women with lupus who get pregnant have more complications and adverse outcomes, although the methodologies across studies vary considerably. Using population-based data we were able compare the occurrence of these pregnancy complications in mothers with lupus to pregnancies from the general population. We were also interested in whether women in our data set who first presented with lupus up to five years post-partum had more pregnancy-related adverse events. Our descriptive study showed that preterm delivery, infant infection, and preeclampsia were more common in the first singleton pregnancies of women with lupus compared to the general population.  These outcomes were also observed more often among women who appeared to present with lupus up to five years post-partum. (more…)
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, NIH / 03.02.2016

MedicalResearch.com Interview with: Dr. Juan M. Saavedra, MD and Dr. Abdel Elkahloun PhD Comparative genomics and Cancer Genetics Branch National Human Genome Research Institute, National Institutes of Health, Bethesda, MD MedicalResearch: What is the background for this study? What are the main findings? Response: Alzheimer’s disease is the most frequent age-related dementia, a progressing, devastating illness without effective treatment. By the time it is diagnosed, major and irreversible cell injury has already occurred. It is therefore imperative to identify therapeutic agents effective against early, pre-symptomatic injury mechanisms and risk factors increasing vulnerability the disease. We focused on a class of compounds blocking receptors for Angiotensin II, the Angiotensin Receptor Blockers (ARBs). These compounds are commonly used for the treatment of hypertension, a major risk factor for Alzheimer’s disease. We and others have found that in addition to their cardiovascular benefits, ARBs are strongly neuroprotective. The present study was designed to explore in depth the neuroprotective effects of one member of the ARB class, candesartan. To this effect we cultured neurons extracted from the rat brain. These neurons were exposed to high concentrations of glutamate, a recently identified early injury mechanism in Alzheimer’s disease. We found that candesartan prevented glutamate-induced neuronal injury. We conducted in-depth examination of our results by genome-wide expression profile analysis. We found that candesartan normalized glutamate-induced alterations in expression of hundreds of genes, including many involved in neuronal inflammation, cardiovascular disease, diabetes and alterations in amyloid metabolism a hallmark for Alzheimer’s disease. This was evidence of direct neuroprotective effects of relevance for this disorder. When we compared our results with published databases obtained from autopsy samples from Alzheimer’s disease patients, we found impressive correlations. The expression of more than 400 genes altered by glutamate and normalized by candesartan in our cultures was similarly changed in the Alzheimer’s databases. The conclusion was that our cell culture results represented alterations found in the human condition. Our observations provide novel evidence of neuroprotection from early mechanisms of injury in Alzheimer’s disease and support testing candesartan in controlled clinical studies including individuals at the early stages of the illness, to unequivocally demonstrate their therapeutic effect. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Lancet, Pediatrics, Radiation Therapy / 02.02.2016

MedicalResearch.com Interview with: Dr. Torunn Yock, MD Director, Pediatric Radiation Oncology Associate Professor, Harvard Medical School Radiation Oncology Quality Assurance Massachusetts General Hospital, Proton Center Boston, MA Medical Research: What is the background for this study? Dr. Yock: Proton radiotherapy is a highly targeted form of radiation therapy that can spare normal tissues better than standard x-ray/photon based radiotherapy. Because, all side effects from radiotherapy come from radiation dose to normal healthy tissues, it is widely believed that proton radiotherapy has great potential to mitigate the side effects of treatment, both acute and long term side effects. There have been many planning studies that show that proton radiation can achieve a more highly conformal dose distribution and appear to spare 50% or more normal tissue from unnecessary irradiation.  However, there have been only a handful of retrospective studies that report disease control and side effects of treatment. While the technology looked promising, the definitive clinical data has been lacking to date. Because of this lack of clinical outcome data, the role and benefit of proton radiotherapy has been a subject of great debate in the oncology community.  Critics assert that proton radiotherapy is expensive and unproven and therefore a leading culprit in escalating costs of oncologic health care. Proponents assert that when used in the appropriate patient setting, the margin of benefit in terms of improved health outcomes, outweighs the increased cost of treatment. We embarked on this study to answer help answer the call for prospectively collected clinical outcome data to better define the most appropriate role for proton radiotherapy. Importantly, this study addresses both disease control and side effects of treatment in a pediatric medulloblastoma cohort of children. Medical Research: What are the main findings? Dr. Yock: This study shows that disease control in the pediatric medulloblastoma population is very much the same as that which is achieved by photon based radiotherapy treatments. However, more importantly, late side effects commonly attributed to radiotherapy such as neurocognitive decline over time and hearing loss appear to be improved compared with published photon treated cohorts of pediatric medulloblastoma patients.  Additionally, adverse late side effects on the cardiopulmonary, GI, and reproductive systems were essentially eliminated. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Nutrition, Pediatrics / 02.02.2016

