Dr. Elvira Gosmanova[/caption]
Elvira Gosmanova MD
Department of Nephrology
University of Tennessee Health Science Center
Memphis TN, 38163
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It has been long known that elevated blood pressure is a risk factor for numerous adverse health-related outcomes. However, the majority of individuals do not have blood pressure in a constant range.
In contrary, blood pressure measured in the same individual tends to fluctuate over time. Moreover, some individuals have more blood pressure fluctuation, as compared with others. The impact of fluctuation in blood pressure is still poorly understood. Smaller studies suggested that increased fluctuation in blood pressure may be associated with hazardous health outcomes. However, large scale studies were still lacking. Therefore, we conducted a study involving close to 3 million US veterans to investigate the association of increased visit-to-visit variability of systolic blood pressure (which was our measure of fluctuation of blood pressure over time) and all-cause mortality, and incident coronary heart disease, stroke, and end-stage renal disease.
We found that there was strong and graded increase in the risk of all the above outcomes with increasing visit-to-visit variability of systolic blood pressure.
Prof. John C. Mathers[/caption]
Prof. John C. Mathers
Director, Human Nutrition Research Centre
Institute of Cellular Medicine and
Newcastle University Institute for Ageing
Newcastle University
Biomedical Research Building
Campus for Ageing and Vitality
Newcastle on Tyne
MedicalResearch.com: What is the background for this study?
Response: More than 90 different genetics variants are associated with body fatness and, of these, the FTO gene has the biggest effect. People who are homozygous for the unusual variant of FTO i.e. carry two copies of the risk allele, are on average 3kg heavier than those not carrying the risk allele. In addition, they have 70% greater risk of being obese. Since the FTO gene is associated with being heavier, we wondered whether it made it more difficult for people to lose weight.
Dr. Anat Mirelman[/caption]
Anat Mirelman, PhD
Director- Laboratory of Early Markers of Neurodegeneration (LEMON)
Center for the study of Movement , Cognition and Mobility (CMCM)
Department of Neurology
Tel Aviv Sourasky Medical Center
Sackler School of Medicine, Tel Aviv University
Tel Aviv 64239, Israel
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The main aim of this research was to evaluate the efficacy of using a motor cognitive training using virtual reality in reducing fall frequency and fall risk in older adults.
Falls are a leading cause of morbidity and mortality in older adults. The prevalence of falls is huge, with one out of every 3 adults aged 65 years or older will fall at least once per year, with approximately half of these fallers suffering multiple falls in this period . These statistics are even higher in neurodegenerative conditions such as in Parkinson’s disease and in people with cognitive impairments. For example, studies have shown that as much as 80% of people with Parkinson’s disease fall each year. So many older adults are falling.
The consequences of falls are huge.
The most dramatic result is hip fracture. But this is relatively rare. However, even in the absence of a fracture or other injury, falls often lead to fear of falling, social isolation, and depression, which in turn often leads to inactivity, muscle weakness, impaired balance and gait, more falls, more social isolation. In other words, falls often start a vicious cycle, which has many important negative health consequences. Falls are associated with morbidity and mortality and they also have a huge economic impact. In many western countries, 1-2% of healthcare dollars are spent on falls.
For many years, age-associated changes in muscle strength, balance and gait were viewed as the key factors that contribute to the risk of falls. However, more recently, we and others showed that certain aspects of cognition are also critical to safe ambulation. For example people with AD often fall, almost to the same amount as people with PD, highlighting the cognitive component of falls. This makes sense intuitively if we Imagine the cognitive skills we need just to cross a busy intersection. These tasks require executive function, specially, planning, the ability to avoid obstacles, and the ability to perform two or more tasks at the same time.
Dr. Layal Chaker[/caption]
Layal Chaker, MD, MSc
PhD candidate
Department of Endocrinology and Epidemiology
Erasmus Medical Center
Rotterdam, The Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The association of thyroid function with coronary heart disease is well–established but not much was known about the association of thyroid function with sudden cardiac death. We conducted the study with the hypothesis that thyroid hormone levels affect cardiovascular risk factors and therefore could also affect the risk of sudden cardiac death (SCD). We were surprised to see that when we control our analyses for these cardiovascular risk factors, the association of high and high-normal thyroid function with SCD remained similar, suggesting that other pathways could play a role. Thyroid hormone has different effects on the cardiovascular systems and future studies should identify which pathway could be responsible for the increased risk of sudden cardiac death with higher thyroid hormone levels. This could lead to better assessment of individual risk and identify possible prevention targets.
