Regardless of Ejection Fraction, Hospitalization for Heart Failure Linked To Increased Risk of Death

MedicalResearch.com Interview with:

Kevin S. Shah, M.D. Cardiology Fellow, University of California, Los Angeles Ronald Reagan UCLA Medical Center

Dr. Shah

Kevin S. Shah, M.D.
Cardiology Fellow, University of California, Los Angeles
Ronald Reagan UCLA Medical Center

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

Response: Heart failure (HF) is a chronic condition and progressive disease which is associated with a high-risk of hospitalization and death. One of the principle ways in which heart function is estimated is the use of ultrasound to calculate the ejection fraction of the heart, an estimate of the heart’s pump function. The ejection fraction can help predict how long patients will live and affects decision-making with regards to what medications may help their condition.

A total of 39,982 patients from 254 hospitals who were admitted for Heart failure between 2005 and 2009 were included. They were followed over time to see if they were admitted to the hospital again or if they died during this period. We compared three subgroups within this large group of patients based on their estimated ejection fraction. Across subgroups, the 5-year risk of hospitalization and death was high when compared with the U.S. population. Furthermore, the survival for patients with a diagnosis of heart failure who have been hospitalized once for this condition have a similarly poor 5-year risk of death and re-hospitalization, regardless of their estimated ejection fraction.
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Anti-Fibrotic Drug May Block Cardiac Scarring That Leads To Heart Failure

MedicalResearch.com Interview with:

Bruno Péault PhD Professor and Chair, Vascular Regeneration Center For Cardiovascular Science MRC Centre for Regenerative Medicine Scientific Director, BHF Laboratories The University of Edinburgh and Professor, David Geffen School of Medicine at UCLA Orthopaedic Hospital Research Center University of California at Los Angeles Los Angeles, CA 90095-7358

Dr. Péault

Bruno Péault PhD
Professor and Chair, Vascular Regeneration
Center For Cardiovascular Science
MRC Centre for Regenerative Medicine
Scientific Director, BHF Laboratories
The University of Edinburgh and
Professor, David Geffen School of Medicine at UCLA
Orthopaedic Hospital Research Center
University of California at Los Angeles
Los Angeles, CA 90095-7358

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

Response: Kidney, lung, liver, muscle, heart are among the many organs which can be severely affected by fibrosis, a natural scarring process whereby healthy tissues are replaced by a fibrous non-functional substitute. For instance, the billions of cardiac muscle cells that die after a heart infarct, consequently to blood supply interruption, are replaced by a fibrotic scar that cannot contract, reducing the capacity of the heart to pump blood, and leading often to heart failure. There is currently no efficient treatment of fibrotic scars, the basic cellular component of which is the myofibroblast, a cell of unremarkable appearance and unclear origin. The transforming growth factor β (TGFβ) molecule triggers fibrosis development after being activated, via the extra-cellular matrix, by αv integrins, which are adhesion molecules present at the surface of the target cells.

To gain further insight into the cells that drive fibrosis in the heart and skeletal muscle, and explore ways to control this deleterious process, mice were used in which cells expressing the β receptor for PDGF (platelet derived growth factor) have been genetically tagged with a green fluorescent protein, a system previously used by Prof. Neil Henderson to trace fibrosis in the diseased liver (cells naturally expressing PDGFRβ are, in their vast majority, perivascular cells surrounding small blood vessels, as well as some interstitial fibroblasts). Skeletal muscle was injured by a small incision or with a targeted injection of cardiotoxin, a snake venom compound that locally kills myofibers, while the heart was damaged by prolonged infusion of angiotensin II. In both settings, progression of fibrosis was followed over time and contribution of green fluorescent cells – i.e. those expressing PDGFRβ – was assessed.

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Cataract Surgery Linked To Improved Health and Survival, As Well As Sight

MedicalResearch.com Interview with:

Anne L. Coleman, MD, PhD Center for Community Outreach and Policy, Stein Eye Institute David Geffen School of Medicine Director, UCLA Mobile Eye Clinic Department of Epidemiology, Fielding School of Public Health UCLA

Dr. Coleman

Anne L. Coleman, MD, PhD
Center for Community Outreach and Policy, Stein Eye Institute
David Geffen School of Medicine
Director, UCLA Mobile Eye Clinic
Department of Epidemiology, Fielding School of Public Health
UCLA

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

Response: Cataracts are a leading cause of vision loss worldwide, and cataract surgery is an intervention that is known to be extremely effective to address the vision loss related to cataract. However, it is unclear if there are benefits of cataract surgery beyond vision improvement in people with cataracts. Previous studies have suggested that in addition to improving vision, cataract surgery may decrease the risk of fractures and accidents, improve mental health, and improve overall quality of life. The purpose of the present study was to further investigate the potential benefits of cataract surgery and to determine if cataract surgery was associated with increased survival in people with cataracts.

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PCSK 9 Inhibitors May Be Cost Effective For Subset of High Risk Patients, If Price is Right

MedicalResearch.com Interview with:

Gregg C. Fonarow, MD, FACC, FAHA Eliot Corday Professor of Cardiovascular Medicine and Science Director, Ahmanson-UCLA Cardiomyopathy Center Co-Chief of Clinical Cardiology, UCLA Division of Cardiology Co-Director, UCLA Preventative Cardiology Program David Geffen School of Medicine at UCLA Los Angeles, CA, 90095-1679

Dr. Gregg Fonarow

Gregg C. Fonarow, MD, FACC, FAHA
Eliot Corday Professor of Cardiovascular Medicine and Science
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Chief of Clinical Cardiology, UCLA Division of Cardiology
Co-Director, UCLA Preventative Cardiology Program
David Geffen School of Medicine at UCLA
Los Angeles, CA 

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

Response: The study identifies the clinical and economic consequences of treating a population of patients with established atherosclerotic cardiovascular disease (ASCVD ) at high-risk of cardiovascular (CV) events and defines the cost-effectiveness of the PCSK-9 inhibitor evolocumab under various clinical scenarios. The analysis is based on the clinical outcomes from the Repatha Outcomes Study (FOURIER) in patients with established atherosclerotic cardiovascular disease (ASCVD), such as those who have already had a heart attack or stroke who require additional therapy.

This is the first cost-effectiveness assessment of evolocumab using a model based on a high-quality outcomes trial, combined with U.S. clinical practice data. The analysis identifies the types of high-risk patients for whom this therapy is both clinically beneficial and cost-effective. This study utilized cost-effectiveness and value thresholds employed by the World Health Organization and the American College of Cardiology/American Heart Association.

Evolocumab was found to exceed generally accepted cost-effectiveness thresholds at current list price. However, this medication could be a cost-effective treatment for patients with established ASCVD in the U.S. when the net price is at or below $9,669 per year.

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Familial Hypercholesterolemia: “Junk” RNA May Facilitate Gene Therapy

MedicalResearch.com Interview with:

Tamer Sallam, MD PhD Assistant Professor of Medicine Co-Director UCLA Center for Lipid Management Lauren B. Leichtman and Arthur E. Levine CDF Investigator Assistant Director, STAR Program Division of Cardiology, Department of Medicine David Geffen School of Medicine at UCLA Los Angeles, California 90095-1679 

Dr. Sallam

Tamer Sallam, MD PhD
Assistant Professor of Medicine
Co-Director UCLA Center for Lipid Management
Lauren B. Leichtman and Arthur E. Levine CDF Investigator
Assistant Director, STAR Program
Division of Cardiology, Department of Medicine
David Geffen School of Medicine at UCLA
Los Angeles, California 90095-1679

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

Response: This study is extension of our previous work published in Nature showing that a gene we named LeXis (Liver expressed LXR induced sequence) plays an important role in controlling cholesterol levels. What is unique about  LeXis is that it belongs to a group of newly recognized mediators known as long noncoding RNAs. These fascinating factors were largely thought to be unimportant and in fact referred to as “junk DNA” prior the human genome project but multiple lines of evidence suggest that they can be critical players in health and in disease.

In this study we tested whether we can use  LeXis “gene therapy”  to lower cholesterol and  heart disease risk. This type of approach is currently approved or in testing for about 80 human diseases.

Our finding was that a single injection of LeXis compared with control significantly  reduced heart disease burden in mouse subjects. Although the effect size was moderate we specifically used a model that mimics a very challenging to treat human condition known as familial hypercholesterolemia..Familial hypercholesterolemia is one of the most common genetic disorders affecting up to 2 million Americans and characterized by 20 fold  fold increase risk of early heart attacks and often suboptimal response to currently available treatments.

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Remediation Programs Linked To Reduced Attrition Among Surgical Residents

MedicalResearch.com Interview with:

Christian de Virgilio, MD LA BioMed lead researcher and corresponding author for the study He also is the former director of the general surgery residency program Harbor-UCLA Medical Center and the recipient of several teaching awards.

Dr. de Virgilio

Christian de Virgilio, MD
LA BioMed lead researcher and corresponding author for the study
He also is the former director of the general surgery residency program
Harbor-UCLA Medical Center and the recipient of several teaching awards.