MedicalResearch.com Interview with: Dr. Maryam S. Farvid, PhD Takemi Fellow Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Farvid: Previous studies of fiber intake and breast cancer have almost all been non-significant, but none of them examined diet during adolescence or early adulthood, a period when breast cancer risk factors appear to be particularly important. Current study supports protective role of dietary fiber intake on breast cancer. The women who reported the highest amount of fiber consumed during high school, about 28 grams daily, had a 16% lower risk of overall breast cancer compared with those who said they consumed an about 15 grams a day. Also highest verses lowest intake of fiber during early adulthood was associated with a 19% lower risk of overall breast cancer. The associations were more apparent for premenopausal breast cancer than postmenopausal breast cancer. Each 10 grams increase in adolescent fiber intake may lead to a 20% lower risk of premenopausal breast cancer, as was a 15% for overall breast cancer. (more…)
Author Interviews, Blood Pressure - Hypertension, Kaiser Permanente, OBGYNE / 01.02.2016

MEDICALRESEARCH.COM INTERVIEW WITH: KRISTI REYNOLDS, PHD, MPH  KAISER PERMANENTE RESEARCH RESEARCH & EVALUATION PASADENA, CA 91101  Medical Research: What is the background for this study? Dr. Reynolds: Hypertensive disorders during pregnancy are common, affecting up to 10 percent of all pregnant women, and include gestational hypertension, preeclampsia (which is a combination of high blood pressure and protein in the urine), and eclampsia, which includes seizures in women with severe preeclampsia. Research has shown that hypertensive disorders in pregnancy are associated with long-term cardiovascular disease risk, but little is known about the effect of these conditions in the early years after delivery. As part of our study, we examined the electronic health records of 5,960 women who had prenatal care and delivered a baby at the Kaiser Permanente Southern California Bellflower Medical Center between 2005 and 2010. Women with high blood pressure before their pregnancy were excluded from the analysis. Medical Research: What are the main findings? Dr. Reynolds: We found that women who had a hypertensive disorder during pregnancy were 2.4 times more likely – and women with pre-eclampsia/eclampsia 2.5 times more likely – to develop pre-hypertension or hypertension in the year after delivery than those who maintained a normal blood pressure during their pregnancy, after controlling for differences between the groups. In comparison to women with normal blood pressure during pregnancy, women with pregnancy-related hypertension tended to be slightly younger and overweight or obese before pregnancy. In addition, they were more likely to have had one or more children previously and to gain excess weight and develop gestational diabetes during their pregnancy. (more…)
Author Interviews, Depression, JAMA, NYU, Pediatrics / 01.02.2016

MedicalResearch.com Interview with: Briannon O'Connor PhD New York University Child Study Center Department of Child and Adolescent Psychiatry New York University School of Medicine New York Medical Research: What is the background for this study? What are the main findings? Dr. O'Connor: a.      As the health care system continues to emphasize accountability for providing high quality care, the development of meaningful quality standards is critical.  This study came from NCQA’s work to develop these quality measures for adolescent depression care.  Prior to this study, little was known about what routine care looked like for adolescents who showed up at their primary care visits with significant symptoms of depression. This study looked at follow up care documented in an electronic health record in the three months after an adolescent was first identified with significant symptoms of depression. Medical Research: What is the background for this study? What are the main findings? Dr. O'Connor:    Key findings from this study include:
  1. Most adolescents (nearly two-thirds) with newly prescribed depression symptoms received some treatment, usually including psychotherapy, within the first 3 months after depression symptoms were first identified.
  2. Among those adolescents who were prescribed antidepressant medications, 40% had no other follow up care in three months, which is quite concerning since current black box warnings highlight the risk for increased suicidality for youth prescribed antidepressants and clearly recommend close monitoring in the few months following initial prescription.
  3. There were low rates of other follow up care events in the three month follow up period:  19% of adolescents  did not receive any follow up care at all, 36% did not receive any treatment, and the majority (68%) lacked documentation that symptoms were monitored or re-assessed using a valid questionnaire
  4. The sites that participated in the study are highly regarded health care institutions, often looked to as leaders in cutting-edge care. Thus, results from this study, discouraging as they are, may overstate the quality of care in other settings.
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Aging, Author Interviews, Cognitive Issues, JAMA, Mayo Clinic, Weight Research / 01.02.2016

