Mutliple Sclerosis: Ocrelizumab Lowers Rate of Disease Progression and Disability

MedicalResearch.com Interview with:

Jerry S. Wolinsky, MD Emeritus Professor in Neurology McGovern Medical School part of UTHealth | The University of Texas Health Science Center at Houston Houston’s Health University Department of Neurology Houston, Texas 77030

Dr. Jerry Wolinsky,

Jerry S. Wolinsky, MD
Emeritus Professor in Neurology
McGovern Medical School
The University of Texas Health Science Center at Houston
Houston’s Health University
Department of Neurology
Houston, Texas 77030

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

Response: Multiple sclerosis (MS) clinically is a very heterogeneous disease. It presents in considerably different ways and has a very poorly predictable clinical course. In an attempt to better communicate between experts in the field, there have been multiple attempts to categorize “typical” courses of the disease. How we think about the disease is in part driven by these somewhat artificial categories that lump our patients into those with relapsing forms of the disease (relapsing remitting with or without accumulating clinical disability, and secondary progressive with accumulating disability eventually occurring even in the absence of apparent clinical episodes of the disease), and primary progressive MS, where patients are slowly or sometimes rather rapidly accumulating disability in the absence of prior clinical relapses.

However, the distinctions between multiple sclerosis patients are not always as clear as the definitions would suggest, and it is certain that patients with primary progressive multiple sclerosis sometimes have clinical relapses after years of never having had relapses, and show MRI evidence of having accumulated many lesions in the brain over the course of their disease. Until now, none of the drugs that have shown benefit for relapsing disease have been able to convincingly show clinical benefit for patients with primary progressive disease, and for that matter have shown variable results when attempted in patients categorized as having secondary progressive courses. While some of our currently approved drugs have shown hints of benefit when tried in major clinical trials in primary progressive MS, the results were not been robust enough to seek regulatory approval.

The Oratorio study design was based on lessons learned from prior trials in primary progressive and relapsing forms of MS, as well as the recognition that B cells might play an important role in the immunopathogenesis of disease based on a considerable amount of preclinical work and observations in patients with multiple sclerosis.

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Can Low Dose Oral Nicotine Have Beneficial Health Effects?

MedicalResearch.com Interview with:

U. H. Winzer-Serhan Ph.D. Associate Professor Department of Neuroscience and Experimental Therapeutics Texas A&M Health Science Center

Dr. Ursula H. Winzer-Serhan

Ursala. H. Winzer-Serhan Ph.D.
Associate Professor
Department of Neuroscience and Experimental Therapeutics
Texas A&M Health Science Center

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

Response: Nicotine is a plant alkaloid that is naturally occurring in the tobacco plant. Smoking delivers nicotine to the brain where it acts as a stimulant. Tobacco and electronic cigarette smoking delivers many other chemicals to the body, which are harmful and can cause cancer.

However, the drug nicotine by itself is relatively benign and poses few health risks for most people. Nicotine acts in the brain on nicotinic receptors, which are ion channels that are widely expressed in the brain. They play an important role in cognitive functions. Research with rodents and in humans has shown that nicotine can enhance learning and memory, and furthermore, can protect neurons during injuries and in the aging brain. With the increasingly older population, it becomes more and more important to delay cognitive decline in the elderly. Right now, there is no drug available that could delay aging of the brain.

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Almost 5 Million Unnecessary Pap Smears Done Annually In Women With Hysterectomy

MedicalResearch.com Interview with:

Fangjian Guo, MD, PhD Assistant Professor BIRCWH Scholar Department of Obstetrics & Gynecology Center for Interdisciplinary Research in Women’s Health The University of Texas Medical Branch

Dr. Fangjian Guo

Fangjian Guo, MD, PhD
Assistant Professor
BIRCWH Scholar
Department of Obstetrics & Gynecology
Center for Interdisciplinary Research in Women’s Health
The University of Texas Medical Branch

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

Response: National guidelines consistently recommend against cervical cancer screening among women with a history of a total hysterectomy for a benign condition. These women are unlikely to develop high-grade cervical lesions. The goal of our study was to assess whether these guidelines are being followed. We examined the use of Pap testing among US adult women with a history of total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of Pap test use.