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

Response: Recent forecasts have predicted the United States will have a deficit of as many as 29,000 surgeons by 2030 because of the expected growth in the nation’s population and the aging of the Baby Boomers. This expected shortfall in surgeons has made the successful training of the next generation of surgeons even more important than it was before. Yet recent studies have shown that as many as one in five general surgery residents leave their training programs before completion to pursue other specialties.

Our team of researchers studied 21 training programs for general surgeons and published our findings in the Journal of the American Medical Association Surgery (JAMA Surgery) on August 16, 2017. What we found was the attrition rate among residents training in general surgery was lower than previously determined – just 8.8% instead of 20% – in the 21 programs we surveyed. Our study also found that program directors’ attitudes and support for struggling residents and resident education were significantly different when the authors compared high- and low-attrition programs.

General surgeons specialize in the most common surgical procedures, including abdominal, trauma, gastrointestinal, breast, cancer, endocrine and skin and soft tissue surgeries. General surgery residency training follows medical school and generally requires five to seven years. The programs are offered through universities, university affiliated hospitals and independent programs.

In this study, the research team surveyed 12 university-based programs, three program affiliated with a university and six independent programs. In those programs, 85 of the 966 general surgery residents failed to complete their training during the five-year period the research team studied, July 1, 2010 to June 30, 2015. Of those who failed to complete their general surgery training, 15 left during the first year of training; 34 during the second year, and 36 during the third year or later.

Notably, we found a nearly seven-fold difference between the training program with the lowest attrition rate, 2.2%, and the one with the highest rate, 14.3%, over the five-year period surveyed. In the programs with lower attrition rates, we found about one in five residents received some support or remediation to help ensure they would complete their https://medicalresearch.com/author-interviews/reduction_in_surgical_residents_work_hours/4475/ In the programs with higher attrition rates, the research team reported that only about one in 15 residents received such remediation. Continue reading

USPSTF: Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors

MedicalResearch.com Interview with:

Carol M. Mangione, MD, MSPH, FACP Barbara A. Levey, MD, and Gerald S. Levey, MD Endowed chair in medicine David Geffen School of Medicine University of California, Los Angeles Professor of public health at the UCLA Fielding School of Public Health

Dr. Mangione

Carol M. Mangione, MD, MSPH, FACP
Barbara A. Levey, MD, and Gerald S. Levey, MD
Endowed chair in medicine
David Geffen School of Medicine
University of California, Los Angeles
Professor of public health at the UCLA Fielding School of Public Health

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

Response: Americans can experience several health benefits from consuming healthy foods and engaging in physical activity. The Task Force recommends that primary care professionals work together with their patients when making the decision to offer or refer adults who are not obese and do not have hypertension, high cholesterol, high blood sugar, or diabetes to behavior counseling to promote healthful diet and physical activity. Our focus was on the impact of a healthful diet and physical activity on cardiovascular risk because this condition is the leading cause of premature morbidity and mortality. The Task Force evaluates what the science tells us surrounding the potential benefits and harms of a particular preventive service. In this case, the Task Force found high quality evidence focusing on the impact a healthful diet and physical activity can have on a patient’s risk of cardiovascular disease. Relying on this evidence, the Task Force was able to conclude that there is a positive but small benefit of behavioral counseling to prevent cardiovascular disease.

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Study Finds Single Antibiotic Cephalexin Alone Is Appropriate Outpatient Treatment For Cellulitis

MedicalResearch.com Interview with:
Gregory John Moran, MD, FACEP
Emergency Medicine Dept. & Infectious Diseases Service
UCLA Medical Center

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

Response: The bacterial etiology of cellulitis is difficult to determine because there is usually no material for culture, but streptococci are believed to be the most common etiology. Since the emergence of MRSA as a common cause of skin infections in the community, many clinicians add a second antibiotic with MRSA activity to an oral cephalosporin, such as a combination of cephalexin plus trimethoprim-sulfamethoxazole. It is unknown if there is an additional benefit to adding MRSA activity for treatment of cellulitis. This randomized, blinded trial compared cephalexin plus placebo to cephalexin plus trimethoprim-sulfamethoxazole for outpatient treatment of cellulitis without an abscess or wound.

Bottom line: We did not find a benefit from addition of trimethoprim-sulfamethoxazole.

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Gene Dosage at 22q11.2 Helps Determine Schizophrenia vs Autism Brain Differences

MedicalResearch.com Interview with:

Carrie Bearden, Ph.D. Professor, Departments of Psychiatry and Biobehavioral Sciences and Psychology Semel Institute for Neuroscience and Human Behavior University of California, Los Angeles

Dr. Bearden

Carrie Bearden, Ph.D.
Professor, Departments of Psychiatry and Biobehavioral Sciences and Psychology
Semel Institute for Neuroscience and Human Behavior
University of California, Los Angeles

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

Response: A 22q11.2 deletion confers the highest known genetic risk for schizophrenia, but a duplication in the same region is strongly associated with autism and is less common in schizophrenia cases than in the general population.

Thus, we became interested in trying to understand whether there were differences in brain development that might predispose to one condition vs. the other.

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Antibiotic Failure in Community Acquired Pneumonia Surprisingly Common

MedicalResearch.com Interview with:

Dr. James A. McKinnell, MD LA BioMed Assistant Professor of Medicine David Geffen School of Medicine at UCLA

Dr. McKinnell

Dr. James A. McKinnell, MD
LA BioMed
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA

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

Response: Pneumonia is the leading cause of death from infectious disease in the United States. We conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society America, published in 2007, provide some direction about prescribing antibiotics for community-acquired pneumonia. But large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure. Antibiotic failure for community-acquired pneumonia is associated with substantial morbidity and mortality and results in significant medical expenditures.

We examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia. We defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.

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Brain Triggers For Eating Differ in Obese Men vs Women

MedicalResearch.com Interview with:

Arpana Gupta, Ph.D. Assistant Professor G. Oppenheimer Center for Neurobiology of Stress and Resilience Ingestive Behavior and Obesity Program Vatche and Tamar Manoukin Division of Digestive Diseases David Geffen School of Medicine, UCLA

Dr. Gupta

Arpana Gupta, Ph.D.
Assistant Professor
G. Oppenheimer Center for Neurobiology of Stress and Resilience
Ingestive Behavior and Obesity Program
Vatche and Tamar Manoukin Division of Digestive Diseases
David Geffen School of Medicine, UCLA

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

Response: Past studies have demonstrated how an imbalance in the processing of rewarding and salient stimuli results in maladaptive or excessive eating behaviors. However, stress and drug use are known to affect how sex and sex hormones modulate responses of the dopamine system involved in reward, and are thought to underlie sex differences in the pathophysiology of drug addiction and treatment response. These results suggest similar sex effects on the mesolimbic reward system may also be at play in obesity.

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Restrictions on Pharmaceutical Detailing Linked To Increase in Generic Drug Prescription

MedicalResearch.com Interview with:

Ian Larkin, PhD</strong> Assistant Professor of Strategy UCLA Anderson School of Management

Dr. Ian Larkin

Ian Larkin, PhD
Assistant Professor of Strategy
UCLA Anderson School of Management

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

Response: The study examined whether restrictions put in by medical centers on salesperson visits to physicians, known as “detailing,” affected subsequent physician prescribing behavior. Detailing represents the most prominent form of pharmaceutical marketing. Detailing visits allow the sharing of scientific information, but they also often involve small gifts for physicians and their staff, such as meals.

Pharmaceutical companies incur far greater expenditures on detailing visits than they do on direct-to-consumer marketing, or even on research and development of new drugs. Specifically, the study examined detailing restrictions put into place by 19 academic medical centers (AMCs) in five states in the U.S. It compared changes in prescribing by thousands of AMC physicians whose practices limited typical elements of detailing visits, such as provisions of meals and educational gifts, to a carefully matched control group of similar physicians practicing in the same geographic regions but not subject to such detailing restrictions.

The study, which included more than 25,000 physicians and all 262 drugs in eight major drug classes — from statins to sleep aids to antidepressants, representing more than $60 billion in aggregate sales in the United States — was, to date, by far the most comprehensive to examine the impact of detailing restrictions. The comprehensive and quasi-experimental methodology, which compared prescribing behavior before and after implementation of policies, and which included a large matched control group of physicians not subject to policy changes, was an important innovation relative to prior research. The study used prescription data from CVS Caremark, one of the largest pharmacy benefit managers in the United States.

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Hospital Based Primary Care Practices Provide More Low Value Services

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Assistant Professor of Medicine Division of General Internal Medicine and Health Services Research UCLA David Geffen School of Medicine Los Angeles, CA 90024 Affiliated Natural Scientist in Health Policy RAND Corporation 1776 Main St, Santa Monica, CA 90401

Dr. John Mafi

John N. Mafi, MD, MPH
Assistant Professor of Medicine
Division of General Internal Medicine and Health Services Research
UCLA David Geffen School of Medicine
Los Angeles, CA 90024
Affiliated Natural Scientist in Health Policy
RAND Corporation
1776 Main St, Santa Monica, CA 90401

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

Response: Between 10-30% of healthcare costs are due to low value care, or patient care that provides little to no benefit to patients, and can sometimes cause harm (e.g., radiation exposure from diagnostic imaging tests). In this study, we found that hospital-based primary care practice provide more low value care than community-based primary care practices across the United States. Understanding where and why low value care occurs is going to be essential if we want to get serious about eliminating it.