MedicalResearch.com Interview with: Rosebud O. Roberts, M.B., Ch.B. Mayo Clinic Rochester, Minn.  Medical Research: What is the background for this study? Dr. Roberts: Decline in weight has been observed 10-20 years prior to onset of dementia. We wanted to study whether this decline also occurs for mild cognitive impairment (an intermediate stage in the progression from normal cognition to dementia). Medical Research: What are the main findings? Dr. Roberts: The main finding was that there was indeed a decline in weight (from the maximum weight in midlife to weight assessed in late life) was associated with a increased risk of mild cognitive impairment. (more…)
Author Interviews, Microbiome, Nature, NYU, OBGYNE / 01.02.2016

MedicalResearch.com Interview with: Maria Dominguez-Bello, PhD Associate Professor, Department of Medicine, Division of Translational Medicine NYU Langone Medical Center and Jose Clemente, PhD Assistant Professor, Departments of Genetics and Genomic Sciences, and Medicine Icahn School of Medicine at Mount Sinai       Medical Research: What is the background for this study? What are the main findings? Response: Humans and animals are a composite of their own cells and microbes. But where they get their microbes from?  For mammals, labor and birth are major exposures to maternal vaginal bacteria, and infants are born already with a microbiota acquired from the mother. Mom’s birth canal is heavily colonized by bacteria that are highly related to milk: some will use milk components and become dominant during early development, an important window for maturation of the immune system, the intestine and the brain. Thus, the maternal vaginal microbiota is thought to be of high adaptive value for newborn mammals. Indeed, studies in mice confirm that microbes acquired at birth are important to develop adequate immune and metabolic responses, and the mature adult microbiome will continue to modulate host metabolism and immunity. Humans are the only mammals that interrupt the exposure to maternal vaginal microbiota, by delivering babies by Cesarean section. C-sections save lives of babies and moms, and they are estimated necessary in 10-15% of the cases. But most Western countries have rates above 30%, with the notable exception of the Scandinavian countries, Holland and Japan, which have excellent health systems and low maternal-infant mortality rates. Previous work by us an others has shown that infants born by C-section acquire different microbiota at birth, and those differences are sustained over time, altering the normal age-dependent maturation of the microbiome. The fundamental questions are then, can we restore the microbiota of Cesarean delivered babies? And if we can, does that reduce the associated disease risks? In relation to the first question, we present here the results of a pilot study in which infants born by Cesarean delivery were exposed to maternal vaginal fluids at birth. A total of 18 infants were recruited for the study. Seven of them were vaginally delivered, the remaining 11 were born by scheduled C-section. Among the C-section infants, 4 were exposed to maternal vaginal fluids at birth and 7 were not. We sampled all infants and their mothers for the first month of life across different body sites (oral, skin, anal, maternal vagina) and determined the microbiome composition on a total of over 1,500 samples. (more…)
Author Interviews, Brigham & Women's - Harvard, Dermatology / 01.02.2016

MedicalResearch.com Interview with: Victor Allen Neel, MD, PhD Director, Dermatologic Surgery Massachusetts General Hospital Medical Research: What is the background for this study? Dr. Neel: Seborrheic keratoses (SKs) are the very common, warty brown skin lesions that are found on the face, chest and back of most people over forty. They affect every race and they increase in size and frequency with age. Although they are not dangerous, they can mimic dangerous conditions and are cosmetically unappealing. There is a high demand in the field of dermatology by both patients and physicians for a topical treatment. Currently there no FDA-approved drugs that have been shown to be effective at removing them. Medical Research: What are the main findings? Dr. Neel: Although seborrheic keratoses are the most common benign tumors in humans, very little was known about what causes them. Our paper was the first to study the biology of SKs in the laboratory, identify the key proteins controlling their abnormal growth and to pinpoint a potential treatment for commercial development. We found that the enzyme called Akt was activated in seborrheic keratoses. Inhibiting this enzyme with a compound called A44 caused the SK cells to undergo "apoptosis,"  or programmed cell death. Normal skin cells were unaffected by A44. (more…)
Author Interviews, Brigham & Women's - Harvard, UCSF, Zika / 31.01.2016