We found that in 2013, 32% of women who have had a hysterectomy received an unnecessary recommendation for cervical cancer screening from a health care provider in the past year; 22.1% of women with hysterectomy received unnecessary Pap testing. Although the majority of Pap tests were performed at a clinician’s recommendation, approximately one fourth were initiated by patients without clinician recommendations. According to standard 2010 US Census population figures, about 4.9 million unnecessary Pap tests are performed annually among women who have had a total hysterectomy for a benign condition. At approximately $30 per test, $150 million in direct medical costs could be saved annually if screening guidelines were followed for these women.

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Statin Users Have Lower Incidence of Uterine Fibroids

MedicalResearch.com Interview with:

Mostafa Borahay, MD, PhD, FACOG Assistant Professor Department of Obstetrics and Gynecology Galveston, TX

Dr. Mostafa Borahay

Mostafa Borahay, MD, PhD, FACOG
Assistant Professor
Department of Obstetrics and Gynecology
Galveston, TX

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

Response: Uterine fibroids are the commonest tumors of the female reproductive system. More than 50% of women are estimated to have uterine fibroids. In fact, 1 out of 4 women undergo a hysterectomy in the United States and half of these hysterectomies are due to fibroids.
Recently we demonstrated that statins, drugs used to fight high cholesterol, have anti-tumor effects on uterine fibroids as shown in cells and animal models.

In this current study, we examined the incidence of uterine fibroids and fibroid-associated symptoms in women taking statins for high cholesterol. We performed this using large national patient database.
We found that compared to non-users, statin users have lower incidence of uterine fibroids. Furthermore, they have less heavy bleeding, pelvic pain and other fibroid-associated symptoms. Also, they needed less surgeries to remove tumors (myomectomy).

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

Response: Currently, we don’t have a successful, safe long term medical treatment for uterine fibroids. Surgeries, typically a hysterectomy, is commonly performed for fibroids. This study provide some evidence that a safe long term medical treatment can be available for treating these tumors. This provides hope for many women, especially those interested in preserving their childbearing potential.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: After finding strong evidence from cellular and animal experiments and using patient databases, our next step is clinical trials. We plan to start a clinical trial for statins in women with fibroids in the near future. The established safety of statins represents a huge advantage.

MedicalResearch.com: Is there anything else you would like to add?

Response: The successful work over the last few years stresses the huge benefits from and the critical need for a multidisciplinary teams in medical research. Our team included clinicians, basic scientists and biostatisticians and epidemiologists.

Also, there is a need for more funding for medical research. Scientific research to discover innovative treatments requires funding and therefore the National Institutes of Health (NIH) and other funding bodies have a large responsibility to fulfil.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Am J Obstet Gynecol. 2016 Jun 28. pii: S0002-9378(16)30381-7. doi: 10.1016/j.ajog.2016.06.036. [Epub ahead of print]
Statin Use and Uterine Fibroid Risk in Hyperlipidemia Patients: A Nested Case-Control Study.
Borahay MA1, Fang X2, Baillargeon JG2, Kilic GS3, Boehning DF4, Kuo YF2.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Could Methylene Blue Improve Memory in Patients With Cognitive Impairment?

MedicalResearch.com Interview with:

Timothy Q. Duong, Ph.D Stanley I. Glickman MD Professor of Ophthalmology, Radiology, and Physiology South Texas Veterans Health Care System, VA Southwest National Primate Research Center University of Texas Health Science Center San Antonio, Texas

Dr. Timothy Duong

Timothy Q. Duong, Ph.D
Stanley I. Glickman MD Professor of Ophthalmology, Radiology, and Physiology
South Texas Veterans Health Care System, VA Southwest National Primate Research Center
University of Texas Health Science Center
San Antonio, Texas

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

Response: A single oral dose of methylene blue increased fMRI response in the bilateral insular cortex during a task that measured reaction time to a visual stimulus. The fMRI results also showed an increased response during short-term memory tasks involving the brain’s prefrontal cortex, which controls processing of memories. Methylene blue was also associated with a 7 percent increase in correct responses during memory retrieval. The findings suggest that methylene blue can regulate certain brain networks related to sustained attention and short-term memory after a single oral low dose.

