Author Interviews, Nature, NYU / 25.08.2015

Robert C. Froemke, PhD, Assistant professor NYU Langone and Skirball Institute of Biomolecular Medicine New York MedicalResearch.com Interview with: Robert C. Froemke, PhD, Assistant professor NYU Langone and Skirball Institute of Biomolecular Medicine New York Medical Research: What is the background for this study? What are the main findings? Dr. Froemke: We studied how a brain area called the ‘locus coeruleus’ is involved in hearing. The locus coeruleus is the brain’s alarm clock, it’s a small region deep in the brainstem that is responsible for arousal and wakefulness, activated by surprising or potentially dangerous events. The locus coeruleus releases the neurochemical noradrenalin (similar to adrenalin) throughout the brain to greatly increase brain activity, and so might convey the significance of sounds related to past events that were very important or startling in some way (like the sound of an alarm, a baby crying, or other sounds that require immediate attention). We found that sounds related to surprising events can come to directly activate the locus coeruleus, meaning that this brain area can learn from past experience. This learning happens quickly (within seconds to minutes) and can be incredibly long-lasting, up to weeks as measured in our study, and we suspect indefinitely or all life-long. We studied this by training lab rats to respond to sounds, poking their nose in a hole to get a food reward whenever they heard a certain sound. We activated the locus coeruleus briefly in some of these animals, and observed that they were much more sensitive to this sound and learned much faster than other unstimulated animals. We made recordings of electrical activity in the locus coeruleus and the auditory cortex, one of the major ‘hearing’ parts of the brain. In stimulated animals, sounds activated the locus coeruleus within tens of milliseconds, releasing noradrenalin into the auditory cortex to greatly boost the audio processing there- making almost every neuron respond very vigorously to that special sound. (more…)
Author Interviews, JAMA, Pediatrics, University Texas / 24.08.2015

Jeffrey R. Kaiser, MD, MA Professor of Pediatrics and Obstetrics and Gynecology Section of Neonatology Baylor College of Medicine Texas Children's Hospital Houston, TX 77030MedicalResearch.com Interview with: Jeffrey R. Kaiser, MD, MA Professor of Pediatrics and Obstetrics and Gynecology Section of Neonatology Baylor College of Medicine Texas Children's Hospital Houston, TX 77030 Medical Research: What is the background for this study? What are the main findings? Dr. Kaiser:  The continuous utero-placental-umbilical infusion of glucose ends at birth, and levels decrease during the first 1–2 hours stimulating counterregulatory hormones and promoting successful glucose homeostasis in healthy newborns. This is important because the newborn brain principally uses glucose for energy, and prolonged and severe hypoglycemia has been linked with poor long-term neurodevelopment. Most previous newborn hypoglycemia-outcome studies, however, are problematic because they did not control for maternal educational level and socioeconomic status, factors that are highly associated with childhood neurodevelopment and academic success. Further, little is known about whether newborn transient hypoglycemia (1 low value followed by a second normal value), frequently considered to be a normal physiological phenomena with no serious sequelae, is associated with poor academic achievement. To address this knowledge gap, we compared initial newborn glucose values from the universal glucose-screening database, available only at the University of Arkansas for Medical Sciences (UAMS), to their matched student achievement-test scores in 4th grade (10 years later). After controlling for gestational-age group, race, gender, multifetal gestation, insurance, maternal education, and gravidity, we observed transient hypoglycemia in a heterogeneous cohort of newborns born at a university hospital was associated with lower fourth-grade achievement-test scores—real-world assessments that predict high school graduation, college attendance, and long-term adult economic success. (more…)
Author Interviews, Dermatology, Emory, JAMA, Sexual Health / 23.08.2015

MedicalResearch.com Interview with: Howa Yeung, MD PGY3, Emory Dermatology Emory University Medical Research: What is the background for this study? What are the main findings? Dr. Yeung: Indoor tanning is a well-established and preventable cause for melanomas and non-melanoma skin cancers. Public health efforts in curbing indoor tanning have focused on known high-risk populations, such as young, college-aged, White women. However, other demographic risk factors for indoor tanning remain unknown. As our nation increasingly focuses on addressing and improving the health of lesbian, gay, bisexual, and transgender (LGBT) individuals, more and more evidence demonstrates that various LGBT subpopulations face higher rates of cancer-related behavior risk factors, such as smoking, alcohol use, obesity, etc. We wanted to find out whether risk factors for skin cancer, such as indoor tanning, disproportionately affected LGBT populations. Our study showed higher rates of indoor tanning among gay and bisexual men, with 1.8-fold and 3.6-fold higher odds of tanning bed use within the past year, compared to straight men, after adjusting for sociodemographic factors. Disparities in frequent tanning, defined as using tanning bed 10 or more times within the past year, are even more prominent among gay and bisexual men. In contrast, no significant sexual orientation disparities were noted among women after adjusting for sociodemographic factors. (more…)
Author Interviews, Cognitive Issues, UCSF / 22.08.2015

Jin-Tai Yu MD, PhD Memory and Aging Center, Department of Neurology University of California San Francisco San Francisco, CA 94158 MedicalResearch.com Interview with: Jin-Tai Yu MD, PhD Memory and Aging Center, Department of Neurology University of California San Francisco San Francisco, CA 94158 Medical Research: What is the background for this study? What are the main findings? Response: The number of dementia cases in the whole world was estimated to be 35.6 million in 2010 and this number was expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. The global prevalence of dementia was 5-7% and Alzheimer’s disease accounts for roughly 60%. This data means that we are facing an increasing number of global populations of this specific neurodegenerative disease and also the heavy burden brought by it. Data from the website of global clinical trials (http://clinicalTrials.gov) showed that a total of 1,732 clinical trials for Alzheimer’s disease were under way. However, the previous results are not so optimistic, possibly due to the complex etiological mechanisms. In one word, we had currently no effective drugs for this disease. Figuring out how to effectively prevent its occurrence is increasingly attracting people’s attentions.Therefore, we have done the most extensive and comprehensive systematic review and meta-analysis to date, which employs a full-scale search of observational studies to calculate effect sizes and grade the evidence strength of various modifiable risk factors for this disease. We hope these results will be informative and instructive. (more…)
Author Interviews, Infections, University of Pennsylvania, Vaccine Studies / 22.08.2015