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Thyroid Hormone Medication Should Not Be Taken With Cow’s Milk

MedicalResearch.com Interview with:
Deborah Chon MD
Endocrinology fellow
UCLA David Geffen School of Medicine 

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

Response: Our study shows that drinking cow’s milk concurrently with oral levothyroxine significantly reduces the absorption of the medication.

Levothyroxine is used for the physiologic replacement of thyroid hormone in patients with hypothyroidism and for serum TSH suppression in patients with thyroid cancer. It is the mostly commonly prescribed medication in the United States as of 2014. Frequent dose adjustments of levothyroxine have been shown to be a costly burden to the national healthcare system.

Previous studies have shown that certain foods and medication, such as calcium supplements, can interfere with levothyroxine absorption. However, this is the first study to demonstrate that ingesting cow?s milk, a common breakfast staple, affects oral levothyroxine absorption.

To determine the possible effect of cow’s milk ingestion, we measured levothyroxine absorption in humans with and without concurrent milk consumption. Pharmacokinetic studies were conducted in healthy adults without allergies to milk or levothyroxine, and who were not pregnant nor using oral contraceptives. All subjects had no history of known thyroid disease and normal thyroid hormone function at baseline. Following an overnight fast, serum total thyroxine T4 (TT4) concentrations were measured at baseline and at 1, 2, 4, and 6 hours after ingestion of 1,000 ?g of oral levothyroxine alone or when co-administered with 12 oz. of milk (2% fat). There was a four-week washout period between the two study visits.

Ten subjects (mean age 33.7?10.2 years, 60% male) completed the study. The serum total T4 absorption over six hours, calculated as area under the curve (AUC), was significantly lower when taking cow?s milk concurrently with levothyroxine compared levothyroxine alone (mean?SD: 67.26?12.13 vs. 73.48?16.96; p = 0.02). Also, peak serum TT4 concentrations were significantly lower in those who ingested levothyroxine concurrently with milk, compared to taking levothyroxine alone (p=0.04).
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Curcumin Gel May Speed Healing of Scalds and Burns

MedicalResearch.com Interview with:

Madalene Heng MD, FRACP, FACD, FAAD</strong> Professor of Medicine/Dermatology UCLA School of Medicine

Dr. Madalene Heng

Madalene Heng MD, FRACP, FACD, FAAD
Professor of Medicine/Dermatology
UCLA School of Medicine

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

Response: Curcumin, the active ingredient in the spice, turmeric, is an excellent anti-inflammatory agent with unique healing properties.

However, this is only observed with our preparation of topical curcumin but not with oral curcumin. This is because curcumin is not absorbed and does not cross cell membranes – low bioavailability.

The biochemical basis for the efficacy of topical curcumin is based on the fact that it is a phosphorylase kinase inhibitor. Phosphorylase kinase is an enzyme released by injured tissue 5 mins following injury, and is responsible for activating the transcription activator (NF-kB), resulting in turning on over 200 genes responsible for inflammation, and scarring among others, resulting in redness, swelling, pain, and eventually scarring. By blocking phosphorylase kinase activity early in the injury pathway, topical curcumin (curcumin gel) results in rapid healing with minimal or no scarring following many types of healing, including burns and scalds. The unique healing properties are also due to the fact that curcumin induces cell death (apoptosis) to damaged cells, resulting in the “space” for replacement by new healthy cells, resulting in normal appearing skin following burns and scalds.

The salutary result depends on when the curcumin gel is applied – the earlier the better. We observed that when curcumin gel was applied within 4 days to second degree burns- hourly applications, tapering after the patient is improved – we observed rapid healing within 5 days, with the skin returning to normal within 6 weeks to 2 months without redness or visible scarring. Minor burns and scalds heal even more rapidly. Pain was improved within hours.

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

Response: If the readers happen to have curcumin gel (Psoria-Gold) in their first aid kit, they should apply curcumin gel multiple times as soon as possible. Within the first hour, they should apply it every 5-10 mins, tapering off when the pain and swelling is improved. If they do this, it is possible that blistering may be aborted. The scarring is also minimal. The curcumin gel should be applied twice daily until the skin returns to normal (no redness, swelling, pigmentation etc) and no visible scarring is seen.

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Physicians, PAs and Nurse Practitioners Provide Similar Amount of Low Value Care

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Division of General Internal Medicine and Health Services Research Department of Medicine, Ronald Reagan UCLA Medical Center Los Angeles, CA

Dr. John N. Mafi

John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA

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

Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.

We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.

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Only a Quarter of Medical Grand Round Speakers Are Women

MedicalResearch.com Interview with:
Julie R. Boiko, MD, MS
Resident Physician, PGY1
Department of Pediatrics
University of California, San Francisco

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

Response: Grand rounds is an over 100-year-old tradition in US medical school clinical departments of recurring, expert-delivered lectures to update physicians and physicians-in-training on recent advances in relevant medicine. We wanted to determine whether gender representation of speakers at grand rounds aligns with the gender distribution of people typically represented in grand rounds audiences — faculty, residents, and medical students — by clinical specialty according to national academic medical trainee and workforce statistics.

We chose to focus on grand rounds speakers as visible representations of women in academic medicine. This is important because, despite women and men entering medicine at comparable rates, women are much more likely to depart academic medical careers. As current and recent medical students, we considered that consistent exposure to successful female role models in grand rounds speaking venues may positively reinforce women trainees’ desires to continue in academic medical careers.

We found that the people at the podiums do not resemble the people in the audience. Only 26% of grand rounds speakers are women. Even accounting that some clinical specialties contain few women faculty and residents, grand rounds speakers in most specialties we studied were statistically less likely to be women as compared to faculty and residents. Across the specialties, grand rounds speakers are 44% less likely than medical students, 39% less likely than residents, and 21% less likely than faculty to be women.

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Testosterone Improves Anemia and Bone Strength, Worsens Coronary Plaque and Has No Effect on Memory

MedicalResearch.com Interview with:

Ronald S. Swerdloff, MD Chief of the Division of Endocrinology, Department of Medicine and Director of a World Health Organization Collaborative Center in Reproduction a Mellon Foundation Center for Contraceptive Development and a NIH Contraceptive Clinical Trial Center Director of the Harbor-UCLA Reproductive Program LA BioMed Lead Researcher David Geffen School of Medicine UCLA Health

Dr. Ronald Swerdloff

Ronald S. Swerdloff, MD
Chief of the Division of Endocrinology, Department of Medicine and
Director of a World Health Organization Collaborative Center in Reproduction
a Mellon Foundation Center for Contraceptive Development and a
NIH Contraceptive Clinical Trial Center
Director of the Harbor-UCLA Reproductive Program
LA BioMed Lead Researcher
David Geffen School of Medicine
UCLA Health

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

Response: While we have long known that testosterone levels decrease as men age, very little was known about the effects of testosterone treatment in older men with low testosterone until last year.

Our team of researchers from LA BioMed and 12 other medical centers in the U.S., in partnership with the National Institute on Aging, conducted a coordinated group of seven trials known as The Testosterone Trials (TTrials). We studied the effects of testosterone treatment for one year as compared to placebo for men 65 and older with low testosterone. The TTrials are now the largest trials to examine the efficacy of testosterone treatment in men 65 and older whose testosterone levels are low due seemingly to age alone.

The first published research from the TTrials last year reported on some of the benefits to testosterone treatment. We have now published four additional studies in the Journal of the American Medical Association (JAMA) and JAMA Internal Medicine that found additional benefits and one potential drawback.

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E-Cigs Linked To Adverse Cardiac Effects

MedicalResearch.com Interview with:

Holly R. Middlekauff, MD Professor UCLA Division of Cardiology David Geffen School of Medicine UCLA

Dr. Holly Middlekauff

Holly R. Middlekauff, MD
Professor
UCLA Division of Cardiology
David Geffen School of Medicine
UCLA

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

Response: E-cigarettes are the fastest rising tobacco product in the US today, but almost nothing is known about their cardiovascular effects. Rather than wait decades for epidemiological data in e-cigarette users to become available, we reasoned that investigations into the known mechanisms by which tobacco cigarettes increase heart disease would provide insights into the health risks of e-cigarettes.

We focused on 2 critical mechanisms:
1) cardiac adrenaline activity, and
2) oxidative stress, measured in chronic e-cigarrete users compared to matched, healthy controls.

The major findings were that, compared to healthy controls, e-cig users had increased cardiac adrenaline activity (measured by a technique called “heart rate variability”). Furthermore, compared to healthy controls, the e-cig users had increased susceptibility to oxidative stress.