Dr. Daria Van Tyne[/caption]
Dr. Daria Van Tyne, PhD
The Gilmore Lab
Department of Ophthalmology
Harvard Medical School
Massachusetts Eye and Ear Infirmary
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A specific clone of E. coli, type ST131, which produces an extended-spectrum beta-lactamase (ESBL – an enzyme that inactivates many penicillin-type antibiotics), has rapidly spread around the globe to become the leading cause of multidrug-resistant, non-intestinal E. coli infection. Despite this, E. coli is a rare cause of infection of the cornea. A patient was recently seen at the Massachusetts Eye and Ear Infirmary with a severe E. coli infection of the cornea, and the large number of antibiotic resistances of this strain tipped us off to the possibility that it might be the highly virulent ST131 ESBL type. By sequencing the DNA of its genome, we found that it was indeed ST131 ESBL E. coli. Moreover, we discovered a new mutation in this strain that allows it to produce a slimy outer coating on its surface. This slime layer, or capsule, makes the bacteria more resistant to removal by phagocytic cells of the immune system. The slime layer also makes these particular colonies appear different on a special type of agar that contains the dye Congo Red.
Dr. Holly Mattix-Kramer[/caption]
Holly Mattix-Kramer, MD, MPH
Public Health Sciences
Medicine, Nephrology
Associate Professor
Loyola Medicine, Illinois
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background is that the Systolic Blood Pressure Lowering Intervention Trial (SPRINT) showed that intensive systolic blood pressure lowering reduces all-cause mortality by 27% compared to standard blood pressure lowering among adults age 50 years and older without diabetes or stroke but with high cardiovascular disease risk. We applied these findings to the U.S. population and asked "What if intensive systolic blood pressure lowering were applied to the U.S. population who meet SPRINT eligibility criteria?
We found that approximately 18.1 million U.S. adults meet SPRINT criteria and that their annual mortality rate is 2.2%. If intensive systolic blood pressure lowering reduces all-cause mortality by 27%, then the annual mortality rate would be reduced to 1.6% and approximately 107,500 deaths would be prevented each year.
Dr. Ilana B. Richman[/caption]
Ilana B. Richman, MD
Palo Alto VA Health Care System, Palo Alto, California
Center for Primary Care and Outcomes Research/Center for Health Policy
Department of Medicine
Stanford University School of Medicine
Stanford, California
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In November of 2015, researchers published results from the Systolic Blood Pressure Intervention Trial (SPRINT). This large, NIH-funded study compared a systolic blood pressure target of 120 mm Hg vs 140 mm Hg among hypertensive, nondiabetic patients at elevated risk for cardiovascular disease. SPRINT reported a 25% reduction in the rate of cardiovascular disease and death among those treated to a lower target. Those treated to a lower target blood pressure, though, experienced certain adverse events more frequently.
Our cost effectiveness analysis asked two questions: given the potential risks and benefits described in SPRINT, does achieving a lower systolic blood pressure result in net benefit over the course of a lifetime? And if it does, how much would it cost, compared to standard treatment? We found that achieving a lower blood pressure target does result in a net benefit, with a gain of about 0.9 years of life (quality adjusted) among those treated to a lower target compared to those treated to a standard target. This gain, though, required some investment. We found that treating to a lower blood pressure target cost $23,777 per quality-adjusted life year gained. Compared to other commonly used interventions here in the US, this would be considered an excellent value.
Dr. Joseph Leigh Simpson[/caption]
Joseph Leigh Simpson, MD FACOG, FACMG
President at International Federation of Fertility Societies
March of Dimes Foundation
White Plains, NY
MedicalResearch.com: What is the background for this study?
