Author Interviews, Endocrinology, Pediatrics, Sleep Disorders, Vanderbilt / 28.02.2015

Dave Kennaway, PhD Professor, Lloyd Cox Senior Research Fellow, Head Circadian Physiology Laboratory School of Paediatrics and Reproductive Health Robinson Research Institute, Faculty of Health Sciences, Medical School, University of Adelaide AustraliaMedicalResearch.com Interview with: Dave Kennaway, PhD Professor Lloyd Cox Senior Research Fellow, Head Circadian Physiology Laboratory School of Paediatrics and Reproductive Health Robinson Research Institute, Faculty of Health Sciences, Medical School, University of Adelaide Australia MedicalResearch: What is the background for this review? What are the main findings? Dr. Kennaway: There is evidence that melatonin is being prescribed to for sleep disorders in children and adolescents who are developing normally despite the fact that there have been no properly designed studies on the effects of prolonged administration to children. In countries where melatonin has been registered, it is for use as a monotherapy for the short term treatment of primary insomnia, characterised by poor quality of sleep in patients who are aged 55 years and over. Use in Paediatrics is always “off-label”. After more than 50 years of melatonin research in animals there is overwhelming evidence that melatonin administration affects many organ systems. These include important effects on the reproductive organs of rodents, cats, ruminants and primates and melatonin is in fact registered as a veterinary drug for this purpose. The effects of melatonin, however, go beyond the potential reproductive consequences, including effects on cardiovascular, immune and metabolic systems. It is clear that many paediatricians, practitioners and parents are unaware of this. MedicalResearch: What should clinicians and patients take away from your report? Dr. Kennaway: Clinicians and patients need to recognise that melatonin is a hormone and not a drug developed for a specific purpose or illness. There have been no appropriate trials in children addressing the effects of prolonged administration of melatonin in children. Given the extensive literature on the role of the hormone in normal physiology it is unlikely that such trials would ever be approved. Should endocrine or other abnormalities appear in the future in children previously treated with melatonin it will not be tenable to argue that we were surprised. (more…)
Author Interviews, Diabetes, Karolinski Institute, NEJM, OBGYNE, Weight Research / 27.02.2015

Kari Johansson, Phd Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, SwedenMedicalResearch.com Interview with: Kari Johansson, PhD Department of Medicine Solna, Karolinska Institutet Clinical Epidemiology Karolinska University Hospital Stockholm, Sweden   MedicalResearch: What is the background for this study? What are the main findings? Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers. The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001).  (more…)
Allergies, Author Interviews, University Texas / 27.02.2015

Rana Suzette Bonds, MD The University of Texas Medical BranchMedicalResearch.com Interview with: Rana Suzette Bonds, MD The University of Texas Medical Branch MedicalResearch: What is the background for this study? Dr. Bonds: Both anaphylaxis and asthma can be life threatening disorders requiring prompt treatment. Each disorder can be successfully treated with medication which is delivered by devices designed for self-administration. Unfortunately there has been evidence in the literature that patients frequently do not use the devices appropriately. We sought to determine which factors were associated with incorrect use of metered dose inhalers and epinephrine autoinjectors, and to determine if rates of correct use have improved since earlier reports. MedicalResearch: What are the main findings? Dr. Bonds: Sixteen percent of patients used the epinephrine autoinjector properly and 7 percent of patients used the metered dose inhaler correctly. The most common error with the autoinjector was not holding the unit in place for at least 10 seconds after triggering. For patients using the metered dose inhaler the most commonly missed step was exhaling to functional residual capacity or residual volume prior to actuating the canister. Male sex, Caucasian race, and previous medical education correlated with correct use of epinephrine autoinjector device. (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Pennsylvania, Women's Heart Health / 26.02.2015

Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of PennsylvaniaMedicalResearch.com Interview with: Dawn Pedrotty, MD, PhD Cardiovascular Medicine Fellowship University of Pennsylvania MedicalResearch: What is the background for this review? What are the main findings? Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation. (more…)
Author Interviews, Nutrition, NYU, Pediatrics, Weight Research / 26.02.2015