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More Than Moderate Alcohol Not Good For The Heart

MedicalResearch.com Interview with:

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS Director of Clinical Research Division of Cardiology Endowed Professor of Atrial Fibrillation Research University of California, San Francisco

Dr. Gregory M Marcus

Gregory M Marcus, MD, MAS, FACC, FAHA, FHRS
Director of Clinical Research
Division of Cardiology
Endowed Professor of Atrial Fibrillation Research
University of California, San Francisco

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

Response: Moderate alcohol consumption has previously been associated with a decreased risk of heart attack. However, as we have previously shown that individuals who believe alcohol to be good for the heart tend to drink more, there is a concern that these previous data might appear to justify excessive alcohol consumption.

In addition, previous research on the topic of alcohol consumption and heart disease has relied almost entirely on participant self-report, which is known to be particularly unreliable among heavy drinkers. Finally, previous research has sought to study relationships between alcohol and various types of heart disease, but there has not been an emphasis on individual-level characteristics that might influence these relationships.
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Patients Who Understand Their Medical Condition Less Likely To Opt For Aggressive Care

MedicalResearch.com Interview with:

Joseph A. Ladapo, MD, PhD David Geffen School of Medicine at UCLA Department of Medicine, Division of General Internal Medicine and Health Services Research Los Angeles, California

Dr. Joseph A. Ladapo

Joseph A. Ladapo, MD, PhD
David Geffen School of Medicine at UCLA
Department of Medicine, Division of General Internal Medicine and Health Services Research
Los Angeles, California

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

Response: Four million stable patients in the US undergo testing for suspected ischemic heart disease (IHD) annually. There is substantial variation in how these patients are managed by physicians, and both clinical and economic factors have been used to explain this variation. However, it is unknown whether patients’ beliefs and preferences influence management decisions, and we aimed to answer this question. Based on interviews of 351 stable patients at Geisinger Health System newly referred for cardiac stress testing/coronary computed tomographic angiography (CTA) for suspected IHD, we found that patients with an accurate understanding of their initial test result were less likely to undergo follow-up tests/procedures if the initial test was negative and more likely to undergo follow-up tests/procedures if the initial test was positive.

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Zika Virus Infection in Pregnant Women in Rio de Janeiro

MedicalResearch.com Interview with:

Karin Nielsen, MD, MPH Professor of Clinical Pediatrics Division of Pediatric Infectious Diseases David Geffen School of Medicine at UCLA Director, Center for Brazilian Studies

Karin Nielsen

Karin Nielsen, MD, MPH
Professor of Clinical Pediatrics
Division of Pediatric Infectious Diseases
David Geffen School of Medicine at UCLA
Director, Center for Brazilian Studies

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

Response: Our research was a prospective study in which pregnant women in Rio de Janeiro who developed a rash in the last 5 days between the end of 2015 to mid 2016 were screened for possible infection with Zika virus by a special molecular test (PCR) which looked for the virus in blood or urine. Women who were found to have Zika virus in either blood, urine or both were followed throughout time to look for pregnancy and infant outcomes. We also followed women who had a negative PCR test for Zika as a comparison group. By July 2016, we had outcomes known for 125 Zika affected pregnancies, of these 58 had abnormal outcomes, with 9 fetal losses and 49 babies who had abnormal findings on physical exam or brain imaging, all consistent with neurologic abnormalities. This meant 46% of the pregnant women in our study had an abnormal pregnancy outcome, and 42% of live birth infants were found to have an abnormality in the first few months of life.

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First Childhood Exposure Determines How Sick You Get From Flu As Adult

MedicalResearch.com Interview with:
Katelyn M. Gostic and
Monique Ambrose

Department of Ecology and Evolutionary Biology
University of California
Los Angeles

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

Monique Ambrose: Influenza pandemics pose a serious, recurrent threat to human public health. One of the most probable sources of future pandemic influenza viruses is the pool of influenza A virus (IAV) subtypes that currently circulate in non-human animals. It has traditionally been thought that the human population is immunologically naïve and unprotected against these unfamiliar subtypes. However, our work suggests that an individual ‘imprints’ to the influenza A virus (IAV) encountered in early childhood in such a way that they retain protection against severe disease if they later encounter a novel IAV subtype that belongs to the same genetic group as their first exposure.

Our research looked at human cases of H5N1 and H7N9, two avian IAV subtypes of global concern, to investigate what factors most strongly predicted risk of severe disease. The most striking explanatory factor was childhood IAV imprinting: our results suggest that individuals who had childhood imprinting on an IAV in the same genetic group as the avian IAV they encountered later in life experienced 75% protection against severe disease and 80% protection against death.

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Neuroimaging Detects Chemical Disturbances in Stuttering

MedicalResearch.com Interview with:
Joseph O’Neill, PhD
Division of Child and Adolescent Psychiatry
University of California–Los Angeles Semel Institute for Neuroscience
Los Angeles

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

Response: Stuttering seriously diminishes quality of life. While many children who stutter eventually grow out of it, stuttering does persist into adulthood in many others, despite treatment. Like earlier investigators, we are using neuroimaging to explore possible brain bases of stuttering, aiming, eventually, to improve prognosis. What’s novel is that our study deploy neuroimaging modalities– arterial spin labelling and, in this paper, magnetic resonance spectroscopy (MRS)– not previously employed in stuttering. MRS offers prospects of detecting possible neurochemical disturbances in stuttering.

The MRS results showed differences in neurometabolite– brain chemicals– levels between people who stutter (adults and children) and those who don’t in many brain regions where other neuroimaging has also observed effects of stuttering. In particular, MRS effects were apparent in brain circuits where our recent fMRI work detected signs of stuttering, circuits subserving self-regulation of speech production, attention and emotion. This reinforces the idea that stuttering has to do with how the brain manages its own activity along multiple dimensions: motivation, allocation of resources, and behavioral output.

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Squamous Cell Carcinoma of Lip Predominantly Affects White Men in Their Mid-60s

MedicalResearch.com Interview with:

Albert Yoon-Kyu Han, PhD Class of 2017 Medical Scientist Training Program David Geffen School of Medicine at UCLA

Dr. Albert Han

Albert Yoon-Kyu Han, PhD
Class of 2017
Medical Scientist Training Program
David Geffen School of Medicine at UCLA

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

Response: Squamous cell carcinoma (SCC) of the lip makes up a large portion of oral cancers (25%). Most of the demographic and prognostic indicators for lip SCC are only available through retrospective case series. Thus, we used the national cancer database (Surveillance, Epidemiology, and End Results, or SEER) to examine the incidence, treatment, and survival of patients with lip SCC.

The main findings of this study were that lip Squamous cell carcinoma predominantly affects white men in their mid-60s. We also found that the determinants of survival for lip SCC include age at diagnosis, primary site, T stage, and N stage. More specifically, on the primary site, SCC of the upper and lower lip had similar survival, whereas SCC of the oral commissure was associated with decreased survival.

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Results of the 2-Year Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) Randomized Trial

MedicalResearch.com Interview with:

Pravin U. Dugel, MD Retina Consultants of Arizona Phoenix, Arizona; USC Roski Eye Institute Keck School of Medicine University of Southern California Los Angeles, California

Dr. Pravin Dugel

Pravin U. Dugel, MD
Retina Consultants of Arizona
Phoenix, Arizona; USC Roski Eye Institute
Keck School of Medicine
University of Southern California
Los Angeles, California 

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

Response: OASIS is an acronym for “OcriplASmIn for Treatment for Symptomatic Vitreomacular Adhesion including Macular Hole”.  It was a Phase IIIB, randomized, prospective, sham-controlled, double-masked, multicenter clinical study. The goal of the study was to further evaluate the long-term (24 months) efficacy and safety of a single injection of 0.125mg of ocriplasmin in patients with symptomatic vitreomacular adhesion (VMA) and vitreomacular traction (VMT), including macular hole (MH).

OASIS evaluated 220 patients with symptomatic VMA/VMT.  One hundred forty-six patients received ocriplasmin while 74 served as a sham control group. In the latter group, no intravitreal injection was administered.  Continue reading

UV Sensitive ‘Band-aid’ Makes Monitoring Sun Exposure Easy

MedicalResearch.com Interview with:

Dr. Andrea M Armani PhD Fluor Early Career Chair and Associate Professor Mork Family Department of Chemical Engineering and Materials Science University of Southern California, Los Angeles, California credit to USC Viterbi.

Dr. Andrea M Armani

Dr. Andrea M Armani PhD
Fluor Early Career Chair and Associate Professor
Mork Family Department of Chemical Engineering and Materials Science
University of Southern California, Los Angeles, California

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

Response: The “Internet of Things” (IoT) has seen an explosion in online sensor technologies, including UV sensors and monitors; for example, those from Apple and Samsung. However, they require connectivity and power, and they are integrated into delicate electronic systems that are not compatible with outdoor, athletic activities such as swimming, which is precisely when you should monitor UV exposure. Therefore, somewhat ironically, the technologies developed to meet the demands of the IoT are not ideal for cumulative UV exposure detection.