MedicalResearch.com Interview with: Mary E. Wilson, MD Visiting Professor of Epidemiology and Biostatistics School of Medicine, University of California San Francisco Adjunct Professor of Global Health and Population Harvard T.H. Chan School of Public Health Boston, Massachusetts  Medical Research: What is the background for this study? Response: Zika virus infections are spreading explosively in the Americas. This flavivirus infection, spread by Aedes mosquitoes, is new to the Americas, so the majority clinicians have little knowledge of the infection and its potential complications. The country most affected so far is Brazil, where more than a million infections have been reported in less than a year. Infection has also spread to at least 20 other countries in the Americas (the Caribbean, Mexico, Central and South America). Prior to 2007 Zika virus was known to cause infections only in Africa and Asia. Since then, it has spread and caused epidemics in Micronesia, French Polynesia, Easter Island, and since 2015 in Brazil. Most of the movement of the virus from one region to another is via travelers who are infected and then are bitten by mosquitoes in a new region. In Brazil an increase in cases of infants born with microcephaly (small head) has been noted coincident with the Zika epidemic, and the virus has been recovered from amniotic fluid and from fetal tissue, suggesting that Zika infection during pregnancy may cause microcephaly in the developing fetus. An increase in cases of Guillain-Barre syndrome has also been observed during this and previous outbreaks. Studies are underway to determine if Zika virus is the cause of microcephaly and Guillain-Barre syndrome.In Brazil an increase in cases of infants born with microcephaly (small head) has been noted coincident with the Zika epidemic, and the virus has been recovered from amniotic fluid and from fetal tissue, suggesting that Zika infection during pregnancy may cause microcephaly in the developing fetus. An increase in cases of Guillain-Barre syndrome has also been observed during this and previous outbreaks. Studies are underway to determine if Zika virus is the cause of microcephaly and Guillain-Barre syndrome. Most countries in the Americas, including the United States, are infested with types of mosquitoes that are competent to transmit the virus, but weather conditions also have to be warm enough to permit the virus to disseminate in the mosquito so that it can be transmitted to another person. The symptoms of Zika virus infection are typically mild and self-limited  – fever, aches, rash, and conjunctivitis. In fact, the majority of those infected have no symptoms. Because the virus can enter the bloodstream even in asymptomatic infected persons, there is concern that the virus could be spread by blood transfusion, if a person donates blood during the short period (probably a few days at most) when virus is in the blood. Other reasons for the paper are to highlight what is known about some of the insect repellents and to point out important gaps in our knowledge of their use and urgent research needs. (more…)
Author Interviews, Mayo Clinic, Melanoma / 29.01.2016

MedicalResearch.com Interview with: Mariah L. White, MD Department of Radiology Mayo Clinic Rochester, MN 55905 Medical Research: What is the background for this study? Dr. White: Stage IV (metastatic) melanoma carries a poor prognosis with median survival of 6 to 10 months, claiming over 9000 lives per year in the United States. There is evidence that aggressive focal treatment in patients with oligometastatic disease with complete eradication of all clinical disease can result in durable remissions and potentially improve overall survival. Oligometastatic disease is typically defined as metastatic disease limited to 5 or fewer lesions. Thermal ablation is an alternative local management strategy to resection of limited sites of distant spread.  Similar to surgical management of oligometastatic disease it can be used in conjunction with systemic medical therapy or as an alternative in those patients where SMT is not well tolerated or unable to achieve complete remission. (more…)
Author Interviews, Brigham & Women's - Harvard, Johns Hopkins, Race/Ethnic Diversity, Surgical Research / 29.01.2016