Brian Elbel, PhD, MPH Associate Professor, Department of Population Health; Associate Professor, Department of Medicine Population Health NYU School of MedicineMedicalResearch.com Interview with: Brian Elbel, PhD, MPH Associate Professor, Department of Population Health; Associate Professor, Department of Medicine Population Health NYU School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Elbel: This study tried to determine whether a new supermarket that received tax and zoning credits from New York City, locating in a high need area, impacted healthy eating for children.  No previous controlled study has looked at children, and supermarkets are tool being increasingly used to improve healthy eating.  We did not find, at least one year after the store opened, any appreciable change in shopping or eating. (more…)
Author Interviews, Education, Outcomes & Safety, Surgical Research, University of Pennsylvania / 25.02.2015

Samuel D. Pimentel Doctoral student Statistics Department Wharton School of the University of PennsylvaniaMedicalResearch.com Interview with: Samuel D. Pimentel Doctoral student Statistics Department Wharton School of the University of Pennsylvania   MedicalResearch: What is the background for this study? What are the main findings? Response: Surgical training has undergone major changes in recent years – including a reduction of six to twelve months of training time – and there is controversy about whether these changes have been good or bad for patient outcomes.   Our work partially addresses the issue by asking whether newly-trained surgeons perform better or worse than experienced surgeons.  We compared surgical patients treated by new surgeons to a similar group of patients treated by experienced surgeons using a new statistical technique called large, sparse optimal matching.  Our analysis found no significant differences in mortality rates between the two groups. (more…)
Author Interviews, JAMA, Lung Cancer, Mayo Clinic / 24.02.2015

MedicalResearch.com Interview with: David Mithun, M.D. Division of Pulmonary and Critical Care Medicine Mayo Clinic, Rochester, Minnesota Medical Research: What is the background for this study? Dr. Mithun: Lung cancer screening should be pursued for those people at highest risk who are otherwise in good enough health to be able to undergo curative intent treatment if cancer is found. The current criteria for screening recommended by the US Preventive Services Task Force of age 55-80 years, 30 pack-years of smoking, and if quit, have done so within 15 years and are based on the National Lung Screening Study (NLST). Medical Research: What are the main findings? Dr. Mithun: Our data was retrospective over a 28 year time period and showed that an increasing number of people who actually got cancer would not have been candidates for screening based on the current criteria.  This suggests there may be some degree of mismatch between risk as defined by the current criteria to screen and those who developed cancer.  An increasing number of those who would not have been candidates for screening yet got lung cancer were among those who quit smoking 15 years or longer. (more…)
Author Interviews, Mayo Clinic, Nature, Pancreatic / 24.02.2015

Peter Storz, Ph.D. Associate Professor & Consultant Department of Cancer Biology Mayo Clinic Jacksonville, FL 32224MedicalResearch.com Interview with: Peter Storz, Ph.D. Associate Professor & Consultant Department of Cancer Biology Mayo Clinic Jacksonville, FL 32224   Medical Research: What is the background for this study? What are the main findings? Dr. Storz:   Our study focuses on cellular signaling mechanisms that lead to the initiation of pancreatic cancer. After acquisition of an oncogenic mutation of Kras, pancreatic acinar cells can undergo a transdifferentiation process to a phenotype that gives rise to pancreatic intraepithelial lesions (PanINs). These lesions then can further progress to pancreatic cancer. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, JAMA, Memory / 24.02.2015

Dr. Rebecca E. Amariglio Ph.D. Massachusetts Alzheimers Disease Research Center Massachusetts General HospitalMedicalResearch.com Interview with: Dr. Rebecca E. Amariglio Ph.D. Massachusetts Alzheimers Disease Research Center Massachusetts General Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Amariglio: As the field of Alzheimer’s disease moves towards early detection and treatment, new tests that can measure very subtle changes in cognitive functioning are needed. A new instrument developed by the Alzheimer’s Disease Cooperative Study that measures subjective report of memory changes of both the study participant and a study partner (usually a family member) was associated with cognitive decline over four years.  Specifically, greater report of memory concerns was associated with worse memory performance over time. (more…)
Author Interviews, Cancer Research, JAMA, Race/Ethnic Diversity, Vanderbilt / 24.02.2015