Our goal was to develop a single use patch – like a smart “band-aid” – for the beach to alert users when they had been in the sun for an hour and needed to re-apply sunscreen or get out of the sun altogether. This application required a rugged system that was waterproof, bendable, and compatible with sunscreen. Additionally, the sensor readout needed to be easy to interpret. These requirements influenced our design and material selection.

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U.S. Hispanics Age More Slowly Than Caucasians and African-Americans

MedicalResearch.com Interview with:

Michael Gurven, Professor Department of Anthropology University of California Santa Barbara, CA 93106

Dr. Michael Gurven

Michael Gurven, Professor
Department of Anthropology
University of California
Santa Barbara, CA 93106

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

Response: Understanding the sources of ethnic and sex disparities in health and longevity is critical in order to insure the health and well-being of everyone. We often hear about disparities due to differences in health care access, education, income, and sometimes genetic differences. But what we’ve done here is to employ a new biomarker developed by Steve Horvath, called the “epigenetic clock”, which measures the cumulative changes to the epigenome, i.e. alterations to DNA that affects gene activity and
expression but do not alter the DNA itself. This new measure is arguably
one of the best biomarkers of aging out there today – so it’s indeed a
biological measure, but tells a different story than conventional genetic
differences. Instead epigenetic age is influenced by the lived experience,
physical and social environment, and genetic make-up of individuals.

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ACEI and ARBs Had Similar Outcomes in Study of PD Dialysis Patients

MedicalResearch.com Interview with:

Jenny Shen, MD, MS Assistant Professor of Medicine David Geffen School of Medicine at UCLA Los Angeles Biomedical Institute at Harbor-UCLA Medical Center

Dr. Jenny Shen

Jenny Shen, MD, MS
Assistant Professor of Medicine
David Geffen School of Medicine at UCLA
Los Angeles Biomedical Institute at Harbor-UCLA Medical Center

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

Response: With cardiovascular disease being the No. 1 cause of death in end-stage kidney disease patients on peritoneal dialysis, we examined two classes of medications commonly prescribed to prevent cardiovascular events in these patients and found no significant difference in outcomes.

The two classes of medications, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-II receptor blockers (ARB), have slightly different mechanisms and could theoretically have differing outcomes. Previous studies had suggested that ACEI may lead to a kinin-mediated increase in insulin sensitivity not seen with ARB. This could potentially lower the cardiovascular risk in patients on peritoneal dialysis because they are exposed to high glucose loads in their dialysate that may lead to insulin resistance and its associated cardiovascular risk.

Using a national database, the U.S. Renal Data System, we surveyed records for all patients enrolled in Medicare Part D who initiated maintenance peritoneal dialysis from 2007 to 2011. Of those, we found 1,892 patients using either drug class. Surveying their medical records, we found no difference in cardiovascular events or deaths between the users for each class of medication.

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Menopause Speeds Up the Aging Process in Women

MedicalResearch.com Interview with:

Morgan Elyse Levine, PhD Postdoctoral Fellow Department of Human Genetics University of California, Los Angeles

Dr. Levine

Morgan Elyse Levine, PhD
Postdoctoral Fellow
Department of Human Genetics
University of California, Los Angeles

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

Response: From an evolutionary perspective, aging and reproduction are two processes that are linked. For instance, in order to maximize fitness, an individual has to survive and remain healthy enough to:

1) reproduce and

2) insure offspring survive to reproductive age.

Thus, the rate of aging is tied to a species’ timing of reproductive senescence and necessary length of parental involvement. There is also evidence that among humans, women with longer reproductive stages (later age at menopause, ability to conceive at older ages) are more likely to live to age 100, which we hypothesize is because they age slower.

Using an epigenetic biomarker believed to capture biological aging (previously developed by the Principle Investigator of this study, Steve Horvath), we tested whether age at menopause, surgical menopause, and use of menopausal hormone therapies were associated with a woman’s aging rate.

We found that the blood of women who experienced menopause at earlier ages (especially those who underwent surgical menopause) was “older” than expected, suggesting they were aging faster on a biological level than women who experienced menopause at later ages. We also found that buccal epithelium samples (cells that line the inside of the cheek) were epigenetically younger than expected (signifying slower aging) for post-menopausal women who had taken menopausal hormone therapy, compared to post-menopausal women who had never taken any form of menopausal hormone therapy.

Finally, we had a number of results that suggested that the previously mentioned findings were a result of the process of menopause directly speeding up the aging process—rather than the alternative explanation, which would have been that women who aged faster experience menopause earlier.

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More Cancer Survivors Developing Second Primary Malignancy

MedicalResearch.com Interview with:

Karim Chamie MD, MSHS Department of Urology Jonsson Comprehensive Cancer Center David Geffen School of Medicine University of California at Los Angeles Los Angeles, California

Dr. Karim Chamie

Karim Chamie MD, MSHS
Department of Urology
Jonsson Comprehensive Cancer Center
David Geffen School of Medicine
University of California at Los Angeles
Los Angeles, California

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

Response: With improved cancer outcomes, there are 14 million cancer survivors alive in the United States in 2012. That number is expected to increase to nearly 20 million by 2024. With such a large population, many of these cancer survivors are at risk for developing a second primary malignancy. Multiple primary cancers now account for approximately 17% of all incident cancers reported each year in the United States.

Cancer survivors may be especially susceptible to developing second primary malignancies due to a variety of unique factors, including genetic syndromes, common etiologic exposures, and the late effects of chemotherapy and radiotherapy. Given the longer duration of cancer survivorship and the substantial proportion of survivors at risk for developing second primary malignancies, the incidence and mortality from second primary malignancies are likely to increase.

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New Bone Balance Index Predicts Bone Loss Across Menopause Transition

MedicalResearch.com Interview with:
Albert Shieh, MD
Division of Endocrinology, Diabetes and Hypertension
David Geffen School of Medicine
University of California, Los Angeles

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

Response: Whether an individual loses or gains bone mass is dependent on how much bone is being broken down (by osteoclasts) and being formed (by osteoblasts). Both processes occur simultaneously in the human body. At present, we can measure markers of bone breakdown (resorption) and formation. However, we hypothesized that to better predict the amount of bone mass that will be lost in the future, these markers should be combined in an “index” to reflect both processes, rather than being interpreted in isolation. Indeed, we found that the ability of our new bone balance index predicted future bone loss across the menopause transition better than the bone resorption marker alone.

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Substantial Number of Deaths in Heart Failure Patients Can Be Reduced with ANRI Therapy

MedicalResearch.com Interview with:

Gregg C. Fonarow, MD, FACC, FAHA Eliot Corday Professor of Cardiovascular Medicine and Science Director, Ahmanson-UCLA Cardiomyopathy Center Co-Chief of Clinical Cardiology, UCLA Division of Cardiology Co-Director, UCLA Preventative Cardiology Program David Geffen School of Medicine at UCLA Los Angeles, CA, 90095-1679

Dr. Gregg Fonarow

Gregg C. Fonarow, MD, FACC, FAHA
Eliot Corday Professor of Cardiovascular Medicine and Science
Director, Ahmanson-UCLA Cardiomyopathy Center
Co-Chief of Clinical Cardiology, UCLA Division of Cardiology
Co-Director, UCLA Preventative Cardiology Program
David Geffen School of Medicine at UCLA
Los Angeles, CA, 90095-1679

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

Dr. Fonarow: Angiotensin receptor neprilysin inhibitors (ARNI) have been demonstrated to reduce mortality in patients with heart failure with reduced ejection fraction. However, to date, the population level impact of optimal implementation of this therapy in the United States has not been evaluated.

This new analysis estimates that as many 28,484 deaths in heart failure with reduced ejection fraction patients annually could be prevented or postponed with optimal use of angiotensin receptor neprilysin inhibitors (with sensitivity analyses demonstrating a range of 18,230 to 41,017).

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Physician Extenders Utilize Similar Rates of Low Value Services as Primary Care Physicians

MedicalResearch.com Interview with:

John N. Mafi, MD, MPH Assistant Professor of Medicine Division of General Internal Medicine and Health Services Research UCLA David Geffen School of Medicine Los Angeles, CA 90024 Affiliated Adjunct in Health Policy RAND Corporation Santa Monica, CA 90401

Dr. John Mafi

John N. Mafi, MD, MPH
Assistant Professor of Medicine
Division of General Internal Medicine and Health Services Research
UCLA David Geffen School of Medicine
Los Angeles, CA 90024
Affiliated Adjunct in Health Policy
RAND Corporation
Santa Monica, CA 90401

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

Dr. Mafi: The U.S. healthcare system faces a looming shortage of primary care physicians, with some estimates as high as 20,000 physicians by the year 2020. In addition, fewer and fewer trainees enter primary care careers because of the harder work and lower salaries. Combine this with the passage of the Affordable Care Act and the millions of newly insured patients looking for a primary care provider, and you have created a perfect storm where timely access to primary care becomes essentially unachievable.

Many advocate for expanding the role of nurse practitioners and physician assistants to mitigate the physician shortage. But this is controversial as most doctors believe nurse practitioners provide inferior care to doctors and many feel that expanding their role would worsen the value and efficiency of the U.S. healthcare system.

