Author Interviews, Biomarkers, Endocrinology, JCEM, OBGYNE, Yale / 25.10.2018
Endometriosis: Biomarker May Allow Personalized Approach to Treatment
MedicalResearch.com Interview with:
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Dr. Flores[/caption]
Valerie A. Flores, MD
Clinical Instructor
Division of Reproductive Endocrinology & Infertility
Department of Obstetrics, Gynecology & Reproductive Sciences
Yale School of Medicine - Yale New Haven Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Endometriosis is a debilitating gynecologic disease that affects 1 in 10 reproductive-aged women, causing pain and infertility. It is a hormonally dependent disorder— estrogens promote growth of endometriosis, while progesterone inhibits estrogen-dependent proliferation. Although progestin-based therapies (including combined oral contraceptives) are first-line therapy in the management of endometriosis-associated pain, response to progestins is variable and currently unpredictable.
Dr. Flores[/caption]
Valerie A. Flores, MD
Clinical Instructor
Division of Reproductive Endocrinology & Infertility
Department of Obstetrics, Gynecology & Reproductive Sciences
Yale School of Medicine - Yale New Haven Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Endometriosis is a debilitating gynecologic disease that affects 1 in 10 reproductive-aged women, causing pain and infertility. It is a hormonally dependent disorder— estrogens promote growth of endometriosis, while progesterone inhibits estrogen-dependent proliferation. Although progestin-based therapies (including combined oral contraceptives) are first-line therapy in the management of endometriosis-associated pain, response to progestins is variable and currently unpredictable.
















Dr. James Freeman[/caption]
Dr. James V. Freeman MD
Assistant professor of cardiology and
Assistant Clinical Professor of Nursing
Internal Medicine
Yale School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Freeman: Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost-effectiveness compared to anticoagulation has not been evaluated using all available contemporary trial data.
We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost-effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of PROTECT AF and PREVAIL randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios (ICER) compared to warfarin and dabigatran were $20,486 and $23,422 per quality adjusted life year (QALY), respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 QALYs, respectively) and more costly.



Dr. Chagpar[/caption]
MedicalResearch.com Interview with:
Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FRCS(C), FACS
Associate Professor, Department of Surgery
Director, The Breast Center
Smilow Cancer Hospital at Yale-New Haven
Assistant Director -- Global Oncology
Yale Comprehensive Cancer Center
Yale University School of Medicine
Medical Research: What is the background for this study?
Dr. Chagpar: Up to 40% of women undergoing breast conserving surgery for breast cancer will have to return to the operating room due to positive margins (or cancer cells being found at the edge of what was removed at the initial surgery). We recently reported the results of a randomized controlled trial, published in the
Dr. Wang[/caption]
MedicalResearch.com Interview with:
Shiyi Wang, MD, PhD
Assistant Professor of Epidemiology (Chronic Diseases)
Yale School of Public Health
Medical Research: What is the background for this study?
Dr. Wang: As magnetic resonance imaging (MRI) of the breast has become part of medical care, there is increasing concern that this highly sensitive test might identify health problems that otherwise would not have had an impact on the patient – so called “overdiagnosis”. However, even if MRI use leads to overdiagnosis, the main “theoretical” benefit of early detection by MRI is to prevent future advanced diseases, the prognosis of which is deleterious. A systematic literature review found that, compared to mammography and/or ultrasound, MRI had a 4.1% incremental contralateral breast cancer (breast cancer in the opposite breast) detection rate. At this point, the impact of MRI on long-term contralateral breast cancer outcomes remains unclear.
Medical Research: What are the main findings?
Dr. Wang: Analyzing the Surveillance, Epidemiology, and End Results-Medicare dataset, we compared two groups of women who had breast cancer (one group receiving an MRI, and the other not) in terms of stage-specific contralateral breast cancer occurrences. We found that after five years, the MRI group had a higher detection rate of cancer in the opposite breast than the non-MRI group (7.2 % vs. 4.0%). Specifically, MRI use approximately doubles the detection rate of early stage contralateral breast cancer, but does not decrease the incidence of advanced stage contralateral breast cancer occurrences after a 5-year follow-up. Our results indicate that nearly half of additional breast cancers detected by the preoperative MRI were overdiagnosed, which means that many of these occult cancers not detected by MRI would not have become clinically evident over the subsequent 5 years. There was no evidence that MRI use was benefiting women because the rate of advanced cancer was similar in the MRI and the non-MRI groups.
Dr. David Katz[/caption]
MedicalResearch.com Interview with:
David L. Katz, MD, MPH, FACPM, FACP, FACLM
Director, Yale University Prevention Research Center
Griffin Hospital
President, American College of Lifestyle Medicine
Founder, True Health Initiative
Medical Research: What is the background for this study? What are the main findings?
Dr. Katz: the evidence that nuts in general, and walnuts in particular, have health promoting properties is vast and conclusive. In our own prior research, we have shown that daily ingestion of walnuts ameliorates overall cardiac risk in type 2 diabetics (