MedicalResearch.com Interview with: Adil H. Haider, MD, MPH Kessler Director for the Center for Surgery and Public Health Brigham and Women's Hospital Harvard Medical School, and the Harvard T.H. Chan School of Public Health Deputy Editor of JAMA SurgeryAdil H. Haider, MD, MPH Kessler Director for the Center for Surgery and Public Health Brigham and Women's Hospital  Harvard Medical School, and the Harvard T.H. Chan School of Public Health Deputy Editor of JAMA Surgery  Medical Research: What is the background for this study? Dr. Haider: Racial/Ethnic disparities have been identified in multiple surgical fields. They are thought to be caused by a complex interplay of patient-, provider-, and systems-level factors. As healthcare professionals, providers play a key role in the care and outcomes that patients experience. However, despite published research about the existence of disparities, it remains unknown the extent to which surgeons perceive that racial/ethnic disparities exist. Medical Research: What are the main findings? Dr. Haider: In a pilot study designed to assess the extent to which US surgeons report awareness of racial/ethnic disparities, only 36.6% agreed that racial/ethnic disparities exist in healthcare. Even fewer, 11.6% acknowledged that disparities were present in their hospital or clinic, and a mere 4.7% reported disparities in their personal practice. (more…)
Author Interviews, Immunotherapy, NEJM, Transplantation, UCSF / 29.01.2016

MedicalResearch.com Interview with: Dr. Flavio Vincenti, M.D Clinical Professor of Medicine and Surgery Departments of Medicine and Surgery Endowed Chair in Kidney Transplantation University of California, San Francisco San Francisco, CA 94143 Medical Research: What is the background for this study? What are the main findings? Dr. Vincenti: This is a phase 3 study of belacept immunosuppression as compared to cyclosporine based immunosuppression in renal transplant recipients randomly assigned to 2 treatments arms of belatacept and a controlled arm consisting of cyclosporine. The main finding of this study is that Belatacept, a fusion receptor protein that blocks co-stimulation and is administered intravenously on the maintenance of a 4 weekly maintenance therapy, had superior outcomes at 5 and 7 years as compared to patients on a CsA-based regimen. The 7 year data show that patients on either arm of belatacept had a 43 percent risk reduction of deaths or grafts loss as compared to patients treated with cyclosporine. In addition, belatcept patients had significantly better preservation of renal function throughout the 7 years of follow up and had lower incidence of donor specific antibodies. Nephrotoxicity from cyclosporine and donor specific antibodies are important causes of late graft loss. (more…)
Author Interviews, Brigham & Women's - Harvard, Diabetes, Diabetologia, Sleep Disorders / 29.01.2016

MedicalResearch.com Interview with: Dr. Yanping Li Research Scientist Harvard T.H.Chan School of Public Health Boston, MA 02115

Medical Research: What is the background for this study? What are the main findings? Dr. Li: Sleeping difficulty is a common disorder but always lack of attention from both the patients and physicians. Our study finds that women with sleeping difficulty is associated with a higher risk of type 2 diabetes. (more…)
Aging, Author Interviews, Columbia, Depression, Geriatrics / 27.01.2016

MedicalResearch.com Interview with: Stanford Chihuri MPH Center for Injury Epidemiology and Prevention Department of Anesthesiology Columbia University Medical Center New York City, New York  Medical Research: What is the background for this study? What are the main findings? Response: For many older adults, driving is instrumental to their daily living and is a strong indicator of self-control, personal freedom and independence. This study assesses and synthesizes evidence in the research literature on the impact of driving cessation on subsequent health and well-being of older adults. The main findings are that driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. (more…)
Annals Internal Medicine, Author Interviews, Biomarkers, Colon Cancer, Kaiser Permanente / 27.01.2016