Dr. Wei Zheng, MD, PhD Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TennesseeMedicalResearch.com Interview with: Dr. Wei Zheng, MD, PhD Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee   Medical Research: What is the background for this study? What are the main findings? Dr. Wei Zheng: Substantial progress has been made in the diagnosis and treatment of cancer, resulting in a steady improvement in cancer survival. However, the degree of improvement by age, race and sex remains unclear. We quantified the differences in the improvement of cancer survival by race, age, and sex over the last two decades. We used cancer diagnosis and follow-up data from more than 1 million cancer patients, collected in nine SEER registries, to investigate trends in improved survival for seven major cancers in the United States by age, race, and sex between 1990 and 2010. We found that elderly patients experienced a smaller improvement in survival for cancers of the colon/rectum, breast, prostate, lung, and liver than their younger counterparts. In particular, the age-related disparities were most pronounced for those cancers with the greatest advancements in diagnosis and treatment over the past two decades, including cancers of colon/rectum, breast and prostate. African Americans experienced poorer survival than whites for all cancers. Because of a greater improvement in prostate cancer survival in African Americans than for whites, the racial difference in the survival of this cancer decreased during the study period. For ovarian cancer, however, the survival rate declined in African Americans but slightly increased in whites, leading to a wider racial gap in the survival of this deadly cancer. No apparent disparities in survival improvement by sex were noted. (more…)
Author Interviews, Biomarkers, Melanoma, NYU, Personalized Medicine / 24.02.2015

Iman Osman, MD Professor, Departments of Dermatology, Medicine and Urology Associate Director, NYU Cancer Institute  Director, Interdisciplinary Melanoma Program  New York University Langone Medical Center New York, NY 10016MedicalResearch.com Interview with: Iman Osman, MD Professor, Departments of Dermatology, Medicine and Urology Associate Director The Laura and Isaac Perlmutter Cancer Center Director, Interdisciplinary Melanoma Program New York University Langone Medical Center New York, NY 10016 MedicalResearch: What is the background for this study? What are the main findings? Dr. Osman: We were interested in exploring molecules that could be biomarkers or functional regulators of metastasis in melanoma in early-stage tumor lesions on the skin. Though these tumors are treated largely the same (by surgical removal ), patients with these tumors have vastly different outcomes (apparent cure vs. metastatic spread of the disease). The reasons for these disparities are unclear and we have little ability to identify or predict the patients that will be cured and those that won’t. We also don’t have much data to know even if these tumors have differences at the molecular level. Our findings indicate that there are molecular differences in these tumors and that some of these differences contribute to tumor spread.  (more…)
AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Michigan, Women's Heart Health / 24.02.2015

Claire Duvernoy, MD Chief, Cardiology Section VA Ann Arbor Healthcare System Professor of Medicine University of Michigan Health System Ann Arbor, MI MedicalResearch.com Interview with: Claire Duvernoy, MD Chief, Cardiology Section VA Ann Arbor Healthcare System Professor of Medicine University of Michigan Health System Ann Arbor, MI MedicalResearch: What is the background for this study? What are the main findings? Dr. Duvernoy: We wanted to look at the indications and outcomes for women veterans undergoing cardiac catheterization procedures as compared with men veterans, given that we know that there are significant gender differences in the non-veteran population between women and men undergoing cardiac catheterization. (more…)
Author Interviews, Melanoma, Yale / 22.02.2015

Douglas E. Brash, PhD Professor of Therapeutic Radiology and Dermatology Yale School of Medicine New Haven, CTMedicalResearch.com Interview with: Douglas E. Brash, PhD Professor of Therapeutic Radiology and Dermatology Yale School of Medicine New Haven, CT MedicalResearch: What is the background for this study? What are the main findings? Dr. Brash: We wanted to know whether the origin of melanoma differed from other cancers because of the melanin. It has long been known that blondes and redheads are sensitive to sunlight, but the prevailing view was that this was because their skin is light. But there are light-skinned, dark-haired people in countries near the equator and they don't have the high skin cancer incidence seen in Australia. Several labs, including ours, had irradiated cells or mice with UV and found more cell death in cells containing melanin than cells lacking melanin. In the last couple of years, two papers have focused attention on the issue; one study found that irradiating mice with UVA only gave melanomas if the skin contained melanin and the other study found that mice genetically predisposed to UV-induced melanoma developed melanomas even without UV if they also had red melanin. The most important findings are: First, our skin continues to be damaged by sunlight even when we're out of the sun. Second, the melanin pigment in your skin is bad for you as well as good: it may be carcinogenic as well as protective. Third, the chemistry underlying these events, chemical excitation of electrons, has not been seen in mammals before. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Radiation Therapy / 22.02.2015