David B. Weiner, Ph.D. Professor, Department of Pathology and Laboratory Medicine Chair, Gene Therapy and Vaccine Program, CAMB Co-Leader Tumor Virology Program, Abramson Cancer Program University of Pennsylvania, Perelman School of MedicineMedicalResearch.com Interview with: David B. Weiner, Ph.D. Professor, Department of Pathology and Laboratory Medicine Chair, Gene Therapy and Vaccine Program, CAMB Co-Leader Tumor Virology Program, Abramson Cancer Program University of Pennsylvania, Perelman School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Weiner: MERS, like the Severe Acute Respiratory Syndrome (SARS), is characterized by high fever and severe cough from pneumonia. MERS is caused by an emerging human coronavirus, which is distinct from the SARS coronavirus. Since its identification in 2012, MERS has been linked to over 1,300 infections and close to 400 deaths. It has occurred in the Arabian Peninsula, Europe, and in the US and in Asia. It can be spread in a hospital setting. Scientists now report that a novel synthetic DNA vaccine can, for the first time, induce protective immunity against the Middle EastRespiratory Syndrome (MERS) coronavirus in animal species.   Researchers from the Perelman School of Medicine at the University of Pennsylvania. The NIH, the Public Health agency of Canada, and from a leading company in the development of synthetic DNA vaccine technology, Inovio described the results in a paper  published their work in Science Translational Medicine (STM) this week.  The experimental, preventive vaccine, given six weeks before exposure to the MERS virus, fully protects rhesus macaques from disease. The vaccine also generated potentially protective antibodies in blood drawn from camels, the purported source of MERS transmission in the Middle East. (more…)
Author Interviews, Cannabis, Smoking, University Texas / 20.08.2015

Francesca M. Filbey PhD School of Behavioral and Brain Sciences Center for Brain Health University of Texas at Dallas Dallas, TXMedicalResearch.com Interview with: Francesca M. Filbey PhD School of Behavioral and Brain Sciences Center for Brain Health University of Texas at Dallas Dallas, TX Medical Research: What is the background for this study? What are the main findings? Dr. Filbey: Most studies exclude tobacco users from participating, but 70% of marijuana users also use tobacco. We were interested in investigating the combined effects of marijuana and tobacco. Our research targeted the hippocampus because smaller hippocampal size is associated with marijuana use. We chose to study short term memory because the hippocampus is an area of the brain associated with memory and learning. The main finding was surprising. The smaller the hippocampus in the marijuana plus nicotine user, the greater the memory performance. We expected the opposite, which was true of the non-using control group. (more…)
Alcohol, Author Interviews, BMJ, Brigham & Women's - Harvard, Cancer Research / 19.08.2015

Dr. Yin Cao MPH, ScD Postdoctoral Fellow, Department of Nutrition Harvard T. H. Chan School of Public HealthMedicalResearch.com Interview with: Dr. Yin Cao MPH, ScD Postdoctoral Fellow, Department of Nutrition Harvard T. H. Chan School of Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Cao: Light-to-moderate drinking, defined as up to 1 drink (roughly corresponds to a 355ml bottle of beer, or a small [118-148 ml] glass of wine or 44ml of liquor) for women and up to 2 drinks for men, is prevalent in many western countries. It is believed that light-to-moderate drinking may be healthy for the heart. However, the influence of light-to-moderate drinking on risk of overall cancer is less clear, although it is well known that heavy alcohol intake increases risk of several cancers, including cancers of colorectum, female breast, oral cavity, pharynx, larynx, liver, and esophagus. Also because drinkers are more likely to be smokers, and smoking is the major risk factor for all of the alcohol-related cancers (mentioned above) except breast cancer, it is thus difficult to tease out the influence of alcohol on cancer in studies among a mixed population of ever and never smokers. In particular, it is important to know how light and moderate drinking would affect cancer risk particularly among never smokers, who now make up the majority of the population in many western countries. Our main findings are that, light-to-moderate drinking minimally increases risk of overall cancer. For men, the association with alcohol related cancers was primarily observed among smokers, and light to moderate drinking did not appreciably increase risk in never smokers. Among women, even consumption of up to one drink per day was associated with increased risk of alcohol-related cancers (mainly breast cancer) for both never and ever smokers. (more…)
Author Interviews, Brigham & Women's - Harvard, Genetic Research, Heart Disease, Nature / 18.08.2015

Susan A. Slaugenhaupt PhD Professor of Neurology, Harvard Medical School Associate Geneticist, Department of Neurology, Molecular Neurogenetics Unit Center for Human Genetic Research Massachusetts General HospitalMedicalResearch.com Interview with: Susan A. Slaugenhaupt PhD Professor of Neurology, Harvard Medical School Associate Geneticist, Department of Neurology, Molecular Neurogenetics Unit Center for Human Genetic Research Massachusetts General Hospital   Medical Research: What is the background for this study? What are the main findings? Dr. Slaugenhaupt: Mitral valve prolapse (MVP) is one of the most common human diseases affecting 1 out of every 40 people worldwide.  The mitral valve is found between two chambers of the heart, and mitral valve prolapse results when the valve does not close properly.  By studying families in which multiple members have mitral valve prolapse, we have identified a biological explanation for the disease.  Mutations in the DCHS1 gene cause mitral valve prolapse in three families, and suggest that early defects in heart valve formation during development contribute to the progressive deterioration of the valve. (more…)
Author Interviews, Baylor University Medical Center Dallas, OBGYNE, Pediatrics / 17.08.2015