MedicalResearch.com Interview with: Douglas A. Corley, MD, PhD Gastroenterologist and Research Scientist III Division of Research Kaiser Permanente Oakland, CA  Medical Research: What is the background for this study? What are the main findings? Dr. Corley: Colorectal cancer is a leading cause of cancer death in the United States, so understanding how cancer screening tests for this cancer are used and if they are effective is extremely important. There are two commonly used tests for colorectal cancer screening in the United States: colonoscopy and fecal immunochemical tests (also known as "FIT"). Colonoscopy requires a bowel preparation to clean you out and is invasive but, if normal, it is done infrequently (every ten years). FIT is simple to do at home but, to be most effective, needs to be done every year. This has the advantage of potentially picking up cancers that grow between tests. There are few studies that have looked at how well FIT picks up cancers when used year after year. If a test picks up most cancers, it is said to be very "sensitive" for picking up cancer. Most studies only looked at 1 or 2 years of use for how well FITdetected cancers. It is possible that the first year of use may "clear out" most of the easily detectable cancers and that FIT might not work as well in subsequent years. This very large study over several years at Kaisier Permanente, where we use both colonoscopy and FIT for colorectal cancer screening, looked at whether FIT worked as well at detecting cancer in years 3 and 4 as it did the first time someone used it. We found that the sensitivity was highest in the first year, likely from clearing out cancers that were there for a while and easily detected, but that in subsequent years the sensitivity, though 5-10% lower, remained high. Also, most people who started with FIT continued doing it, suggesting that it is both feasible and effective for colorectal cancer screening. (more…)
Author Interviews, Brigham & Women's - Harvard, End of Life Care, JAMA / 27.01.2016

MedicalResearch.com Interview with: Joel Weissman, PhD, Deputy Director and Zara Cooper, MD, MSc Associate Surgeon Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: A major priority for providers of end-of-life care is balancing the intensity of a patient’s treatment with quality of life. Previous studies have looked at the intensity of end-of-life care for the general population, but not whether physicians, the group most familiar with end-of-life care, receive more or less intense end-of-life care compared to non-physicians. Research from the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital found that for 3 of 5 end-of-life care intensity measures, physicians received significantly less intensive end-of-life care than the general population.  The findings are published in the January 19, 2016 issue of JAMA, in a special themed issue focusing on end-of-life care. The analysis included non-health maintenance organization Medicare beneficiaries aged 65 years or older who died between 2004 and 2011 in Massachusetts, Michigan, Utah, and Vermont, and was based on availability of electronic death records and ability to link to Medicare. Researchers used data from these records to look at 5 validated measures of end-of-life care intensity during the last 6 months of life: surgery, hospice care, intensive care unit (ICU) admission, death in the hospital, and expenditures. They then compared these measures between physicians and the general population (excluding other health care workers and lawyers), physicians vs. lawyers, who are presumed to be socioeconomically and educationally similar, and lawyers vs. the general population. There were 2,396 deceased physicians, 2,081 lawyers, and 666,579 people included in the analysis. Overall, physicians were less likely to die in a hospital compared with the general population (27.9 percent vs. 32 percent, respectively), less likely to have surgery (25.1 percent vs. 27.4 percent), and less likely to be admitted to the ICU (25.8 percent vs. 27.6 percent). Physicians were less likely to die in a hospital compared to lawyers (27.9 percent vs. 32.7 percent, respectively), but did not differ significantly in other measures. (more…)
Author Interviews, Emergency Care, Hepatitis - Liver Disease, NYU / 26.01.2016

Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016MedicalResearch.com Interview with: Dr Waridibo Allison MD PhD Department of Medicine, Division of Infectious Diseases and Immunology New York Langone University School of Medicine New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Allison: It was found that among 383 baby boomers presenting to a large urban emergency department in New York City the prevalence of HCV antibody reactivity was 7.3%. Only four patients were successfully linked to care and only one patient was started on HCV treatment. The study highlights the possibility that there may be problems in linking patients to care from the ED compared to other clinical settings such as primary care and inpatient settings. It was concluded that only with strategies to improve linkage to care could a screening program for baby boomers be recommended in the ED where the study was carried out. The study additionally had a qualitative component and, via structured interviews, evaluated knowledge about HCV infection amongst baby boomers presenting to the ED. Overall knowledge was good but some misconceptions about transmission persisted and many patients mistakenly believed that there is a vaccine for hepatitis C. (more…)
Asthma, Author Interviews, Brigham & Women's - Harvard, JAMA, Vitamin D / 26.01.2016