Ann Caroline Raldow, M.D. Brigham and Women's Hospital Resident in Radiation OncologyMedicalResearch.com Interview with: Ann Caroline Raldow, M.D. Brigham and Women's Hospital Resident in Radiation Oncology Medical Research: What is the background for this study? What are the main findings? Dr. Raldow: Active surveillance (AS) means monitoring the course of prostate cancer (PC) with the expectation to start treatment if the cancer progresses. Men who enter an AS program are able to defer and possibly avoid the side effects of prostate cancer treatment. According to the National Comprehensive Cancer Network (NCCN) guidelines, active surveillance is currently considered as an initial treatment approach for men with low-risk PC and a life expectancy of at least 10 years. However, no direct comparison has been made between favorable intermediate-risk and low-risk PC with regard to PC-specific mortality or all-cause mortality following treatment with high-dose radiation therapy such as brachytherapy, where radioactive seeds are placed inside the prostate to kill the cancer. We therefore assessed whether the risks of prostate cancer-specific mortality and all-cause mortality following brachytherapy were increased in men with favorable intermediate-risk versus low-risk prostate cancer. The study consisted of more than 5,000 men who were treated with brachytherapy at the Prostate Cancer Foundation of Chicago. After a median follow-up of 7.69 years, there were no significant differences in prostate cancer-specific mortality and all-cause mortality between men with low-risk and favorable intermediate-risk prostate cancer, suggesting that men with favorable intermediate-risk prostate may also be candidates for AS. (more…)
Author Interviews, BMJ, NIH, Pediatrics, Weight Research / 21.02.2015

Yeyi Zhu, PhD IRTA Postdoctoral Fellow Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIHMedicalResearch.com Interview with: Yeyi Zhu, PhD IRTA Postdoctoral Fellow Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH MedicalResearch: What is the background for this study? What are the main findings? Dr. Zhu: Currently in the US, nearly two thirds of reproductive-aged women are overweight or obese. Moreover, the amount of weight gained during pregnancy can have immediate and long-lasting impacts on health of a woman and her infant. Previous evidence implicates that excessive gestational weight gain above the Institute of Medicine guidelines is related to high birthweight (>4000 g), a marker of intrauterine over-nutrition which may impose a greater risk of offspring’s obesity and metabolic diseases in later life. Given that more than one third of children and adolescents are overweight or obese in the US, it is of great public health significance to improve our understanding of determinants and mediators of childhood obesity. The length of breast feeding and age at introduction of solid foods are infant feeding practices that are potentially modifiable in early life. We therefore examined whether birthweight and infant feeding practices, specifically length of breast feeding, mediate the relationship between maternal gestational weight gain and childhood growth in the National Children’s Study Formative Research in Anthropometry, a cross-sectional multi-ethnic study of 1387 mothers and their children aged 0-5.9 years in the US (2011-2012). We illustrated that the intergenerational relationship between maternal gestational weight gain and early childhood growth (i.e., z scores for weight-for-age, weight-for-height, and body mass index-for-age) largely acts through birthweight rather than directly on childhood growth. Further, given the negative association of breastfeeding duration with childhood anthropometrics, longer length of breastfeeding suppressed the positive associations of gestational weight gain and birthweight with childhood growth. In addition, analysis by ethnicity revealed that these associations were only significant in non-Hispanic White and non-Hispanic Black participants as opposed to Hispanics and other ethnicities. (more…)
Author Interviews, Connective Tissue Disease, Emory, Kidney Disease, Race/Ethnic Diversity / 20.02.2015

Laura Plantinga, PhD Assistant Professor Division of Renal Medicine, Department of Medicine Emory University School of Medicine Atlanta, GA 30322MedicalResearch.com Interview with: Laura Plantinga, PhD Assistant Professor Division of Renal Medicine, Department of Medicine Emory University School of Medicine Atlanta, GA 30322 Medical Research: What is the background for this study? What are the main findings? Dr. Plantinga: Quality of care for end-stage renal disease (ESRD), which is treated with dialysis or kidney transplantation, is a high priority for the U.S. healthcare system, given universal coverage of these services. However, quality of ESRD care remains relatively unexplored in lupus patients, who have multiple providers and may have greater access to care. We found that, overall, nearly three-quarters of U.S. ESRD patients with lupus had pre-ESRD nephrology care and about 20% of lupus patients on dialysis were waitlisted for kidney transplant per year; however, fewer than one-quarter of those who started on dialysis had a permanent vascular access in place, which is associated with better outcomes than a temporary catheter. Furthermore, patients who were black or Hispanic were nearly a third less likely to have pre-ESRD care and were also less likely to be placed on the kidney transplant waitlist in the first year of dialysis than white patients. Having Medicaid or no insurance at the start of ESRD were both associated with lower likelihood of quality ESRD care by all measures, despite universal Medicare coverage after the start of ESRD. While there was geographic variation in quality of ESRD care, patterns were not consistent across quality measures. (more…)
Author Interviews, Diabetes, Ophthalmology, UCLA / 20.02.2015