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Requests for Abortions in South American Rise Dramatically Since Zika, Especially in Brazil

MedicalResearch.com Interview with:

Abigail R.A. Aiken, MD, MPH, PhD Assistant Professor LBJ School of Public Affairs University of Texas at Austin Austin, TX, 78713

Dr. Abigail Aiken

Abigail R.A. Aiken, MD, MPH, PhD
Assistant Professor
LBJ School of Public Affairs
University of Texas at Austin
Austin, TX, 78713

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

Response: As Zika began to emerge as an epidemic in Latin America and its links with microcephaly began to be realized, we were aware that women in the region who were already pregnant or who would become pregnant would have a very limited set of reproductive options. Research and media attention about the possible biological effects of Zika in pregnancy began to appear rapidly. But much less attention was been paid to the impacts of Zika on women. We followed the responses of governments and health organizations and when they began to issue advisories warning women to avoid pregnancy, we knew it would be important to investigate the impacts of those advisories. A country-wide policy that is impossible to follow if you are pregnant or cannot avoid pregnancy is an unusual and important public issue. Accurate data on abortion are very difficult to obtain in Latin America because in most countries, abortion is highly restricted. We wanted to provide a window on the issue of how women were responding to the risks of Zika and its associated advisories, so we worked with Women on Web (WoW), an online non-profit telemedicine initiative that provides safe medical abortion to women in countries where safe, legal abortion is not universally available.

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Fixing An Evolutionary Omission: Adding Proof-Reading to Reverse

MedicalResearch.com Interview with:

Jared Ellefson, PhD Postdoctoral fellow University of Texas Austin's Center for Systems and Synthetic Biology

Dr. Jared Ellefson

Jared Ellefson, PhD
Postdoctoral fellow
University of Texas Austin’s Center for Systems and Synthetic Biology

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

Response: Reverse transcriptases (RT) have revolutionized the field of biology – enabling the conversion of RNA into DNA. This initially allowed the cloning of mature messenger RNA into cDNA libraries (e.g. cloning human genes), but has since been finding a more modern role in high throughput RNA-seq which can accurately depict the physiological status of a cell. Despite its critical role, an inherent flaw exists in all known reverse transcriptases. They make many errors while copying RNA – due to the lack of an error-checking (proofreading) domain. Consequently, the errors produced in reverse transcription are propagated into RNA sequencing potentially leading to corrupted data.

The reason for the low fidelity of reverse transcriptases is due to their evolutionary heritage. All RTs are evolved from polymerase enzymes which lack the proofreading domain. This is in stark contrast to certain DNA polymerases which have extreme fidelity. The idea was, what if you could take a high fidelity DNA polymerase and transform it into a high fidelity RT. To do this we developed directed evolution techniques that would enrich these DNA polymerases for reverse transcriptase activity. After a monumental engineering effort, we were left with the world’s first reverse transcriptase that could error-check during polymerization. We found that this increased the fidelity of RNA sequencing, in addition to a number of other interesting properties (for instance this single enzyme can do both reverse transcription and PCR).

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Fat Cells Signal Cancer to Become More Aggressive

MedicalResearch.com Interview with:

Mikhail Kolonin, PhD, Associate Professor Director, Center for Metabolic and Degenerative Diseases Harry E. Bovay, Jr. Distinguished University Chair in Metabolic Disease Research The Brown Foundation Institute of Molecular Medicine University of Texas Health Science Center at Houston Houston, TX 77030

Dr. Mikhail Kolonin

Mikhail Kolonin, PhD, Associate Professor
Director, Center for Metabolic and Degenerative Diseases
Harry E. Bovay, Jr. Distinguished University Chair in Metabolic Disease Research
The Brown Foundation Institute of Molecular Medicine
University of Texas Health Science Center at Houston
Houston, TX 77030

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

Response: Epidemiology studies have indicated that in obese patients progression of prostate, breast, colorectal, and other cancers is more aggressive. Adipose (fat) tissue, expanding and undergoing inflammation in obesity, directly fuels tumor growth. Adipose tissue is composed by adipocytes and stromal/vascular cells, which secrete tumor-trophic factors. Previous studies by our group have demonstrated that adipose stromal cells, which support blood vessels and serve as adipocyte progenitors, are recruited by tumors and contribute to cancer progression. Mechanisms underlying stromal cell trafficking from fat tissue to tumors have remained obscure. We discovered that in obesity a chemokine CXCL1, expressed by cancer cells, attracts adipose stromal cells to tumors.