MedicalResearch.com Interview with: Augusto A. Litonjua, MD, MPH Associate Professor Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 USA  Medical Research: What is the background for this study? What are the main findings? Response: Vitamin D deficiency has been hypothesized to contribute to the asthma and allergy epidemic.  Vitamin D has been shown to affect lung development in utero. However, observational studies have shown mixed results when studying asthma development in young children. Since most asthma cases start out as wheezing illnesses in very young children, we hypothesized that vitamin D supplementation in pregnant mothers might prevent the development of asthma and wheezing illnesses in their offspring.  We randomly assigned 881 pregnant women at 10 to 18 weeks' gestation and at high risk of having children with asthma to receive daily 4,000 IU vitamin D plus a prenatal vitamin containing 400 IU vitamin D (n = 440), or a placebo plus a prenatal vitamin containing 400 IU vitamin D (n = 436). Eight hundred ten infants were born during the study period, and 806 were included in the analyses for the 3-year outcomes. The children born to mothers in the 4,400 IU group had a 20% reduction in the development of asthma or recurrent wheeze compared to the children born to mothers in the 400 IU group (24% vs 30%, respectively; an absolute reduction of 6%).  However, this reduction did not reach statistical significance (p=0.051). (more…)
Author Interviews, Brigham & Women's - Harvard, Multiple Sclerosis, Neurological Disorders, Stem Cells / 26.01.2016

MedicalResearch.com Interview with: Zhigang He, PhD, BM Professor of Neurology  and Michela Fagiolini, PhD Assistant Professor of Neurology F.M. Kirby Neurobiology Center, Department of Neurology Children’s Hospital, Harvard Medical School Boston, MA 02115, USA

Medical Research: What is the background for this study? Drs. Fagiolini and He: Brain or spinal cord injury is still a major medical problem and there is no effective treatment of promoting functional recovery. A key issue is the nerve fibers, or axons, connecting different brain regions are damaged and cannot be repaired. For example, the axons in the optic nerve are the only channels transmitting visual signals from eye to brain. If damaged, our brain will not be able to receive visual signals and be blinded. Thus, a logical therapy should be to stimulate damaged axons to regrow to the targets and reconnect the eyes and brain. Studies in the past from us and others revealed several approaches of promoting the regrowth of injured axons, but it was unknown whether these regenerated axons could form functional connections and mediate functional recovery. Medical Research: What are the main findings? Drs. Fagiolini and He:  What we discovered in this study is that these regenerated axons could form functional connections, synapses, in the brain targets, but surprisingly fail to mediate behavioral visual function recovery. In mammals, many long projecting axons are insulated by lipid-enriched myelin sheets which could significantly speed up nerve conduction and facilitate the functional coordination of different brain regions during behavior. Interestingly, we found that different from intact optic nerves, these regenerated axons fail to be myelinated and thus possess poor conductance. When we treat these mice with compounds that can improve nerve conduction, we do observe partial yet significant functional recovery. Thus, there are at least two pieces of information from this study:
  • First, axon regrowth might not enough for functional recovery, nerve conduction could be another hurdle;
  • Second, the combination of these manipulations could serve a proof-of-principle example for achieving functional recovery.
(more…)
AACR, Author Interviews, Melanoma, NYU, Personalized Medicine / 25.01.2016

MedicalResearch.com Interview with: Tomas Kirchhoff, PhD Assistant Professor, Departments of Population Health and Environmental Medicine NYU Langone Medical Center Member, Laura and Isaac Perlmutter Cancer Center NYU Langone  Medical Research: What is the background for this study? Dr. Kirchhoff: Melanoma is the deadliest form of skin cancer, and the cause of approximately 80% of all skin cancer patients annually. One factor that can help reverse this negative trend is efficient prediction of which patients at early melanoma stage will likely progress to more advanced metastatic disease. Current clinical predictors of patient survival, based on tumor characteristics, are important, but are relatively non-specific to inform melanoma prognosis to an individual patient level. It is critical to identify other factors that can serve as more personalized markers of predicting the course of melanoma. Medical Research: What are the main findings? Dr. Kirchhoff: In our study, we found that inherited genetic markers that impact activity of certain immune genes correlate with melanoma survival. More specifically, our findings show that patients with more frequent forms of these genetic markers (genotypes) have, on average, a five-year shorter survival than patients with less common genotypes. We suggest that these genetic markers are independent of the current tumor surrogates and, as such, can serve as novel personalized markers of melanoma prognosis. (more…)
Author Interviews, Duke, Genetic Research, Infections / 24.01.2016