Rohit Varma, MD, MPH Professor and Chair, Department of Ophthalmology USC Eye Institute, Keck School of Medicine University of Southern California, Los Angeles, CaliforniaMedicalResearch.com Interview with: Rohit Varma, MD, MPH Professor and Chair, Department of Ophthalmology USC Eye Institute, Keck School of Medicine University of Southern California, Los Angeles, California Medical Research: What is the background for this study? What are the main findings? Dr. Varma: The Centers for Disease Control and Prevention estimates that 4.4% of adults with diabetes aged 40 and older have advanced diabetic retinopathy that may result in severe vision loss. Clinical trials have shown that intravitreal injections of anti-VEGFs, such as ranibizumab, can reduce visual impairment and even in some cases improve visual acuity outcomes in patients with diabetic macular edema. We developed a model, based on data from the RIDE and RISE clinical trials, to estimate the impact of ranibizumab treatment on the number of cases of vision loss and blindness avoided in non-Hispanic white and Hispanic persons with diabetic macular edema in the United States.Results from the model suggest that, compared with no treatment, every-4-week ranibizumab 0.3 mg reduces legal blindness between 58%-88% and reduces vision impairment between 36%-53% over 2 years in this population. (more…)
Author Interviews, Cost of Health Care, Duke, JAMA, Radiation Therapy, Thyroid / 19.02.2015

Sanziana Roman MD FACS Professor of Surgery Duke University  Section of Endocrine Surgery Director of the Endocrine Surgery Fellows and Scholars Program Duke University School of Medicine Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMCMedicalResearch.com Interview with: Sanziana Roman MD FACS Professor of Surgery Duke University Section of Endocrine Surgery Director of the Endocrine Surgery Fellows and Scholars Program Duke University School of Medicine Chief, General Surgery and Associate Chief of Surgery for Clinical Affairs, DVAMC Medical Research: What is the background for this study? Dr. Roman: Adjuvant radioactive iodine (RAI) is commonly used in the management of differentiated thyroid cancer. The main goals of adjuvant RAI therapy are to ablate remnant thyroid tissue in order to facilitate long-term follow-up of patients, decrease the risk of recurrence, or treat persistent and metastatic lesions. On the other hand, Adjuvant radioactive iodine ( therapy is expensive, with an average cost per patient ranging between $5,429.58 and $9,105.67. It also carries the burden of several potential complications, including loss of taste, nausea, stomatitis with ulcers, acute and/or chronic sialoadenitis, salivary duct obstruction, dental caries, tooth loss, epiphora, anemia, neutropenia, thrombocytopenia, acute radiation pneumonitis, pulmonary fibrosis, male infertility, and radiation-induced malignancies. Therefore, Adjuvant radioactive iodine ( should be used only for appropriately selected patients, for whom the benefits would outweigh the risks. Based on current guidelines, adjuvant RAI is not recommended for patients with papillary thyroid cancers confined to the thyroid gland when all foci are ≤1 cm (papillary thyroid microcarcinoma, or PTMC). Similarly, Adjuvant radioactive iodine ( does not have a role in the treatment of medullary and anaplastic thyroid cancer. Given the fact that variation in treatments exist, our goal was to analyze patterns of inappropriate adjuvant RAI use in the U.S. in order to identify potential misuses leading to an increase of costs for the healthcare system and unnecessary patients’ exposure to risks of complications. (more…)
Author Interviews, Genetic Research, UCSD / 18.02.2015

Dr. Rahul S. Desikan MD, PhD Department of Radiologoy University of California, San Diego School of MedicineMedicalResearch.com Interview with: Dr. Rahul S. Desikan MD, PhD Department of Radiologoy University of California, San Diego School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Desikan: The MAPT gene encodes the tau protein, which plays an integral role in Alzheimer's disease (AD) neurodegeneration. Though a number of studies have investigated this issue, the role of the MAPT gene in Alzheimer's disease is still unclear. In contrast, a number of studies have found a robust association between MAPT and increased risk for other 'tauopathies' like Parkinson's disease (PD). In our study, rather than evaluating all possible genetic loci, we only assessed shared genetic variants between Alzheimer's disease and PD. By using this type of approach, we were able to increase our statistical power for gene discovery in Alzheimer's disease. We found genetic overlap between Alzheimer's disease and Parkinson's disease at a locus on chromosome 17 within the MAPT region. Our findings demonstrate that this MAPT associated locus increases risk for Alzheimer's disease, correlates with gene expression of MAPT and is associated with brain atrophy of the entorhinal cortex and hippocampus on longitudinal MRI scans. (more…)
Author Interviews, Heart Disease, JAMA, Karolinski Institute / 18.02.2015