While studies suggest they provide similar quality of care to physicians, few have actually evaluated whether they provide greater amounts of inefficient or low value care. Low value care is important because it can harm patients (antibiotics for colds don’t help patients and have harmful side effects) and they can raise healthcare costs. In this context, we used a large national database on ambulatory visits to compare the quality and efficiency of care among nurse practitioners, physician assistants, and physicians in the U.S. primary care setting.

In our 15 year analysis of nearly 29,000 patients who saw either a nurse practitioner, physician assistant, or a physician, we found similar rates of inappropriate antibiotic use for colds, unnecessary imaging (such as x-rays, CT scans, and MRI scans) for back pain and headache, and potentially necessary referrals to specialists for these same three conditions.

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Intestinal Bacteria May Decrease Cancer Risk By Reducing Inflammation

MedicalResearch.com Interview with:

Robert H. Schiestl PhD Department of Environmental Health Sciences, Fielding School of Public Health, Department of Pathology Department of Radiation Oncology Geffen School of Medicine University of California Los Angeles, Los Angeles, California

Dr. Robert Schiestl

Robert H. Schiestl PhD
Department of Environmental Health Sciences, Fielding School of Public Health,
Department of Pathology
Department of Radiation Oncology
Geffen School of Medicine
University of California Los Angeles,
Los Angeles, California

Medical Research: What is the background for this study? What are the main findings?

Dr. Schiestl: When we moved from Harvard to UCLA 13 years ago, after 6 years at UCLA our Atm mouse colony lived significantly 4 fold longer and the frequency of DNA deletions was 4.5 fold reduced and the latency of lymphoma 2.5 fold different. Ultimately we identified the reason behind this as a difference in the intestinal bacteria. The Atm deficient mice are hypersensitive to inflammation and the bacteria reduced inflammation. Then I isolated the most prevalent bacterium among the health beneficial bacteria and this bacterium by itself called Lactobacillus johnsonii 456 reduced genotoxicity and all markers of inflammation.

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UCLA Expert Discusses Campbell’s Decision to Remove BPA from Cans

MedicalResearch.com Interview with:

Nancy L. Wayne, PhD Professor, Department of Physiology UCLA School of Medicine Los Angeles, CA 90095

Prof. Nancy Wayne

Nancy L. Wayne, PhD
Professor, Department of Physiology
UCLA School of Medicine
Los Angeles, CA 90095

MedicalResearch.com editor’s note: Campbell Soup Co. will stop using the chemical Bisphenol A in its canned products by the middle of 2017 due to consumers concerns that BPA raises the risk of cancer, brain damage and hormonal problems.

Professor Nancy Wayne, is a reproductive endocrinologist and professor of physiology at UCLA. She has conducted extensive research on the health effects of the endocrine disruptors bisphenol A (BPA), a chemical widely used by manufacturers to strengthen plastic, and its replacement, bisphenol S (BPS). Professor Wayne was kind of enough to discuss the implications of the Campbell Soup Co. announcement for the readers of MedicalResearch.com. 

MedicalResearch.com: What is the background for this announcement?  What are the real and potential harmful effects of BPAs?

Prof. Wayne: There has been increasing research publications on the impact of BPA on body functions in animal models, human cells in culture, and associations between high levels of BPA in human urine samples and dysfunctions and diseases. a pubmed (biomedical article search engine) keyword search of bisphenol + BPA showed 39 articles published in the 1990s, 1127 articles published in the 2000s, and over 2300 articles published since January 2010. The public is much more aware of this research now — even though the message from the U.S. FDA has been consistently that low levels of BPA are not harmful (this is not the case according to independent research). Public pressure is causing companies to re-think their use of BPA in their products that could lead to environmental exposure of humans to this chemical.

BPA has been shown in animal models to alter genes in fetal heart that are known to play a role in heart diseases, leads to increased genetic abnormalities in fertilized eggs and miscarriages, increased premature birth, increases susceptibility to breast cancer, stimulates early development of the reproductive system, and increases the risk of obesity. We cannot do controlled studies in humans with toxins like we can with laboratory animals. However, there has been shown to be an association between high levels of BPA in human urine and many of the same problems seen in animals: increased body weight and fat in children, increased risk of miscarriages and premature birth, and increased incidence of prostate cancer. Although association doesn’t mean cause-and-effect, taken together with the animal studies — it is meaningful.

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New Technology Aims To Diagnosis Cancer From Drop of Saliva

MedicalResearch.com Interview with:

Dr. David Wong D.M.D, D.M.S.C Professor Associate Dean for Research Director for UCLA Center for Oral/Head & Neck Oncology Research (COOR) Felix and Mildred Yip Endowed Chair in Dentistry UCLA

Dr. David Wong

DrDavid Wong D.M.D, D.M.S.C
Professor
Associate Dean for Research
Director for UCLA Center for Oral/Head & Neck Oncology Research (COOR)
Felix and Mildred Yip Endowed Chair in Dentistry
UCLA

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

Dr. Wong: The EFIRM technology is an electrochemical technology developed for the optimal detection of saliva targets for molecular diagnostics.

It is a multiplexible platform (nucleic acid and proteins) that has sensitivity and specificity that comparable with PCR and luminex-based assays. It permits direct target detection in bio-samples without processing.

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CRISPR Getting Closer To Correcting Gene Defect in Duchenne Muscular Dystrophy

MedicalResearch.com Interview with:

April D. Pyle PhD Associate Professor, Microbiology, Immunology & Molecular Genetics Molecular Biology Institute Center for Duchenne Muscular Dystrophy Edythe Broad Center of Regenerative Medicine and Stem Cell Research University of California, Los Angeles, CA

Dr. April Pyle

April D. Pyle PhD
Associate Professor, Microbiology, Immunology & Molecular Genetics
Molecular Biology Institute
Center for Duchenne Muscular Dystrophy
Edythe Broad Center of Regenerative Medicine and Stem Cell Research
University of California, Los Angeles, CA

Medical Research: What is the background for this study? What are the main findings?

Dr. Pyle: We have developed a CRISPR/Cas9 gene editing platform that is applicable for approximately 60 percent of Duchenne muscular dystrophy patients. Duchenne is a devastating muscle wasting disorder affecting approximately1 in 5000 boys worldwide. It is caused by lack of the dystrophin protein. In our study, we demonstrate that we can restore the dystrophin reading frame by deleting up to 725kb of the DMD gene between exons 45 and 55, the largest deletion shown to date in this gene, which results in a functional dystrophin protein being expressed. We demonstrated feasibility of this platform in Duchenne patient-derived human induced pluripotent stem cells differentiated to skeletal and cardiac muscle cells.

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Virtual Tumor Model Allows Precision Treatment of Glioblastomas

Dr. Chirag Patil, MD American Board Certified Neurosurgeon, Brain & Spine Tumor Program Lead Investigator, Precision Medicine Initiative Against Brain Cancer Program Director, Neurosurgical Residence training program Director, Center for Neurosurgical Outcomes Research – Cedars-Sinai Medical Center, Los Angeles, California

Dr. Chirag Patil

MedicalResearch.com Interview with:
Dr. Chirag Patil, MD

American Board Certified Neurosurgeon
Brain & Spine Tumor Program
Lead Investigator, Precision Medicine Initiative Against Brain Cancer
Program Director, Neurosurgical Residence training program
Director, Center for Neurosurgical Outcomes Research Cedars-Sinai Medical Center, Los Angeles, California

MedicalResearch.com Editor’s note: Dr. Patil’s research is focused on developing a method of personalized cancer treatment through the harnessing of genome wide mutational analysis of a specific patient’s cancer.

MedicalResearch.com: Would you tell us a little about yourself and your research interests?

Dr. Patil: I am a Stanford-trained, Board Certified Neurosurgeon and cancer researcher at Cedars-Sinai Medical Center in Los Angeles, California. I primarily focus on the care of patients with malignant brain tumors, particularly glioblastomas. I received my undergraduate degree from Cornell, followed by a medical degree from the University of California, San Francisco (UCSF), where I was a Regent’s scholar. I completed a residency in neurosurgery and a fellowship in stereotactic radiology at Stanford University. I also have a master’s degree in epidemiology with a focus on clinical trial design and mathematical modeling from Stanford.

MedicalResearch.com: Can you tell us about some of your research interests?

Dr. Patil: I am keenly interested in and focused on developing precision science-powered novel brain tumor therapies, immuno-therapies, and patient-centered “big data” outcomes research. I lead the recently-funded Cedars-Sinai Precision Medicine Initiative Against Brain Cancer, which utilizes tumor genomics to build a mathematical computer model, i.e., a virtual cancer cell of each patient’s unique tumor. The White House and several other stakeholders have taken keep interest in this research initiative as an example of a leading precision medicine program.