MedicalResearch.com Interview with: Ephraim L. Tsalik, MD MHS PhD Assistant Professor of Medicine Division of Infectious Diseases Center for Applied Genomics & Precision Medicine Duke University Medical Center Emergency Department Service Line Durham VA Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Tsalik: This study was motivated by the convergence of two research interests.  The first was spearheaded by Dr. Sack, leading our collaboration at Johns Hopkins.  Dr. Sack and his colleagues have a long history and expertise in studying enteric infections such as E. coli.  The second is our group here at Duke’s Center for Applied Genomics & Precision Medicine as well as the Durham VA Medical Center.  Specifically, we have an interest in studying the host response to infectious disease.  One of the ways we’ve done that historically is through challenge studies where healthy volunteers are exposed to a pathogen in a controlled setting.  Despite everyone getting the same exposure, not everyone gets sick.  That observation gives us a unique opportunity to study the host biology of symptomatic individuals, asymptomatic individuals, and what distinguishes the two from each other.  That is precisely what we did here. Volunteers ingested Enterotoxigenic E. coli (ETEC), which is a common cause of traveler’s diarrhea.  Some subjects became ill with diarrhea while others remained well.  In this study, we focused on gene expression patterns, which is a snapshot of how genes in the body are being used in response to this infection.  Some genes are more active, some are less.  The pattern of those changes that occur in response to infection is what we call a “signature”. This approach allowed us to generate some key findings.  First of all, we were able to define the genes involved in the body’s response to this type of E. coli infection.  Second, we discovered genes that were differentially expressed at baseline that could distinguish people who would go on to become ill from those that would remain healthy.  Although this study was not designed to identify the mechanism for that resilience to infection, it does focus our attention on where to look.  We suspect the genes we identified are likely to play a role in infectious disease resilience and susceptibility based on their known immune function roles.  We also have data, which wasn’t published in this study, that implicates some of these genes in the resilience to other infections such as influenza. The last major finding was something called Drug Repositioning Analysis.  This is a tool that allowed us to identify drugs and drug classes that could be used to mitigate infections caused by ETEC.  That analysis highlighted some compounds already known to be effective such as Zinc.  But it also identified several other drug classes that have not previously been investigated and could be important tools to combat such infections especially as antibiotic resistance looms. (more…)
Author Interviews, Cancer Research, Genetic Research, Personalized Medicine, UCLA / 24.01.2016

MedicalResearch.com Interview with: Dr. Chirag Patil, MD American Board Certified Neurosurgeon Brain & Spine Tumor Program Lead Investigator, Precision Medicine Initiative Against Brain Cancer Program Director, Neurosurgical Residence training program Director, Center for Neurosurgical Outcomes Research Cedars-Sinai Medical Center, Los Angeles, California MedicalResearch.com Editor’s note: Dr. Patil’s research is focused on developing a method of personalized cancer treatment through the harnessing of genome wide mutational analysis of a specific patient’s cancer. MedicalResearch.com: Would you tell us a little about yourself and your research interests? Dr. Patil: I am a Stanford-trained, Board Certified Neurosurgeon and cancer researcher at Cedars-Sinai Medical Center in Los Angeles, California. I primarily focus on the care of patients with malignant brain tumors, particularly glioblastomas. I received my undergraduate degree from Cornell, followed by a medical degree from the University of California, San Francisco (UCSF), where I was a Regent’s scholar. I completed a residency in neurosurgery and a fellowship in stereotactic radiology at Stanford University. I also have a master’s degree in epidemiology with a focus on clinical trial design and mathematical modeling from Stanford. MedicalResearch.com: Can you tell us about some of your research interests? Dr. Patil: I am keenly interested in and focused on developing precision science-powered novel brain tumor therapies, immuno-therapies, and patient-centered “big data” outcomes research. I lead the recently-funded Cedars-Sinai Precision Medicine Initiative Against Brain Cancer, which utilizes tumor genomics to build a mathematical computer model, i.e., a virtual cancer cell of each patient’s unique tumor. The White House and several other stakeholders have taken keep interest in this research initiative as an example of a leading precision medicine program. (more…)