Karolina Szummer, MD, PhD Section of Cardiology, Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm, Sweden MedicalResearch.com Interview with: Karolina Szummer, MD, PhD Section of Cardiology, Department of Medicine Karolinska Institutet Karolinska University Hospital Stockholm, Sweden Please note: This work is comparing the anticoagulant fondaparinux with low-molecular-weight heparin (not heparin). Medical Research: What is the background for this study? What are the main findings? Dr. Szummer: Since the publication of the OASIS-5 trial in 2006, many hospitals chose to change their medical practice and start using fondaparinux instead of low-molecular-weight heparin in the treatment of myocardial infarctions. In this study from the nation-wide near-complete myocardial infarction registry we were able to follow how the use of fondaparinux instead of low-molecular-weight heparin translated in clinical life was associated to a reduction in bleeding events and death. It is a very satisfying study, that confirms that the randomized clinical trial results are transferred with improvements in outcome to the treated patients. (more…)
Author Interviews, JAMA, Mayo Clinic, Smoking / 17.02.2015

Jon Ebbert, M.D. Associate director for research Mayo Clinic Nicotine Dependence CenterMedicalResearch.com Interview with: Jon Ebbert, M.D. Associate director for research Mayo Clinic Nicotine Dependence Center   Medical Research: What is the background for this study? What are the main findings? Dr. Ebbert: Some cigarette smokers prefer to reduce the number cigarettes that they smoke before quitting smoking completely. Previous studies have evaluated the use of nicotine replacement therapy and one smaller study looked at varenicline to help smokers quit through smoking reduction. We wanted to conduct a larger study with varenicline using a longer duration of treatment. We enrolled cigarette smokers who had no intention of quitting in the next month but who were willing to reduce the number of cigarettes they smoked while working toward a quit attempt in the next 3 months. (more…)
Author Interviews, MRSA, University of Pennsylvania / 17.02.2015

MedicalResearch.com Interview with: Valerie Cluzet, MD Hospital of the University of Pennsylvania Division of Infectious Diseases Philadelphia, PA 19104 MedicalResearch: What is the background for this study? What are the main findings? Dr. Cluzet: MRSA is a major cause of skin and soft tissue infection (SSTI) in the community and we know that colonization is an important risk factor for subsequent infection. Past studies have calculated duration of colonization based on colonization at hospital admission or focused on populations not representative of the typical community-dwelling patient. We wanted to identify the factors associated with duration of colonization in a typical patient that clinicians would see (i.e. adults and children presenting to ambulatory setting with a MRSA SSTI), so that the findings would be generalizable and relevant to their practice. In addition, there has been an increasing focus on the role of the household in transmission of MRSA, so wanted to specifically examine that in a longitudinal, systematic way. There are a few major points that emerged from our study. 1) The first is that the duration of colonization after treatment for a methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) is relatively short, but there is a significant subset of patients (approximately 20%) who will have persistent colonization. 2) We also found that treatment of the MRSA SSTI with clindamycin was associated with shorter duration of colonization, an association we did not see with other MRSA-active agents. 3) Finally, this study highlights the potential role of MRSA colonization among household members as a contributing factor in duration of colonization in patients. (more…)
Author Interviews, Blood Pressure - Hypertension, BMJ, Brigham & Women's - Harvard / 17.02.2015

dr-alexander-turchinMedicalResearch.com Interview with: Dr. Alexander Turchin M.D.,M.S. Director of Informatics Research Division of Endocrinology, Brigham and Women’s Hospital Boston, MA Medical Research: What is the background for this study? What are the main findings? Dr. Turchin: Hypertension is the most common risk factor for cardiovascular events. High blood pressure increases the risk for stroke, myocardial infarction, heart failure and kidney failure. Treatment of high blood pressure reduces these risks. However, our understanding of optimal treatment of hypertension is incomplete. In particular, there is little information to guide clinicians on how quickly they should achieve blood pressure control in their patients. There have been no clinical trials focusing on this question. Current guidelines are sparse and are based only on expert opinion. Our study analyzed treatment of nearly 90,000 patients in primary care practices in the U.K. between 1986 and 2010. We found that patients whose blood pressure medications were adjusted within 1.4 months after systolic blood pressure reached over 150 mm Hg and whose blood pressure was re-assessed within 2.7 months after their treatment was adjusted had the lowest risk for acute cardiovascular events and death from any cause. (more…)
AHA Journals, Author Interviews, Stroke, UCLA / 15.02.2015