Arpitha Chiruvolu MD FAAP Neonatologist Baylor University Medical Center Department of Neonatology Dallas, TX 75246 MedicalResearch.com Interview with: Arpitha Chiruvolu MD FAAP Neonatologist Baylor University Medical Center Department of Neonatology Dallas, TX 75246  MedicalResearch: What is the background and main findings of the study? Dr. Chiruvolu: There is growing evidence that delaying umbilical cord clamping (DCC) in very preterm infants may improve hemodynamic stability after birth and decrease the incidence of major neonatal morbidities such as intraventricular hemorrhage (IVH) and necrotizing enterocolitis. Recently, the American College of Obstetricians and Gynecologists (ACOG) published a committee opinion that supported delaying umbilical cord clamping in preterm infants, with the possibility for a nearly 50% reduction in IVH. However, the practice of DCC in preterm infants has not been widely adopted, mainly due to the concern of a delay in initiating resuscitation in this vulnerable population. Furthermore, there is uncertainty regarding the magnitude of published benefits in very preterm infants, since prior trials were limited by small sample sizes, wide variability in the technique and inconsistent reporting of factors that may have contributed to clinical outcomes. We recently implemented a delaying umbilical cord clamping quality improvement (QI) process in very preterm infants at a large delivery hospital. The objective of this cohort study was to evaluate the clinical consequences of a protocol-driven delayed umbilical cord clamping implementation in singleton infants born £ 32 weeks gestation. We hypothesized that DCC would not compromise initial resuscitation and would be associated with significant decrease in early red blood cell transfusions and IVH compared to a historic cohort. Delayed umbilical cord clamping was performed on all the 60 eligible infants. 88 infants were identified as historic controls. Gestational age, birth weight and other demographic variables were similar between both groups. There were no differences in Apgar scores or admission temperature, but significantly fewer infants in theDelayed umbilical cord clamping cohort were intubated in delivery room, had respiratory distress syndrome or received red blood cell transfusions in the first week of life compared to the historic cohort.  A significant reduction was noted in the incidence of IVH inDelayed umbilical cord clamping cohort compared to historic control group (18.3% versus 35.2%). After adjusting for gestational age, an association was found between the incidence of IVH and Delayed umbilical cord clamping with IVH significantly lower in the DCC cohort compared to historic cohort with odds ratio of 0.36 (95% CI 0.15 to 0.84, P <0.05). There were no significant differences in mortality and other major morbidities. (more…)
Author Interviews, Brigham & Women's - Harvard, Gastrointestinal Disease, Technology / 16.08.2015

MedicalResearch.com Interview with: Dr. Jeff Karp Ph.D Associate Professor of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge, MA 02139 Dr. Jeff Karp Ph.D Associate Professor of Medicine Brigham and Women's Hospital Harvard Medical School Cambridge, MA  02139 and Giovanni Traverso M.B., B.Ch., Ph.DDr-Giovanni-Traverso The David H. Koch Institute for Integrative Cancer Research Massachusetts Institute of Technology, Cambridge, MA   Medical Research: What is the background for this study? What are the main findings Dr. Karp: Almost all patients with ulcerative colitis will require enema-based therapy at some point in their treatment.  Enema therapy has 3 major issues.
  • It is difficult to retain
  • There is high systemic absorption of the drug (that can lead to toxic side effects), and
  • Compliance is low as patients must take enemas every day.
Our approach can potentially address all three.  The engineered gel that we designed has dual targeting capability. It rapidly attaches to ulcers within seconds to minutes (we have 5-10x less systemic absorption as the gel only attaches to ulcers) and selectively releases drug in the presence of ulcers, and we showed that we could reduce the dosing frequency. (more…)
Author Interviews, HIV, NIH, Pediatrics, Vaccine Studies / 15.08.2015

George K Siberry, MD, MPH, Medical Officer Maternal and Pediatric Infectious Disease (MPID) Branch Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, MDMedicalResearch.com Interview with: George K Siberry, MD, MPH, Medical Officer Maternal and Pediatric Infectious Disease (MPID) Branch Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health Bethesda, MD Medical Research: What is the background for this study? Dr. Siberry:  Vaccines may not work as reliably in children with HIV infection, especially when their HIV is not under effective treatment. Today, most children in the United States who were born with HIV infection are receiving effective HIV treatment and have reached school age or even young adulthood. However, many received their childhood vaccines before they got started on their HIV treatment (because modern HIV treatments weren’t available when they were very young or their HIV infection was diagnosed late). So we wanted to see if these older children still had immunity from the vaccines they received when they were much younger. Medical Research:  What are the main findings? Dr. Siberry: We looked specifically at whether older children with HIV since birth were protected against measles, mumps, and rubella, the three viral infections covered by the measles-mumps-rubella (or MMR) vaccine. We found that 1/3 up to almost 1/2 of these children were not protected against these viruses, even though nearly all of the children had received at least 2 MMR doses, as recommended. And even if their HIV was currently under excellent control.  When we analyzed factors that were linked to being protected, we found that one of the most important factors was whether you got your MMR vaccine doses after you got on good treatment for your HIV infection.  For instance, over 85% of children who had gotten at least 2 MMR vaccine doses after being on effective HIV treatment were protected against measles compared to less than half of those who didn’t get both of their MMR vaccine doses while on effective HIV treatment. (more…)
Author Interviews, Lung Cancer, Outcomes & Safety, Surgical Research, University of Michigan / 15.08.2015