Response: Preterm birth (PTB) is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. A total of 1.1 million infants die each year. Preterm births and their complications are the leading cause of deaths in children under age 5.
The biological basis of preterm birth remains poorly understood, and for that reason, preventive interventions are often empiric and have only limited benefit. Large differences exist in preterm birth rates across high income countries: 5.5 percent in Sweden and at present 9.6 percent in the U.S. The International Federation of Gynecologists and Obstetricians (FIGO)/March of Dimes Working Group on Preterm Birth Prevention hypothesized that identifying the risk factors underlying these wide variations could lead to interventions that reduce preterm birth in countries having high rates.
Dr. Kevin LaBar[/caption]
Kevin S. LaBar, Ph.D.
Professor and Head, Cognition & Cognitive Neuroscience Program
Co-Director of Undergraduate Studies in Neuroscience
Center for Cognitive Neuroscience
Duke University
Durham, NC
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Emotion research is limited by a lack of objective markers of emotional states. Most human research relies on self-report, but individuals may not have good insight into their own emotions. We have developed a new way to identify emotional states using brain imaging and machine learning tools. First, we induced emotional states using film and music clips while individuals were in an MRI scanner. We trained a computer algorithm to identify the brain areas that distinguished 7 emotions from each other (fear, anger, surprise, sadness, amusement, contentment, and a neutral state). This procedure created a brain map for each of the 7 emotions. Then, a new group of participants self-reported their emotional state every 30 seconds in an MRI scanner while no stimuli were presented. We could predict which emotion was spontaneously reported by the subjects by comparing their brain scans to each of the 7 emotion maps. Finally, in a large group of 499 subjects, we found that the presence of the fear map during rest predicted state and trait anxiety while the presence of the sadness map predicted state and trait depression.
Prof. Jenny Donovan[/caption]
Professor Jenny Donovan PhD
OBE FMedSci NIHR-SI AcSS FFPHM
Director, NIHR CLAHRC West
(National Institute for Health Research Collaboration for
Leadership in Applied Health Research and Care West)
at University Hospitals Bristol NHS Trust
Bristol, UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: PSA testing identifies many men with prostate cancer, but they do not all benefit from treatment. Surgery, radiation therapy and various programs of active monitoring/surveillance can be given as treatments for fit men with clinically localized prostate cancer. Previous studies have not compared the most commonly used treatments in terms of mortality, disease progression and patient-reported outcomes. In the ProtecT study, we used a comprehensive set of validated measures, completed by the men at baseline (before diagnosis), at six and 12 months and then annually for six years.
The main finding is that each treatment has a particular pattern of side-effects and recovery which needs to be balanced against the findings from the paper reporting the clinical outcomes (Hamdy et al).
Dr. Gillian D. Sanders-Schmidler[/caption]
Gillian D. Sanders-Schmidler Ph.D.
Professor of Medicine
Duke Evidence Synthesis Group, Director
Duke Evidence-based Practice Center, Director
Duke Clinical Research Institute
Duke University
MedicalResearch.com: What is the background for this study?
Response: In 1996, the original panel on cost effectiveness in health and medicine published recommendations for the use of cost effectiveness analysis. During the 20 years since the original panel’s report, the field of cost-effectiveness analysis has advanced in important ways and the need to deliver health care efficiently has only grown. In 2012 the Second Panel on Cost Effectiveness in health and Medicine was formed with a goal of reviewing and updating the recommendations.
This paper summarizes those recommendations. This process provided an opportunity for the Panel to reflect on the evolution of cost-effectiveness analysis and to provide guidance for the next generation of practitioners and consumers.
Dr. Larissa Meyer[/caption]
Larissa A. Meyer, MD MPH F.A.C.O.G.
Assistant Professor
Dept of Gynecologic Oncology and Reproductive Medicine
Houston, TX 77030-1362
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Despite the completion of two randomized controlled trials, controversy regarding the optimal approach for the treatment of advanced ovarian cancer remains. Our observational study highlights the importance of thoughtful selection of individuals for primary cytoreductive surgery for advanced ovarian cancer. Our results suggest that primary cytoreductive surgery may improve survival for patients with stage IIIC ovarian cancer who are likely to achieve an optimal cytoreduction, while neoadjuvant chemotherapy may be the preferred option for many women with stage IV ovarian cancer.