Dr. May Nour MD PhD Neurology Fellow UCLA MedicalResearch.com Interview with: Dr. May Nour MD PhD Neurology Fellow UCLA Medical Research: What is the background for this study? What are the main findings? Dr. Nour: In October of 2014, results from the MR CLEAN trial were the first to demonstrate better functional outcomes in stroke patients as a result of endovascular therapy. Among patients whose stroke was caused by clot blocking a large vessel responsible for delivering blood to the vital tissue of the brain, the use of endovascular therapy, primarily utilizing second-generation clot retrieval devices, showed improved outcomes in most cases evaluated in combination with medical therapy, when compared to medical therapy alone. Currently, the standard of care involves delivery of intravenous tissue plasminogen activator (IV tPA) within a short time window (up to 3-4.5 hrs) with the intention of dissolving, rather than physically removing the clot as in the case of endovascular retrieval. (more…)
AHRQ, Author Interviews, Education, NIH, Race/Ethnic Diversity / 13.02.2015

MedicalResearch.com Interview with: Robert M. Kaplan Office of Behavioral and Social Sciences Research National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? What are the main findings? Response: Years of formal education is one of the strongest correlates of life expectancy. The purpose of this study was to examine the relationship between educational attainment and life expectancy with adjustments for other social, behavioral, and biological factors. Using data from a large cohort of nearly 30,000 adults, we found that education was a very strong predictor of survival and that biological and behavioral factors only partially explained the relationship. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, University of Pennsylvania / 13.02.2015

Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health Policy Perelman School of Medicine and Department of Health Care Management The Wharton School University of Pennsylvania Philadelphia, PAMedicalResearch.com Interview with: Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health Policy Perelman School of Medicine and Department of Health Care Management The Wharton School University of Pennsylvania Philadelphia, PA Editor’s note: Dr. Emanuel is a medical oncologist as well as director of the department of Medical Ethics and Health Policy at the University of Pennsylvania. Dr. Emanuel was kind enough to answer several questions regarding his most recent study, published in the new JAMA Oncology journal, Patient Demands and Requests for Cancer Tests and Treatments. Medical Research: What is the background for this study? What are the main findings? Dr. Emanuel: The genesis for this study is twofold. One, the first referenced article, by John Tilbert1 discussed how physicians explain US health care costs. In this study, physicians felt patients, insurance companies, drug companies, government regulations and malpractice lawyers...all were more to blame than doctors themselves for the high cost of US health care. Secondly, I give lots of presentations to doctors who offer two explanations for escalating health care costs: fear of malpractice litigation, and demanding patients, who request extensive testing and drugs. We decided to see whether the impression doctors frequently held of patients’ demands driving up health care costs, had been previously investigated. We could find no article to substantiate this belief. In addition, demanding patients were not common in my medical experience. In our study we included 5050 patient encounters. We asked the clinician coming out of the encounter, did the patient make a demand or request? (By asking immediately after the doctor left the examination room, there was little risk of inaccurate recall of the specifics of visit). In 8.7% there was a patient request and of these, over 70% were deemed clinically appropriate as determined by the physician (i.e. a request for pain medication, palliative care or imaging to address a new symptom or finding). In only 1% of all encounters (50/5050) was a clinically inappropriate request made as determined by the doctor, and the doctors hardly filled any of these inappropriate requests (total of 7 of 5050 encounters). We concluded that it is pretty rare for patients to make demands or requests, at least in this oncology setting, and even less common for the demands to be complied with by the doctor. Therefore it seems unlikely to us that health care costs are significantly driven by inappropriate patient requests. It is possible that there are more or different patient demands in other health care settings but we were very surprised to find no difference in patient requests based on patient-income, i.e. wealthier, more educated patients made no more demands than patients of lesser means. (more…)
Annals Internal Medicine, Author Interviews, Lung Cancer, NIH, Radiology / 13.02.2015