Tyler Grenda, MD House Officer VI Section of General Surgery Department of Surgery University of Michigan MedicalResearch.com Interview with: Tyler Grenda, MD House Officer VI Section of General Surgery Department of Surgery University of Michigan   Medical Research: What is the background for this study? What are the main findings? Dr. Grenda: The main purpose for this study was to better understand the factors underlying differences in mortality rates for hospitals performing lung cancer resection.  The methodology we used included only the highest and lowest mortality hospitals (Commission on Cancer accredited cancer programs) so the sampling frame was specific. There are wide variations in mortality rates across hospitals performing lung cancer resection (overall unadjusted mortality rates were 10.8% vs. 1.6%, respectively. (more…)
Author Interviews, Baylor College of Medicine Houston, Heart Disease / 14.08.2015

Dr. Kristin Kostick PhD on behalf of the authors Research Associate - Decision Making and Ethics Research Program Center for Medical Ethics and Health Policy Baylor College of Medicine Houston, TXMedicalResearch.com Interview with: Dr. Kristin Kostick PhD on behalf of the authors Research Associate - Decision Making and Ethics Research Program Center for Medical Ethics and Health Policy Baylor College of Medicine Houston, TX Medical Research: What is the background for this study? What are the main findings? Response: The idea of this study came from a larger research study we’re doing to develop and test a decision aid for patients and caregivers considering LVAD treatment. As part of that study, we interviewed LVAD patients, candidates, caregivers and decliners of LVAD treatment to explore their decisional needs. One of the things that kept coming up in these interviews was the need for “support,” which everyone, including clinicians, identified as a crucial aspect of post-implant recovery. There is an excellent clinical support team at our partnering hospital in Houston, as well as a community of LVAD recipients and caregivers where people can get together to share their stories and resources face-to-face. But for other people who find it difficult to get to the hospital, either because they have transportation barriers or they simply live too far away, we began to wonder whether support services might be available to them in virtual settings. So we decided to do this analysis to see what social media sites exist for the LVAD community. What is the content of these sites? Are there different kinds for different support needs? What are patients getting from them? How might they be used in the future for improving patient care and support? (more…)
Author Interviews, NIH, Pain Research / 14.08.2015

Richard L. Nahin, Ph.D., M.P.H National Center for Complementary and Integrative Health National Institutes of Health, Bethesda, MarylandMedicalResearch.com Interview with: Richard L. Nahin, Ph.D., M.P.H National Center for Complementary and Integrative Health National Institutes of Health, Bethesda, Maryland Medical Research: What is the background for this study? Dr. Nahin: In 2011 the Institute of Medicine published a blueprint for transforming pain care in the United States.  In this report the IOM noted the lack of a comprehensive picture of pain’s prevalence and severity in the U.S., and especially noted that lack of data examining racial and ethnic groups. The current analysis of data from the 2012 National Health Interview survey is a step toward addressing these deficiencies.  Medical Research: What are the main findings? Dr. Nahin: The analyses found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain.  Those with severe pain are also likely to have worse health status.  There were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, while Asians were less likely.  Minorities who did not choose to be interviewed in English are markedly less likely to report pain. (more…)
Author Interviews, Case Western, Diabetes, Infections, PLoS / 14.08.2015

Wesley M. Williams, PhD Cell molecular biologist Department of Biological Sciences Case Western Reserve University School of Dental MedicineMedicalResearch.com Interview with: Wesley M. Williams, PhD Cell molecular biologist Department of Biological Sciences Case Western Reserve University School of Dental Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Williams: Individuals with uncontrolled blood sugar levels frequently present with higher than normal rates of infection and protracted wound healing. The beta-defensin family of antimicrobial peptides responds to bacterial, fungal and viral invasion. As part of the innate immune system, these cationic peptides normally expressed by epithelial cells are important early responders that, together with other components of the innate immune response, act to inhibit microbial infection. Our initial observations led us to question whether glucose or a metabolite of glucose could contribute to antimicrobial peptide dysfunction, and thus compromise control of infection. Elevated levels of glucose result in increased production of dicarbonyls, a class of molecule that can selectively react with proteins having an unusually high content of cationic amino acids, such as arginine and lysine. We first investigated the effects of two well-characterized dicarbonyls, methylglyoxal (MGO) and glyoxal (GO) on recombinant beta-defensin 2 (rHBD-2) structure using MALDI TOF and LC/MS/MS mass spectral analysis of the recombinant peptide. We found MGO to be particularly reactive with the rHBD-2 peptide as it readily and irreversibly adducted to two arginine residues and the N-terminal glycine. Next we tested in vitro for the effects of adducted rHBD-2 on antimicrobial and chemotactic functions, both essential to an effective innate and adaptive immune response in vivo. Through radial diffusion testing on gram-negative E. coli and P. aeruginosa, and gram-positive S. aureus, and a chemotaxis assay for CEM-SS cells, we found that both antimicrobial and chemotactic functions of rHBD-2 were significantly compromised by MGO. (more…)
Author Interviews, Columbia, Emergency Care, Race/Ethnic Diversity, Stroke / 14.08.2015