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Strong Home Life Can Counteract Prenatal Effects of Methamphetamine

More on Pediatrics on MedicalResearch.com

MedicalResearch.com Interview with:
Lynne M. Smith, MD FAAP
LA BioMed lead researcher
Vice Chair for Academic Affairs
Professor of Clinical Pediatrics
Department of Pediatrics Division of Neonatology
Medical Director, High Risk Infant Follow-up Program
Associate Program Director, Neonatal-Perinatal Fellowship Training Program
Co-Director, Third Year Medical Student Clerkship
Founding co-Leader, Schwartz Rounds at Harbor-UCLA
David Geffen School of Medicine at UCLA Harbor-UCLA Medical Center
Torrance, CA

Medical Research: What is the background for this study? What are the main findings?

Dr. Smith: It is the first study of its kind, and it holds hope for improving outcomes for children exposed to the methamphetamine in the womb. The study found that while prenatal methamphetamine exposure can lead to targeted behavioral issues, a supportive home environment significantly decreases the severity and risk of these issues.

The study is a follow-up to the Infant Development, Environment and Lifestyle (IDEAL) study, which is a prospective, multi-center, longitudinal study of children exposed to methamphetamine in the womb. It is designed to address some of the limitations of earlier studies.

The IDEAL study enrolled children from Los Angeles; Des Moines, IA; Tulsa, OK, and Honolulu, HI, who had been exposed to methamphetamine in utero. Previous reports from the IDEAL study documented the outcomes up to age 5 and found emotional issues and attention deficit hyperactivity disorders in the children with prenatal methamphetamine exposure.

The new study surveyed 290 children enrolled in IDEAL up to age 7.5 years and found a strong relation between prenatal methamphetamine exposure and rule-breaking and aggressive behavior. It also found a strong relation between adversities in the home and rule-breaking and aggressive behavior. Among the adverse conditions considered were maternal substance abuse, extreme poverty, changes in the primary caregiver, sexual abuse of the caregiver and maternal depression.

The researchers concluded that while prenatal methamphetamine exposure is strongly related to behavioral and emotional control issues, early adversities may be a strong determinant of behavioral outcomes.

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Mental Health May Improve For Some Patients After Bariatric Surgery

Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024

Dr. Aaron Dawes

MedicalResearch.com Interview with:
Aaron J. Dawes, MD
Fellow, VA/RWJF Clinical Scholars Program
Division of Health Services Research
University of California Los Angeles
Los Angeles, CA 90024

Medical Research: What is the background for this study? What are the main findings?

Dr. Dawes: We reviewed the published literature to answer three basic questions about bariatric surgery and mental health conditions.

First, how common are mental health conditions among patients being referred for or undergoing bariatric surgery?

  • Second, do patients who carry a diagnosis of one of these conditions lose less weight after surgery than patients without these conditions?
  • And, third, what happens to the clinical course of mental health conditions after patients undergo surgery? Do they get better, worse, or stay the same?

We found that mental health conditions are surprisingly common among bariatric patients, especially depression and binge eating disorder, which occur at almost twice the rate among bariatric patients than in the general U.S. population. We also found no strong evidence to suggest that patients with depression lose less weight after surgery and some evidence that the condition may actually improve after surgery. Eleven of the twelve studies on the topic found either lower rates or fewer symptoms of depression, at least during the first 3 years post-operatively.

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Estriol Reduced Multiple Sclerosis Relapses

Professor Rhonda Voskuhl, M.D. Jack H. Skirball Chair in MS Research Director of the UCLA MS Program David Geffen School of Medicine University of California, Los Angeles

Prof. Voskuhl

MedicalResearch.com Interview with:
Professor Rhonda Voskuhl, M.D.
Jack H. Skirball Chair in MS Research
Director of the UCLA MS Program
David Geffen School of Medicine
University of California, Los Angeles

Medical Research: What is the background for this study? What are the main findings?

Dr. Voskuhl: It had been known for decades that relapses were reduced during pregnancy in women with Multiple Sclerosis (MS), psoriasis and rheumatoid arthritis. We viewed this as a major clue to help find new disease modifying treatments. Focusing on MS, we investigated treatment with estriol, an estrogen that is made by the fetus/placenta during pregnancy. Preclinical studies and a pilot clinical trial at UCLA showed good results leading to the current Phase 2 clinical trial at 16 sites across the U.S. It showed that treatment with estriol pills compared to placebo pills, each in combination with standard of care (glatirmar acetate) injections, reduced relapses by one third to one half over and above standard of care treatment.

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Surgical Treatment An Option For Patients With Recalcitrant Sleep Apnea

Dr-Soroush-Zaghi.jpg

Dr. Soroush Zaghi

MedicalResearch.com Interview with:
Soroush Zaghi, MD
Department of Head and Neck Surgery
David Geffen School of Medicine at UCLA
University of California, Los Angeles

MedicalResearch: What is the central message for clinicians and surgeons from your results?

Dr. Zaghi: Multiple studies from different practitioners and institutions agree that Maxillomandibular Advancement (MMA) is a highly effective surgical option for patients with obstructive sleep apnea who cannot tolerate positive pressure therapy and have not found success with other surgical procedures.

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Large Racial and Ethnic Gaps Exist In US For Premature Births

Edward R. B. McCabe, MD, PhD Senior Vice President and Chief Medical Officer Professor Adjunct of Pediatrics, Yale University School of Medicine Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine Inaugural Physician-in-Chief, Mattel Children's Hospital UCLA Professor Adjunct of Pediatrics, Yale School of Medicine Chief Medical Officer March of Dimes

Dr. McCabe

MedicalResearch.com Interview with:
Edward R. B. McCabe, MD, PhD
Senior Vice President and Chief Medical Officer
Professor Adjunct of Pediatrics
Yale University School of Medicine
Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine
Inaugural Physician-in-Chief, Mattel Children’s Hospital
Chief Medical Officer March of Dimes

Medical Research: What is the background for this study? What are the main findings?

Dr. McCabe: The March of Dimes Prematurity Campaign was launched in 2003. The goal of the campaign is to lower the rate of premature birth to 8.1 percent of live births by 2020 and to 5.5 percent by 2030.

Premature birth is the leading cause of death for newborns, and a major cause of childhood disabilities. Worldwide, 15 million babies are born preterm, and nearly one million die due to complications of an early birth. The U.S. preterm birth rate ranks among the worst of high-resource nations. Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays.

The US earned a “C” on the 8th annual March of Dimes Premature Birth Report Card which revealed persistent racial, ethnic and geographic disparities within states. The report card provided preterm rates and grades for each state and the largest cities. The report card showed that although some progress is being made in reducing preterm births, not all families are sharing in the success.

State specific information is available at marchofdimes.org/reportcard

Portland, Oregon has the best preterm birth rate of the top 100 cities with the most births nationwide, while Shreveport, Louisiana has the worst, according to the 2015 Report Card. The U.S. preterm birth rate was 9.6 percent in 2014. The report card shows more than 380,000 babies were born too soon last year.

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Non-Invasive MRI Demonstrates Reduced Brain Connectivity in Autism Spectrum Disorder

MedicalResearch.com Interview with:
Kay Jann, PhD, Department of Neurology

Danny JJ Wang, Prof., Department of Neurology
Laboratory of Functional MRI Technology
Ahmanson-Lovelace Brain Mapping Center
Department of Neurology
University of California Los Angeles
Los Angeles 

Medical Research: What is the background for this study? What are the main findings?

Response: The brain controls most of our behavior and thus changes in how brain areas function and communicate with each other can alter this behavior and lead to impairments associated with mental disorders. Higher cognitive functions are controlled by brain areas that form complex interconnected networks and alterations in these networks can lead to cognitive impairments. In autism, one such network is the so called default mode network. This network controls self-referential thoughts, reasoning past and future and is involved in understanding mental states of others (i.e. Theory of Mind).

Functional MRI based functional connectivity is a research tool to understand the interrelations between brain areas and how separate, distributed areas can be organized into brain networks that serve specific cognitive functions. In autism, local hyperconnectivity along with hypoconnectivity in long range connections between anterior and posterior cingulate cortices has been discussed to be one of the physiological underpinnings of the behavioral symptoms in social interaction and cognition observed in austism. It is hypothesized to be due to a developmental delay and disbalance of the balance between neuronal excitation/inhibition in brain areas that lead to oversynchronized strong short-range (local) networks while long-range connections that develop later in neurodevelopment are less well established.

In our study, we used a non-invasive MRI technique called arterial spin labeling (ASL) perfusion MRI for the first time in autism research. Similarly to Positron Emission Tomography (PET) this technique allows measuring cerebral blood flow (CBF), however without the need to inject radioactive tracers. ASL MRI uses magnetically labeled blood water as an endogenous tracer to quantify CBF. Accordingly, our approach enabled us to combine information about how brain areas are functionally connected, as well as their associated metabolic energy consumption in autism spectrum disorder. 

We found that in typically developing children, the known relation between how strongly an area is connected to other areas in a brain network, the more energy it requires holds. In children with autism spectrum disorder this relation, however, was disrupted in a major brain area (the dorsal anterior cingulate cortex) that is relevant to social interactions and in Theory of Mind. Both are cognitive processes that are to some extent impaired in persons with autism spectrum disorders.

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What Can We Learn From Small Group of Smokers Who Survive To Old Age?