Dr. Pooja Rao[/caption]
Pooja Rao, MD, MSCE
Assistant Professor
Division of Pediatric Hematology/Oncology
Milton S. Hershey Medical Center
Penn State College of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although many chemotherapy drugs can cause birth defects, no standardized guidelines exist for pregnancy screening in adolescent female patients with cancer. Additionally, little is known about how often they are screened prior to receiving treatment.
Our study found that adolescent girls are not adequately screened for pregnancy prior to receiving chemotherapy or CT scans that could potentially harm a developing fetus. Adolescents with acute lymphoblastic leukemia, the most common childhood cancer, had the lowest pregnancy screening rates of the patients studied.
Prof. Xavier Jouven[/caption]
Prof. Xavier Jouven
Service de Cardiologie
Hôpital Européen Georges Pompidou
Paris
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are many cardiac arrests (around 300 000 per year in United States). The possibility to collect organs from a certain proportion of those cardiac arrests represents an important opportunity to fill the gap of the organ shortage.
It is absolutely mandatory to identify patients with no chance of survival. This study showed 3 criteria which allow this early identification. Several thousands of patients die every year waiting for organ transplantation.
Dr. R. Grant Steen[/caption]
R. Grant Steen, PhD
Medical Affairs,
Bioventus LLC
Durham, North Carolina
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: When we started this research, it was really only guesswork as to how big a problem fracture nonunion really is. What we've done is to work with an enormous database of patient health claims, with two goals.
First, we wanted to characterize how common fracture nonunion is among patients across a wide age range.
Second, we wanted to identify risk factors that make a patient more likely to have problems healing.
We've now succeeded in both aims. We know that roughly 5% of fracture patients will go to nonunion, and we know a whole host of risk factors that predispose them to do so.
Most of the risk factors that we've identified—with a few exceptions—would not be a surprise to physicians who treat fracture patients. However, what we've done is to put all of these risk factors in a broader context, so that we know which risk factors are most important and which are less so.
For example, it has been known for a long time that smoking is a risk factor for nonunion. What we've shown is that, in the scheme of things, it's not all that important. Let me be more precise here, because this is an important point. If all you know about a patient is that they smoke, we've shown that smoking is associated with a 62% increase in risk of nonunion. That's a lot. But, as you learn more about that patient and can factor that new knowledge into a risk prediction, it turns out that smoking, all by itself, increases the risk of nonunion by only about 20%. However, smoking is a surrogate marker for a range of other risk factors that also increase risk, including male gender, cardiovascular disease, obesity, vitamin D deficiency, alcoholism, and so on. Once you factor these separate risk factors into your new nonunion prediction, you have a much more nuanced—and probably much more accurate—prediction of nonunion risk.
Dr. del Río Hernández[/caption]
Armando E. del Río Hernández, PhD
European Research Council Fellow
Head, Cellular and Molecular Biomechanics Laboratory
http://biomechanicalregulation-lab.org/
Senior Lecturer, Department of Bioengineering
Imperial College London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Pancreatic cancer is an extremely aggressive disease with an unacceptably low survival rate that has not changed during the last 40 years despite significant efforts aimed at developing therapies against cancer cells.
Pancreatic cancer is characterised by an extensive desmoplasia, which forms the majority of the tissue around the tumour. This desmoplastic tissue is known to help the tumour to grow and metastasize, and hinders drug delivery.
We have focused our efforts on understanding how pancreatic stellate cells (PSCs), which are the key effectors that orchestrate the desmoplastic reaction in pancreatic cancer, can promote tumour progression. PSCs in healthy pancreas have abundant vitamin A storage in their cytoplasm and exist in a quiescent state that guarantees a balanced tissue homeostasis. In pancreatic cancer, loss of this balance activates PSCs, which lose the vitamin A content and remodel the surrounding tissue to make it favourable for cancer cell invasion.