Heidi Mochari-Greenberger Ph.D., M.P.H Associate research scientist Columbia University Medical Center New York, N.YMedicalResearch.com Interview with: Heidi Mochari-Greenberger Ph.D., M.P.H Associate research scientist Columbia University Medical Center New York, N.Y MedicalResearch: What is the background for this study? Dr. Mochari-Greenberger: Differences in activation of emergency medical services (EMS) may contribute to race/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity or sex among a contemporary, diverse national sample of hospitalized acute stroke patients. MedicalResearch: What are the main findings? Dr. Mochari-Greenberger: Use of EMS transport among hospitalized stroke patients was less than 60% and varied by race/ethnicity and sex; EMS use was highest among white females and lowest among Hispanic males. Our analyses showed that Hispanic and Asian men and women were significantly less likely than their white counterparts to use EMS; black females were less likely than white females to use EMS, but black men had a similar rate to white men. These observed associations between race/ethnicity and sex with EMS use persisted after adjustment for stroke symptoms and other factors known to be associated with EMS use, indicating they were not driven solely by stroke symptom differences. (more…)
Author Interviews, Cognitive Issues, Geriatrics, UCSF, Weight Research / 13.08.2015

Meera Sheffrin MD Geriatrics Fellow Division of Geriatrics | Department of Medicine San Francisco VA Medical Center University of California, San Francisco MedicalResearch.com Interview with: Meera Sheffrin MD Geriatrics Fellow Division of Geriatrics | Department of Medicine San Francisco VA Medical Center University of California, San Francisco Medical Research: What is the background for this study? What are the main findings? Dr. Sheffrin: The main drug treatments for dementia are a class of medications called cholinesterase inhibitors. They have only modest effects on cognition and function in most patients, but since they are one of the few available treatments for dementia and thus very commonly prescribed. However,they are known to cause GI side effects (nausea, vomiting, diarrhea, and anorexia) in many patients when first started. It is plausible they could also caust weight loss, espeically considering they cause nausea and anorexia. However, the data on weight loss from randomized controlled trials is very limited and inconclusive, so we did a very large observational study in a real-world of the VA national healthcare system who were newly started on these medications, to see if they were associated with weight loss. We found that patient with dementia started on cholinesterase inhibitors had a substantially higher risk of clinically significant weight loss over a 12-month period compared to matched controls. 1,188 patients started on cholinesterase inhibitors were matched to 2,189 similar patients who were started on other new chronic medications. The primary outcome was time to a 10-pound weight loss over a 12-month period, as this represents a degree of loss that would be clinically meaningful – not only noticed by a clinician but would perhaps prompt further action in considering the causes of the weight loss and medical work-up. We found that starting cholinesterase inhibitors was associated with a 24% greater risk of developing weight loss. Overall, 29% of patients started on cholinesterase inhibitors experienced a weight loss of 10 pounds or more, compared with 23% of the control group. This corresponds to a number needed to harm of 21 over 1 year; meaning only 21 patients need to be treated with a cholinesterase inhibitor over the course of a year for one patient to experience a 10 pound weight loss. (more…)
Author Interviews, Biomarkers, Dermatology, JAMA, Pulmonary Disease, University of Pennsylvania / 12.08.2015

Misha A. Rosenbach, MD Assistant Professor of Dermatology at the Hospital of the University of Pennsylvania Assistant Professor of Dermatology in MedicineMedicalResearch.com Interview with: Misha A. Rosenbach, MD Assistant Professor of Dermatology at the Hospital of the University of Pennsylvania Assistant Professor of Dermatology in Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Rosenbach: Sarcoidosis is an inflammatory disease of unknown etiology where genetically susceptible patients develop multi-organ granulomatous inflammation in response to an as-yet unidentified stimulus.  Patients with sarcoidosis typically have granulomatous inflammation in their lungs, but the second most commonly affected organ is the skin; the eyes, lymph nodes, liver, heart, brain, and other organs can be affected as well.  Patients with sarcoidosis can experience a few disease trajectories; some spontaneously recover, while others have persistent, active inflammation, whereas another group can experience inflammation which leads to scarring and fibrosis.  It can be challenging to distinguish these cohorts of patients based on their lungs alone. The skin is much easier to evaluate, as it is right there on the surface, and can be examined by physicians without resorting to invasive tests or radiography.  At Penn, we developed a novel cutaneous sarcoidosis assessment tool, called the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI), which is designed to accurately measure how inflamed skin sarcoid lesions are in a given patient, as well as describing which type of cutaneous lesion patients’ have.  The CSAMI has in previously studies been shown to be reliable when used by dermatologists, with excellent inter-rater and intra-rater reproducibility. In this study, we had a group of Pulmonologists, Rheumatologists, and Dermatologists (representing the groups of physicians who most commonly care for patients with sarcoidosis, especially if there is skin involvement) evaluate a group of patients with cutaneous sarcoidosis, using the CSAMI and another sarcoidosis activity instrument, the SASI, which has also previously been used to measure skin sarcoidosis activity in a number of settings.  We were able to demonstrate that these cutaneous scoring tools are reliable and reproducible and able to accurately measure cutaneous sarcoidosis disease activity in a variety of patients with a range of skin disease severity.  We also compared the physician scores to patients’ own evaluations of their disease, and showed that the CSAMI (physician impression of disease) correlated well with patients’ own perception of their disease activity and severity. (more…)
Author Interviews, JAMA, Neurological Disorders, Ophthalmology, Vanderbilt / 11.08.2015