Dr. Morgan Elyse Levine PhD Postdoctoral Fellow Department of Human Genetics University of California, Los Angeles
MedicalResearch.com Interview with:
Dr. Morgan Elyse Levine PhD
Postdoctoral Fellow
Department of Human Genetics
University of California, Los Angeles

Medical Research: What is the background for this study? What are the main findings?

Dr. Levine: Studies using mice, worms, and flies have suggested that longevity may be linked to stress resistance. All of us are constantly encountering things that damage our cells and tissue and disrupt physiological functioning. Therefore, people who are genetically predisposed to better prevent or repair this damage may age slower. Smoking is one of the most damaging things someone can do to their health, yet some smokers are able to survive to extreme ages. This study looked at long-lived smokers to see if we could identify a “genetic signature”. We generated a genetic risk score that was found to be associated with longevity both in smokers and non-smokers, and also appeared to be associated with cancer risk.

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Compliance With Guidelines Not Linked To Outcomes in Traumatic Brain Injury

Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research, University of California Los Angeles Los Angeles, CA 90024MedicalResearch.com Interview with:
Aaron J. Dawes, MD
Fellow, VA/RWJF Clinical Scholars Program
Division of Health Services Research, University of California Los Angeles
Los Angeles, CA 90024

Medical Research: What is the background for this study? What are the main findings?

Dr. Dawes: In the fall of 2013, we formed the Los Angeles County Trauma Consortium, building upon a prior administrative relationship between LA County’s 14 trauma centers. We added health research researchers from UCLA and USC, and shifted the focus of the group from logistical issues to quality improvement. As a first project, our hospitals wanted to know if there was any variation in how traumatic brain injury patients are cared for across the county. Traumatic brain injury accounts for over 1/3 of all injury-related deaths in the U.S. and is the number one reason for ambulance transport to a trauma center in LA County.

When we looked at the data, we found widespread variation in both how these patients were cared for at different hospitals and what happened to them as a result of that care. After adjusting for important differences in patient mix, we found that mortality rates varied by hospital from roughly 25% to 55%. As we tried to explain this variation, we looked into how often hospitals complied with two evidence-based guidelines from the Brain Trauma Foundation, hoping that we could eventually develop an intervention to boost compliance with these recommended care practices. While compliance rates varied even more widely than mortality—from 10 to 65% for intracranial pressure monitoring and 7 to 76% for craniotomy—they did not appear to be associated with risk-adjusted mortality rates. Put simply, we found no connection between how often hospitals complied with the guidelines and how likely their patients were to survive.

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Some Breast Cancer Patients Have Excellent Results With Partial Breast Radiation

Dr. Mitchell Kamrava MD Department of Radiation Oncology University of California Los Angeles Los Angeles, CAMedicalResearch.com Interview with:
Dr. Mitchell Kamrava MD
Department of Radiation Oncology
University of California Los Angeles
Los Angeles, CA

Medical Research: What is the background for this study? What are the main findings?

Dr. Kamrava: Breast conservation (lumpectomy followed by radiation) is known, based on multiple randomized trials with over 20 years of follow-up, to provided equivalent outcomes as mastectomy.  The radiation component of breast conservation has standardly been delivered to the whole breast.  Studies show that the majority of breast recurrences occur near the lumpectomy cavity causing some to ask whether it is necessary to treat the whole breast in order to reduce the risk of a recurrence.

Partial breast radiation delivers treatment just to the lumpectomy cavity with a small margin of 1-2 cm.  It’s delivered in a shorter time of 1 week compared with about 6 weeks for standard whole breast radiation and 3-4 weeks for hypofractionated whole breast radiation.

The original method developed to deliver partial breast radiation is interstitial tube and button brachytherapy.  This uses multiple small little tubes that are placed through the lumpectomy cavity to encompass the area at risk.  One end of these tubes can be connected to a high dose rate brachytherapy machine that allows a motorized cable with a very small radiation source welded to the end of it to be temporarily pushed in and out of each of the tubes so that the patient can be treated from “inside out”.  This helps concentrate the radiation to the area of the lumpectomy cavity while limiting exposure to normal tissues.  This treatment is most commonly delivered as an out-patient two times per day for a total of 10 treatments.

The main finding from our paper is that in reviewing the outcomes on over 1,000 women treated with this technique with an average follow-up of 6.9 years that the 10 year actuarial local recurrence rate was 7.6% and in women with more than 5 years of follow-up physician reported cosmetic outcomes were excellent/good in 84% of cases.

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Brain Scans May Predict Which OCD Patients Will Relapse After Cognitive-Behavioral Therapy

Jamie D. Feusner, M.D. Associate Professor of Psychiatry and Biobehavioral Sciences Director, Adult OCD Program Director, Eating Disorder and Body Dysmorphic Disorder Research Program Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, CA 90095MedicalResearch.com Interview with:
Jamie D. Feusner, M.D.
Associate Professor of Psychiatry and Biobehavioral Sciences
Director, Adult OCD Program
Director, Eating Disorder and Body Dysmorphic Disorder Research Program
Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine at UCLA
University of California, Los Angeles
Los Angeles, CA 90095

Medical Research: What is the background for this study? What are the main findings?

Dr. Feusner: Cogntive-behavioral therapy (CBT), is an effective treatment for most people OCD,with response rates between 50-70%. However, a portion of the people who respond will experience a return of their symptoms after the therapy, with 20% meeting criteria for relapse. In this study we set out to determine if brain connectivity patterns prior to treatment, derived from fMRI brain scans, can help predict worsening of symptoms after a course of intensive CBT.

We found that a pattern of “small-worldness,” which is a measure of efficiency of brain network organization, was significantly associated with worsening of OCD symptoms after 4 weeks of intensive cogntive-behavioral therapy. Those with higher network efficiency, interestingly, were the ones more likely to experience worsening. Yet almost all of the participants improved in their OCD symptoms with the treatment. So (although it remains to be further studied) one possible interpretation is that brain network reorganization may need to occur contemporaneously with symptom improvement during CBT in order to maintain the gains beyond the therapy period. Those who are already at the “ceiling” of network efficiency may not have room for this network reorganization.

Another interesting finding was that the severity of symptoms prior to treatment, and even after treatment, did not predict who would experience worsening of symptoms in the follow-up period.

Medical Research: What should clinicians and patients take away from your report?

Dr. Feusner: In addition to the finding that CBT is an effective treatment for obessive compulive disorder that results in reorganization of brain networks, this is a promising early indication that in the future we may be able to use brain scans to help predict who may do better or worse in the long run after CBT. This could potentially help improve personalization of treatment, so that we can identify which treatments (e.g. shorter or longer courses of CBT, medications, medications plus CBT, brain stimulation) could be the most likely to help an OCD sufferer, in the long run. This could reduce time, cost, and suffering otherwise associated with “trial and error” approaches to treatment for OCD.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Feusner: This is a small, preliminary study. Thus, we need to replicate the results in a larger sample of people with OCD, and with a more controlled follow-up so we can make sure that other factors are not contributing to changes in symptoms after CBT. In addition, we plan to test whether combinations of other brain factors such as neurochemistry and other connectivity patterns may be able to provide even better predictors, which could eventually be tested to determine their predictive value on the level of an individual person.

Citation:

Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive–compulsive disorder

Jamie D. Feusner,1,* Teena Moody,1 Tsz Man Lai,1 Courtney Sheen,1 Sahib Khalsa,2,3 Jesse Brown,4 Jennifer Levitt,1 Jeffry Alger,5 and Joseph O’Neill1

Front. Psychiatry, 20 May 2015
http://dx.doi.org/10.3389/fpsyt.2015.00074

 

Jamie D. Feusner, M.D. Associate Professor of Psychiatry and Biobehavioral Sciences, & Director, Adult OCD Program (2015). Brain Scans May Predict Which OCD Patients Will Improve With Cogntive-Behavioral Therapy 

Many Women Still Have Heavy Menstrual Bleeding Leading To Anemia

Anita L. Nelson, MD Professor, Department of Obstetrics and Gynecology at Harbor-UCLA Medical Center Los Angeles BioMedical Research Institute Harbor-UCLA Medical Center Torrance, California MedicalResearch.com Interview with:
Anita L. Nelson, MD
Professor, Department of Obstetrics and Gynecology at Harbor-UCLA Medical Center
Los Angeles BioMedical Research Institute
Harbor-UCLA Medical Center
Torrance, California

Medical Research: What is the background for this study? What are the main findings?

Dr. Nelson: The clinical impact heavy menstrual bleeding has often been expressed in terms of quality of life issues, but many women have heavy and prolonged bleeding that can lead to serious medical problems. The frequency with which women were treated at Harbor-UCLA Medical Center with profoundly low hemoglobin levels prompted us to do a comprehensive review of such women during a recent five year period to remind readers that even in the 21st century, this is not an uncommon problem. Overall 149 woman were treated 168 times for severe anemia (hemoglobin < 5.0 g/dL); 40% had previously been transfused (but not effectively treated). Over a quarter had reactive thrombocytosis which placed them at high risk for thrombosis (DVT, PE, and stroke). Over a third were discharged without therapy to prevent recurrence.

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