MedicalResearch.com Interview with: Paul F. Pinsky, PhD MPH Acting Chief Early Detection Research Group National Cancer Institute Bethesda, MD, 20892 Medical Research: What is the background for this study? What are the main findings? Response: The National Lung Screening Trial (NLST) reported, in 2011, a 20% reduction in lung cancer mortality with low-dose CT screening. However, there was a high false positive rate, around 25% in the first two screening rounds, and somewhat lower in the final round. In order to reduce the high false positive rate, and also to standardize the reported system for low-dose CT screening, analogous to the use of BIRADS for mammography screening, the American College of Radiology (ACR) developed the Lung-RADS classification system. It was released in May, 2014. Although it was developed based on published summary data from several studies, including the NLST, it was never applied to a large group of screened subjects on an individual basis. Therefore, we retrospectively applied Lung-RADS to previously collected, detailed screening data from the National Lung Screening Trial . The major findings were that the false positive rate decreased very substantially using Lung-RADS instead of the original National Lung Screening Trial criteria. At the baseline screen, it decreased by 50% and at subsequent screens it decreased by 75%. There was also, however, a modest decrease in the sensitivity rate, from 93% to 85% at baseline and from 93% to 79% at subsequent screens. (more…)
Author Interviews, JAMA, Mental Health Research, UCSF / 12.02.2015

Carol Mathews UCSF Professor, Psychiatry UCSF School of MedicineMedicalResearch.com Interview with: Carol Mathews Professor, Psychiatry UCSF School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Mathews: The background for this study is that, as a part of ongoing genetic studies of Tourette Syndrome, the Tourette Syndrome Association International Genetics Collaborative (TSAICG) has collected a wealth of information about commonly co-occurring psychiatric disorders in individuals with Tourette Syndrome and their families, providing us with an opportunity to explore questions about Tourette Syndrome that are relevant to individuals with Tourette Syndrome, their families, and their treating clinicians. (more…)
Author Interviews, Cancer Research, JAMA, MD Anderson, Outcomes & Safety / 12.02.2015

Kenneth L. Kehl, MD Division of Cancer Medicine, MD Anderson Cancer Center Houston, TexasMedicalResearch.com Interview with: Kenneth L. Kehl, MD Division of Cancer Medicine, MD Anderson Cancer Center Houston, Texas Medical Research: What is the background for this study? What are the main findings? Response: Prior studies have demonstrated that most patients with cancer wish to participate in their treatment decisions.  We studied a cohort of patients with lung or colorectal cancer and assessed whether patient involvement in decision-making was associated with perceived quality of care or ratings of physician communication.  We found that patients who described a more shared decision-making process gave higher ratings of their care quality and physician communication.  This effect was independent of patients' stated preferences regarding involvement in decision-making. (more…)
Author Interviews, Baylor College of Medicine Houston, Breast Cancer / 10.02.2015

Dr. Xiang (Shawn) Zhang PhD Assistant Professor Department of Molecular and Cellular Biology Lester and Sue Smith Breast Center Baylor College of Medicine Houston, TexasMedicalResearch.com Interview with: Dr. Xiang (Shawn) Zhang PhD Assistant Professor Department of Molecular and Cellular Biology Lester and Sue Smith Breast Center Baylor College of Medicine Houston, Texas   Medical Research: What is the background for this study? What are the main findings? Response: Bone metastases present a major clinical problem for oncologists. They are very painful and unpleasant due to the ability of metastatic cells to dissolve bones, and if they spread to the spine or vertebrate bone they  the spinal cord compression could cause paralysis. There is a gap in our knowledge about bone metastasis in breast cancer. We know a lot about when they are fully established and already dissolving the bone, but little about what happens early on, right after the cancer cells get there but before they start the bone-dissolving process. In the study, we revealed that in the early stages, when there are only a few cancer cells, these cells tend to locate themselves in a microenvironment that is enriched in bone making cells called osteoblasts whose normal job is to help make new bones. The cancer cells appear to be surrounded by these bone-making cells before they acquire the ability to dissolve bones. We also uncovered the pathway that gets activated when the cancer cells lodge into the bone-making cells, and helps them progress to more malignant metastases. The action is mediated by a class of proteins that helps bind the cancer cells to the bone tissue called heterotypic adherens junctions (hAJs) involving the adherens proteins E-cadherin (cancer-derived) and N-cadherin (bone-promoting). This then activates the mTOR pathway in cancer cells, which drives the progression from single cells to metastases. (more…)