MedicalResearch.com Interview with: Matthew Schrag MD Department of Neurology Yale University New Haven, Connecticut   Medical Research: What is the background for this study? What are the main findings? Dr. Schrag: Central retinal artery occlusion  (CRAO) is a relatively rare disorder that is caused by interruption of blood flow to the retina, usually by a clot or some other embolus.  Despite around 150 years of research, no compelling treatment has been found for this disease.  Treatment with fibrinolytics has been used experimentally for a long time and some of the results have been encouraging.  The point of the current study was to aggregate all of this observational data and compare how patients withCentral retinal artery occlusion do when treated with fibrinolytics versus when they are treated with other approaches or not treated at all. The biggest surprise in the data was the poor performance of conventional treatments at less than half the recovery rate of patients who were simply left alone.  The literature on treating central retinal artery occlusion with ocular massage, hemodilution or anterior chamber paracentesis has never been particularly compelling, but these treatments were thought to be harmless and are often practiced in the acute management of central retinal artery occlusion.  This new analysis strongly suggests that these interventions may be harmful.  While this data is not perfect (it is retrospective, non-randomized, acquired over long periods of time, etc), for me it raises enough doubt that I think ocular massage, anterior chamber paracentesis and hemodilution should be abandoned as treatments for acute CRAO. (more…)
Author Interviews, Kidney Disease, Mayo Clinic, Radiology / 11.08.2015

MedicalResearJennifer S. McDonald Ph.D Assistant Professor Department of Radiology Mayo Clinicch.com Interview with: Jennifer S. McDonald Ph.D Assistant Professor Department of Radiology Mayo Clinic Medical Research: What is the background for this study? What are the main findings? Dr. McDonald: Our research group is interested in studying contrast-induced nephropathy (CIN), which is the development of acute kidney injury following administration of iodinated contrast material. Iodinated contrast material is frequently administered during CT examinations. Recent publications, including those by our group, suggest that the incidence of contrast-induced nephropathy has been overestimated by prior, uncontrolled studies. The purpose of our study was to better evaluate the incidence and severity of CIN in patients with diminished renal function (eGFR < 60 ml/min/1.73m2). In the current article, we performed a controlled retrospective study comparing patients who received a contrast-enhanced CT scan at our institution to patients who received an unenhanced CT scan. We used propensity score analysis that incorporated numerous variables to match contrast recipients and control patients with similar clinical characteristics. After performing this analysis, we found that the rate of AKI, emergent dialysis, and short-term mortality was similar between contrast recipients and control patients. (more…)
Author Interviews, Emory, JAMA, Kidney Disease / 11.08.2015

Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Department of Surgery Division of Transplantation Emory University School of MedicineMedicalResearch.com Interview with: Rachel Patzer, PhD, MPH Director of Health Services Research, Emory Transplant Center Assistant Professor Department of Surgery Division of Transplantation Emory University School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Patzer: There are two main treatments for patients with end stage kidney disease: dialysis or kidney transplantation.  Kidney transplantation offers the best survival and quality of life compared to dialysis.  However, there is a limited supply of organs in the U.S., so not all patients with end stage organ failure get a kidney transplant. Certain regions of the country have lower access to kidney transplantation than other regions.  The Southeastern United States (GA, NC, and SC) has the lowest rates of kidney transplantation in the nation, and Georgia (GA) is the state that ranks at the very bottom. Our research team and collaborators from the Southeastern Kidney Transplant Coalition sought to examine some of the reasons for why Georgia had the lowest rates of kidney transplantation in the nation.  The transplant centers in our Coalition collaborated to share data on patient referrals from dialysis facilities, where the majority of end stage renal disease patients receive treatment, to transplant centers in Georgia. Referral from a dialysis facility to a transplant center is required for patients to undergo the extensive medical evaluation that is required for a patient to either be placed on the national deceased donor waiting list, or to receive a living donor kidney transplant (e.g. from a friend or family member). There were several major findings: 1)    That overall, referral of patients from a dialysis facility to a kidney transplant center is low (only about 28% of patients with kidney failure are referred to a transplant center within a year of starting dialysis). 2)    There was much variation in referral for transplantation across dialysis facilities in GA, where some facilities referred no patients within a year, and others referred up to 75% of their patient population. (more…)
Author Interviews, Biomarkers, Brain Injury, Johns Hopkins / 09.08.2015

Frederick Korley MD Ph.D Johns Hopkins University School of Medicine Emergency Medicine Baltimore, MarylandMedicalResearch.com Interview with: Frederick Korley MD Ph.D Johns Hopkins University School of Medicine Emergency Medicine Baltimore, Maryland Medical Research: What is the background for this study? Dr. Korley: Each year, millions of Americans are evaluated in emergency departments for traumatic brain injuries. Currently the only test available for diagnosing traumatic brain injury is a brain CT scan. Brain CT scans accurately identify bleeding in the brain from trauma. However, they are unable to identify damage to brain cells. Approximately 90% of patients with traumatic brain injury have no bleeding in the brain and therefore have unremarkable brain CT scans. However, these patients typically have damaged brain cells and they continue to suffer headaches, dizziness, attention and memory deficits, sleep problems among others for months after their injury and can’t figure out why. Therefore new tests are needed to identify traumatic brain injury patients with damaged brain cells and especially those who are likely to have persistent traumatic brain injury-related symptoms for months after injury. If you or any one in your family has sustained a brain injury in an accident, you might want to get in touch someone similar to this Personal Injury Lawyer St. Louis or a law firm more local to your area, who might be able to look into your case. Medical Research: What are the main findings? Dr. Korley: Our study determined that the blood levels of a protein called brain derived neurotrophic factor (BDNF) can help predict whether a patient will continue to have symptoms related to traumatic brain injury at six 6 months after injury, even if they had an unremarkable brain CT scan. (more…)
Author Interviews, Clots - Coagulation, Duke, Heart Disease, JACC / 09.08.2015