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Weight Loss Improves Quality of Life But Not Atrial Fibrillation Ablation Outcomes

MedicalResearch.com Interview with:
Sanghamitra Mohanty, MD MS FHRS

Director, translational research, Texas Cardiac Arrhythmia Institute and Associate Professor (affiliate) Dell Medical School

What is the background for this study? What are the main findings?

Dr. Mohanty:  In the last few years, several trials from a research group in Australia have generated tremendous interest in life-style modifications to manage AF more effectively. These studies reported significant decrease in arrhythmia burden and symptom severity and improvement in ablation outcome in patients with paroxysmal and persistent atrial fibrillation. We investigated the impact of weight-loss on procedure outcome in terms of arrhythmia burden, quality of life and arrhythmia-free survival in long-standing persistent (LSPAF) patients undergoing catheter ablation.

Our main findings were the following;

  1. In patients with long-standing persistent atrial fibrillation, weight loss improved quality of life but had no impact on symptom burden and long-term ablation outcome
  2. No change in AF type or status was detected after the weight loss
  3. Extensive ablation including pulmonary vein (PV) isolation plus ablation of posterior wall and non-PV triggers resulted in comparable outcome in both groups at 1-year follow-up, irrespective of weight-loss interventions (63.8% vs 59.3%, p=0.68).

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Poor Outcomes with FIRM-ablation Alone in Non-Paroxysmal Atrial Fibrillation

MedicalResearch.com Interview with:
Sanghamitra Mohanty, MD MS FHRS
Director, translational research, Texas Cardiac Arrhythmia Institute and Associate Professor (affiliate) Dell Medical School

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

Dr. Mohanty: In patients with atrial fibrillation, Focal Impulse and Rotor Modulation (FIRM)-ablation alone or in combination with pulmonary vein (PV) isolation has been documented to possibly be a better alternative to PV isolation only. However, none of those trials had a randomized study design. The current study was the first attempt to compare 3 ablation strategies namely FIRM ablation alone (group 1), FIRM +PV isolation (group 2) and PV isolation combined with ablation of non-PV triggers (group 3) in a randomized controlled trial in persistent and long-standing persistent AF.

MedicalResearch.com: What are the main findings?

Dr. Mohanty: Our main findings were the following:

1)      Procedure time was significantly shorter in group 3 (no FIRM ablation) compared to group 1 and 2 (with FIRM ablation)

2)      FIRM-ablation alone had very poor outcome in terms of arrhythmia recurrence (86%)

3)      FIRM ablation plus PV isolation had significantly longer procedure time and lower efficacy than PV isolation + non-PV trigger-ablation (52.4% vs 76%, p=0.02).

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High Fructose Diet During Pregnancy Predisposes Children to Obesity

MedicalResearch.com Interview with:

Antonio Saad, MD Fellow in Maternal Fetal Medicine University of Texas Medical Branch at Galveston.

Dr. Antonio Saad

Antonio Saad, MD
Fellow in Maternal Fetal Medicine & Critical Care Medicine
University of Texas Medical Branch at Galveston

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

Dr. Saad: Recently the WHO announced an alarming news, the prevalence of diabetes has increased four fold in the past quarter-century. The major factors attributed for this increase included excessive weight, and obesity. In the US alone, two thirds of people are either overweight or obese. There are shocking numbers that should alert physicians, patients and government officials for awareness and interventions that we can alter the path away from this drastic epidemic.