We found that treating PSCs which ATRA (All trans-retinoic acid), the active metabolite of vitamin A mechanically reprograms PSCs to promote quiescence in vitro. Quiescent PSCs are unable to remodel the microenvironment to allow pancreatic cancer cell invasion.
To get more information about our findings please find the article in the open access journal Nature Communications:http://www.nature.com/articles/ncomms12630
Dr. Patricia Ducy[/caption]
Patricia Ducy, PhD
Associate Professor
Department of Pathology & Cell Biology
Columbia University
New York, NY 10032
MedicalResearch.com: What is the background for this study?
Response: In the past few years, several large clinical studies have reported an association between the use of selective serotonin reuptake inhibitors (SSRIs) and an increased risk of bone fractures. Yet, a few studies conducted on small cohorts using these drugs for a short time showed a decrease in bone resorption parameters and thus minor bone gain.
To understand this paradox and to define how the deleterious effect of SSRIs could be prevented we conducted a series of studies in mice treated with fluoxetine, the active molecule of the widely prescribed SSRI Prozac.
Dr. Andrew Eppstein[/caption]
Andrew C. Eppstein, MD, FACS
Assistant Professor of Clinical Surgery
Indiana University School of Medicine
Department of Surgery, Division of General Surgery
Richard L. Roudebush VA Medical Center
Indianapolis, Indiana
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A few years ago we encountered long wait times for patients undergoing elective general surgery in our tertiary care VA medical center. Demand had grown and our existing systems were not able to accommodate surgical patients in a timely fashion. By fiscal year (FY) 2012, our wait times averaged 33 days, though patients with malignancies would be moved to the head of the line, pushing more elective cases further back.
To address rising demand and worsening wait times, our Surgery Service convened an analysis of our processes using Lean methodology in collaboration with the Systems Redesign Service. Multidisciplinary meetings were held in 2013 to analyze inefficiencies in the current system and ways to address them to create a streamlined, ideal system. The collaborations included surgeons, nurses, ancillary staff, operating room and sterile processing staff, and hospital administration. Projects were rolled out stepwise in mid-2013 under General Surgery, the busiest surgical service at our institution.
We noted a sharp decline in patient wait times after initiation of reforms such as improved OR flexibility, scheduling process changes, standardization of work within the department, and improved communication practices. These wait times dropped to 26 days in FY 2013 and further to 12 days in FY 2014, while operating volume and overall outpatient evaluations increased, with decreased no-shows to clinic. Our decreased wait times were sustained through the remainder of the observed period.
Dr. Conny Vrieling[/caption]
Conny Vrieling, M.D., Ph.D.
Radiation Oncologist
Clinique des Grangettes
Geneva
MedicalResearch.com: What is the background for this study?
Response: In the early ’90s, the EORTC (European Organisation for Research and Treatment of Cancer) ran the “boost no-boost” trial, randomizing 5569 early-stage breast cancer patients, treated with breast-conserving surgery and whole-breast irradiation, between no boost and a 16-Gy boost. A third of the patients were included in a central pathology review. The 10-year follow-up results of this subpopulation showed that young age and high-grade invasive carcinoma were the most important risk factors for ipsilateral breast tumor recurrence (IBTR).
In this study, we re-analyzed with long-term follow-up the pathological prognostic factors related to IBTR, with a special focus on the evolution of these effects over time.
Dr. Francisco Garcia[/caption]
Dr. Francisco García M.D. M.P.H.
Task Force member and
Director and Chief medical officer at
Pima County Department of Health
Tucson, AZ
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Tuberculosis infection is one of the most common infectious diseases in the world.
Although less common in the United States, many people still become infected every year and are at risk of getting sick and spreading the infection to others. We know there are effective screening tests that can detect latent tuberculosis infection before people become sick with active tuberculosis disease. Additionally, there are effective treatments to prevent people from progressing from latent tuberculosis infection to active tuberculosis disease.
Thus, for people with increased risk of contracting tuberculosis, the Task Force recommends screening for latent tuberculosis infection.
People who are considered at increased risk include those who were born in or have lived in countries where tuberculosis is highly prevalent, or who have lived in congregate settings where exposure to tuberculosis is more likely, such as homeless shelters or correctional facilities.