Connie N. Hess, MD, MHS Duke Clinical Research Institute Duke University Durham, North CarolinaMedicalResearch.com Interview with: Connie N. Hess, MD, MHS Duke Clinical Research Institute Duke University Durham, North Carolina Medical Research: What is the background for this study? What are the main findings? Dr. Hess: Guidelines recommend the use of anticoagulation for thromboembolic prophylaxis in atrial fibrillation and also recommend use of dual antiplatelet therapy to reduce cardiovascular events after myocardial infarction and percutaneous coronary intervention.  The use of triple therapy in patients with indications for DAPT and anticoagulation is challenging due to the increased bleeding risk associated with this regimen.  The optimal antithrombotic regimen in this population has not yet been defined. This study specifically focused on older patients, a population that is at greater risk for Atrial Fibrillation-related stroke and recurrent events after MI but also higher risk for bleeding. Despite a growing population of older patients with indications for triple therapy, these patients have been underrepresented in clinical trials and are therefore understudied. We found that relative to DAPT, patients on triple therapy had a similar risk of 2-year major adverse cardiac events but a significantly increased risk of bleeding requiring hospitalization, including greater risk of intracranial hemorrhage. (more…)
Author Interviews, Cancer Research, JAMA, Radiation Therapy, University of Michigan / 08.08.2015

Dr. Reshma Jagsi MD, DPhil Associate Professor and Deputy Chair for Faculty and Financial Operations in the Department of Radiation Oncology at the University of Michigan Health System Research Investigator at the Center for Bioethics and Social Sciences in Medicine University of MichiganMedicalResearch.com Interview with: Reshma Jagsi, MD, DPhil Associate Professor and Deputy Chair Department of Radiation Oncology University of Michigan Medical Research: What is the background for this study? What are the main findings? Response: In recent years, there has been accumulating evidence from clinical trials that have supported the long-term safety and effectiveness of shorter courses of radiation therapy—“hypofractionated radiation therapy”—for patients with breast cancer.  However, little has been known about the experiences of patients during treatment, especially when this new approach is administered outside the setting of closely controlled clinical trials.  Our study examined the side effects and patient-reported experiences during radiation treatment of over 2000 breast cancer patients in the state of Michigan.  It found that women who received hypofractionated treatment were less likely to report side effects (including skin reaction and fatigue) than patients treated with more traditional courses of radiation treatment, delivered daily over 5-6 weeks or longer. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Fertility, Nursing, Occupational Health / 08.08.2015

Dr. Audrey J Gaskins Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MAMedicalResearch.com Interview with: Dr. Audrey J Gaskins Department of Nutrition Harvard T.H. Chan School of Public Health Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Gaskins: Previous studies have linked shift work, long working hours, and physical factors to an increased risk of menstrual cycle disturbances, spontaneous abortion, preterm birth, and low birth weight; however the association with fecundity is inconsistent. Several papers have also reviewed the occupational exposures of health care workers and concluded that reproductive health issues are a concern. Therefore we sought to determine the extent to which work schedules and physical factors were associated with fecundity in a large cohort of nurses. Women who work in an industry that requires them to work from a height or even lift heavy objects requires them to undertake training which guides them though the effective stages on how to work safely at heights. Without the right training, this sort of work can become very dangerous. Our main findings were that that working >40 hours per week and moving or lifting a heavy load >15 times per day (including repositioning or transferring patients) were associated with reduced fecundity in our cohort of female nurses planning pregnancy. However, all other factors such as frequency of night work, duration of rotating and non-rotating night shifts, and time spent walking or standing at work were not significantly associated with fecundity in this cohort. (more…)
Author Interviews, Genetic Research, NYU, PLoS / 08.08.2015

Dr. Arthur Caplan Ph.D. Drs. William F and Virginia Connolly Mitty Professor Head of the Division of Medical Ethics New York University, Langone Medical Center, NYMedicalResearch.com Interview with: Dr. Arthur Caplan Ph.D. Drs. William F and Virginia Connolly Mitty Professor Head of the Division of Medical Ethics New York University, Langone Medical Center, NY Medical Research: What is the background of the Down Syndrome Prenatal Education Act? Dr. Caplan: For many years women who  receive a positive prenatal test for Down syndrome have been aborting their pregnancies.  Rates of pregnancy termination, while somewhat disputed, are very high.  In the USA, UK and Denmark they have consistently been over 80% for many years.   This has led some parents of children with Down to wonder if the counseling that women receive is biased negatively against a life with Down. They working with pro life legislators in many states have promoted legislation to insure that mothers carrying an infant with a diagnosis of Down Syndrome have access to positive information and helpful resources about life with a child with Down.  This legislation has been enacted in many states and there is a Federal law as well. Medical Research: How does Chloe's Law impact genetic testing? Dr. Caplan: These laws represent a seismic shift in counseling about genetic disorders and diseases.  Historically counselors aspired to be value-free—simply trying to provide objective information to their patients/clients.  With laws like Chloe’s the public is saying they do not trust the neutrality of counselors and counseling and want more positive messages sent about Down.  This is quite simply an ethical revolution in how counseling for Down will be done in the future.  It is also a direct Challenge to the legitimacy of value-neutrality as a counseling norm that certainly will be extended to other conditions and disabilities where abortion rates are high and where there is the belief that there is unjustified prejudice or bias against disabilities among those working in clinical genetics. (more…)
Author Interviews, Hospital Readmissions, JAMA, Johns Hopkins / 08.08.2015