In light of recent events, our group strongly believes that poor diet during pregnancy predisposes offspring in adult life to develop obesity and diabetes through fetal programming. High fructose introduction into our food chain has coincided with the obesity and diabetes epidemics. Hence, we designed an animal study where we fed pregnant mice with either regular diet or high fructose diet until delivery. Then we looked at the offspring, at 12 months of age. We looked at  their blood pressure, glucose tolerance tests, insulin resistance,  and weights. We also tested for serum marker of metabolic dysfunction and used computed tomography imaging to assess for liver fat infiltration and percent visceral adipose tissue. To our surprise, these offspring (mothers were fed high fructose diet) developed several features of metabolic syndrome.  Female offspring’s cardiovascular and metabolic function at one year of age (adulthood) had increased weight, blood pressure, visceral adiposity, liver fat infiltrates and  insulin resistance with impaired glucose tolerance).  The  male counterparts were limited to high blood pressure  and glucose intolerance. Keeping in mind that the amount of fructose given to these animals were equivalent to daily soda cans consumption in humans.

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Epidemic of Burnout Among Physicians, Especially Surgeons, Is Increasing

MedicalResearch.com Interview with:

Francesca M Dimou, MD Research Fellow University of Texas Medical Branch Galveston, TX

Dr. Francesca Dimou

Francesca M Dimou, MD
Research Fellow University of Texas Medical Branch
Galveston, TX

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

Dr. Dimou: Burnout is a syndrome defined by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. Over the past decade the problem of physician and surgeon burnout has come to the forefront. The demands on physicians at academic healthcare institutions are expanding rapidly and include increasing regulation, increased demands on clinical productivity, difficulty funding research efforts, medicolegal liability, inefficient systems, loss of autonomy, rising student debt, and difficulty balancing professional and personal lives. This challenges the wellbeing of everyone in the organization, including the physicians and the patients they treat.

MedicalResearch.com: What are the main findings?

Dr. Dimou: Our systematic review identified a significant number of studies reporting on surgeon burnout with rates exceeding 50% in some surgical specialties. Even more striking, is that the incidence of burnout among surgeons is increasing steadily and the consequences of burnout impact all aspects of their professional and personal lives. Review of the literature demonstrates that surgeons meeting criteria for burnout had an increased probability of committing and reporting medical errors, increased depression, and increased suicidal ideation. Most importantly, despite the strong data highlighting that magnitude, acuity, and consequences of the burnout problem, we could not find definitive, reproducible intervention programs for surgeons dealing with burnout, nor could we identify prevention programs.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Dimou:    The epidemic of burnout among physicians, and surgeons in particular is increasing. The unique surgical culture adds additional challenges. Surgeons are perfectly capable of “running on empty”, continuing to see patients and meet other expectations long after they are completely drained and exhausted. In fact, their ability to do this is a core component of their medical education and training. The surgical environment is one that discourages “weakness”; it is an environment that teaches surgeons to feel guilty if they take care of themselves. There are many system and culture issues in surgery and medicine that need to be addressed. The article highlights the need to design interventions to both help physicians who are already burned out as well as develop interventions to improve physician wellbeing at the individual level while working to make needed changes in the system as a whole.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Dimou:    Research has already significantly raised awareness around burnout and its consequences. The next step is to identify intervention and prevention programs for physicians to promote physician wellbeing and resiliency – teaching surgeons to respond to their stressful environment in a way that promotes their wellbeing. Several programs throughout the country are beginning to promote physician wellbeing, such as the Balance in Life Program at Stanford and the Physician Well-being Program at Mayo Clinic. Such programs need to be designed and studied systematically to identify effective, reproducible, and scalable interventions to allow for widespread adoptability.

MedicalResearch.com: Is there anything else you would like to add?

Dr. Dimou:    A career in surgery can be an unparalleled privilege. Being a surgeon truly gives you the ability to change someone’s life and a surgical career will always require time, hard work, and sacrifices; we teach surgeons to operate and teach them to take care of patients, but we don’t teach them to respond to their environment effectively. The ramifications of continuing on the current path are potentially profound. If we do not change the system and create a surgical culture that promotes wellbeing we are at the risk of losing not only our current surgeon workforce, but also the best and brightest of the next generation. Systematic efforts to improve physician wellbeing at the individual level and change surgical culture to support this change are essential. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Surgeon Burnout: A Systematic Review
Dimou, Francesca M. et al.
Journal of the American College of Surgeons , Volume 0 , Issue 0 ,
Published Online:March 25, 2016

DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2016.03.022

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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