Timothy M. Pawlik, MD, MPH, MTS, PhD, FACS, FRACS (Hon.)Professor of Surgery and Oncology John L. Cameron M.D. Professor of Alimentary Tract Diseases Chief, Division of Surgical Oncology Program Director, Surgical Oncology Fellowship Director, Johns Hopkins Medicine Liver Tumor Center Multi-Disciplinary Clinic Johns Hopkins Hospital Baltimore, MD 21287MedicalResearch.com Interview with: Timothy M. Pawlik, MD, MPH, MTS, PhD, FACS, FRACS (Hon.) Professor of Surgery and Oncology John L. Cameron M.D. Professor of Alimentary Tract Diseases Chief, Division of Surgical Oncology Program Director, Surgical Oncology Fellowship Director, Johns Hopkins Medicine Liver Tumor Center Multi-Disciplinary Clinic Johns Hopkins Hospital Baltimore, MD 21287 MedicalResearch: What is the background for this study? What are the main findings? Dr. Pawlik: In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Hospital Readmission Reduction Program (HRRP) whereby hospitals with higher than expected 30-day readmission incur financial penalties. Initially proposed to target readmissions following acute myocardial infarction, pneumonia and congestive heart failure, the program has since expanded to encompass knee and hip replacement surgery with the inclusion of additional surgical procedures anticipated in the near future. Although initial results from the Hospital Readmission Reduction Program have been promising, several concerns have been raised regarding potential limitations in methodological approach; specifically in the ability to adequately risk-adjust and account for variations in patient, provider and disease. As a consequence, many fear that the Hospital Readmission Reduction Program may disproportionately penalize safety-net hospitals as well as hospitals caring for “sicker” and more vulnerable populations. In the current study we sought to investigate factors associated with the variability in 30-day readmission among a cohort of 22,559 patients discharged following a major surgical procedure at the Johns Hopkins Hospital between 2009 and 2013. Overall, 30-day readmission was noted to be 13.2% varying from 2.1% to 24.8% by surgical specialty / procedure and from 2.1% to 32.9% by surgeon. Non-modifiable patient specific factors such as preoperative comorbidity, insurance status and race / ethnicity, were found to be most predictive of 30-day readmission as well as postoperative factors such as complications and length of stay both of which may also be influenced by preoperative comorbidity. Overall, we noted that 2.8% of the variation in 30-day readmission was attributed to provider-specific factors, 14.5% of the variability was due differences in surgical specialty / procedure while over 84% of the variability in 30-day readmission remained unaccounted for due to non-modifiable patient-specific factors. (more…)
Author Interviews, Dermatology, JAMA, NIH, Pain Research / 07.08.2015

Edward W. Cowen, MD, MHSc Dermatology Branch, Center for Cancer Research National Cancer Institute Bethesda, MarylandMedicalResearch.com Interview with: Edward W. Cowen, MD, MHSc Dermatology Branch, Center for Cancer Research National Cancer Institute Bethesda, Maryland Medical Research: What is the background for this study? Dr. Cowen: Cutaneous leiomyomas are benign smooth muscle proliferations that are associated with pain that is typically not well-controlled by topical remedies or systemic pain medication. Hereditary leiomyomatosis and renal cell cancer is a rare syndrome in which patients may have dozens or even hundreds of these painful tumors. We sought to determine if botulinum toxin injected directly into leiomyomas may ameliorate discomfort and improve quality of life in patients who experience significant pain from cutaneous leiomyomas. Medical Research: What are the main findings? Dr. Cowen: In a double-blinded placebo-controlled study, we found that injection of botulinum toxin was associated with improved skin-related quality of life (p = 0.007) and decreased skin-specific pain (p = 0.048) on the Dermatology Life Quality Index. A trend for decreased pain (p = 0.06) by visual analog score was reported in the botulinum toxin treated group compared to the placebo group. (more…)
Author Interviews, Inflammation, Lipids, University of Pennsylvania / 04.08.2015

Carsten C. Skarke MD Research Assistant Professor of Medicine McNeil Fellow in Translational Medicine Institute for Translational Medicine and Therapeutics Perelman School of Medicine University of PennsylvaniaMedicalResearch.com Interview with: Carsten C. Skarke MD Research Assistant Professor of Medicine McNeil Fellow in Translational Medicine Institute for Translational Medicine and Therapeutics Perelman School of Medicine University of Pennsylvania Medical Research: What is the background for this study? What are the main findings? Dr. Skarke: A growing body of publications suggests anti-inflammatory actions of fish oils. These health benefits are proposed to emerge from lipids called specialized pro-resolving mediators, (SPMs), which can be formed from omega-3 polyunsaturated fatty acids found in fish. A limitation to date, though, in this field is that there is little evidence of their formation in humans. And the cases where presence of these lipids is reported in humans, less rigorous analytical approaches, such as enzyme immunoassay (EIA), radioimmunoassay (RIA) or mass spectrometry without internal authentic standards, have been used. Thus, the specific aim for our study was to use state-of-the-art mass spectrometry to identify and quantify these specialized pro-resolving mediators. Several aspects of our study design set us apart from what was done in previous studies.
  • First, we biased our ability to detect SPMs formed in healthy volunteers by giving fish oil in high doses which had been previously shown to influence blood pressure and platelet aggregation under placebo-controlled conditions.
  • Second, we also looked at lower doses of fish oil, those more commonly consumed by the general public, for the formation of SPMs during an acute inflammatory response and its resolution.
  • Third, we relied in our measurements of SPMs on authentic internal standards. These deuterated lipids, d4-resolvin E1 for example, facilitate distinct identification of the naturally formed lipid.
  • And fourth, we achieved very low limit of detection levels, below 10 pg/ml for resolvin E1, for example.
The surprising finding of our studies is that we failed to detect a consistent signal of SPM formation in urine or plasma of healthy volunteers who had taken fish oil. Even more surprising was that we found no alteration in the formation of SPMs during the resolution of inflammation. These results let us question the relevance of endogenous specialized pro-resolving mediators to the putative anti-inflammatory effects of fish oils in humans. (more…)