Dr. Kirsten Herrick[/caption]
Dr. Kirsten Herrick Ph.D.
Division of Health and Nutrition Examination Surveys
National Center for Health Statistics
Centers for Disease Control and Prevention
Hyattsville, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The benefits of breastfeeding are well established: for children, it offers protection against infections and increases in intelligence; for nursing women, it protects against breast cancer and improves birth spacing. But there is no nationally representative information about whether there are differences in breastfeeding by birth weight (BW).
Using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014, we estimated the proportion of infants ever breastfed (initiated), and those reporting any breastfeeding at 1 month, 4 months, and 6 months by birth weight categories and birth year cohorts. Our sample size was 13,859.
Dr. Venkatesh Murthy[/caption]
Venkatesh Locharla Murthy MD,
PhD, FACC, FASNC
Assistant Professor, Internal Medicine
Frankel Cardiovascular Center
University of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Technetium-99m, which is very commonly used for cardiac stress testing, has had multiple supply disruptions due to aging nuclear reactors where it is produced coupled with changing regulations to minimize the risk of nuclear proliferation. The most severe of these disruptions occurred over six months in 2010.
We asked whether this disruption lead to changes in patterns of care among Medicare beneficiaries. We found that during this time, use of technetium-99m in nuclear stress testing fell from 64% to 49%, reflecting a shift towards thallium-201, which has higher radiation exposure and lower diagnostic specificity. This was reflected in a 9% increase in the rate of cardiac catheterization after a nuclear stress test during the study period, implying nearly 6,000 additional, possibly unnecessary, catheterizations during that time.
Dr. Aditya Bardia[/caption]
Aditya Bardia, MD, MPH
Massachusetts General Hospital Cancer Center
Harvard Medical School
Boston, MA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: While endocrine therapy is the recommended therapy for Estrogen Receptor positive (ER+) breast cancer, the role of endocrine therapy in neoadjuvant (pre-surgical) setting is unclear. We performed this systematic review and meta-analysis to comprehensively evaluate the efficacy of neoadjuvant endocrine therapy, both alone and in combination with other therapies, compared to neoadjuvant chemotherapy for localized ER+ breast cancer. We found no statistically significant differences between the two treatments in regards to clinical response, imaging response, rates of breast conservation therapy, and achievement of pathologic complete response.
Dr. Femke Rutters[/caption]
Dr. Femke Rutters
Department of Epidemiology and Biostatistics
Vrije Universiteit Medical Centre
Amsterdam, The Netherlands;
EMGO+ Institute for Care Research
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In the past 10 years the interest in sleep as a possible cause for obesity/diabetes has risen. But data up until now used mainly self-reported sleep and simple measures of diabetes (related parameters), such as fasting glucose. A study on well-measured insulin sensitivity and beta-cell function was lacking. Such a study could provide more information on the pathophysiology.
Mangalam~Ashu[/caption]
Ashutosh K Mangalam PhD
Assistant Professor
Department of Pathology
University of Iowa
Iowa City, IA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Every human carries trillions of bacteria in their gut (gut microbiome) and recent advances in research indicate that these tiny passengers play an important role in our overall health maintenance. Having evolved over the time span of millions of years with the gut microbiome, they keep us healthy in multiple ways such as fermentation and absorption of undigested carbohydrates, synthesis of some vitamins, metabolism of bile acids etc.
However, new research suggests that gut microbiome, also regulating our body’s defense system. It is hypothesized that a diverse gut microbiome is good for our health and perturbations in this might predispose us to disease development. Therefore, we asked whether multiple sclerosis (MS) patients have a gut microbiome which is distinct from healthy individuals. We collected fecal samples from MS patients and healthy controls and performed microbiome analysis. I have recently moved to UI but the entire study was completed at Mayo Clinic Rochester. This study involved a big team comprised of neurologist, gastroenterologist, bioinformatician, system biologist and study coordinators. We found that multiple sclerosis patients indeed have a gut microbiome which is different from what is observed in healthy people. We identified certain bacteria which are increased or decreased in the gut of patients with multiple sclerosis compared to healthy controls.
Dr. Bradley Belsher[/caption]
Bradley E. Belsher, Ph.D.
Chief of Research Translation and Integration,
Deployment Health Clinical Center,
Defense Center of Excellence for PH
and TBI
Research Assistant Professor, Department of Psychiatry
Uniformed Services University of the Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: One out of five U.S. military service members returning from overseas military conflicts meets screening criteria for at least one mental health condition, yet fewer than half of service members will receive help from a mental health professional. The consequences of inadequate mental health treatment are considerable and can lead to significant social and functional problems for service members and their families. In response to these mounting concerns, the Military Health System (MHS) has increased efforts to expand and improve the identification and treatment of mental health disorders. Given that the average service member visits primary care three times each year, the MHS has invested considerable resources into the integration of mental health services into the primary care setting. Collaborative care is an effective model for integrating mental health services into primary care and has demonstrated effectiveness in treating different mental health conditions to include depression and anxiety disorders. However, no previous studies have examined whether the concept can work in the MHS.
Recently, the first large-scale, randomized effectiveness trial evaluating an integrated health care model in primary care for PTSD and depression in the DoD was conducted. This trial randomized 666 military members treated across six large Army bases to a centrally-assisted collaborative telecare (CACT) approach for PTSD and depression or to the existing standard of care (usual collaborative care). This effectiveness trial targeted a large population of service members as they came into primary care and minimized exclusion criteria to improve the generalizability of the findings and broaden the applicable reach of the intervention.
Prof. Christiane Angermann[/caption]
Prof. Dr. med. Christiane E. Angermann, FESC, HFA
Deutsches Zentrum für Herzinsuffizienz Würzburg
Comprehensive Heart Failure Center (CHFC)
Universitätsklinikum Würzburg
Würzburg
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Previous meta-analysis indicates that depression prevalence in patients with heart failure is much higher than in the general population, 10 percent to 40 percent, depending on disease severity. Depression has been shown to be an independent predictor of mortality and rehospitalization in patients with heart failure, with incidence rates increasing in parallel with depression severity. Furthermore, it is associated with poor quality of life and increased healthcare costs.
It would, against this background, seem desirable to treat the depression, and when planning the study we hypothesized that by doing so we might be able to improve depression and thus reduce mortality and morbidity of this population. Long-term efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), which are widely used to treat depression and have proven efficacious in individuals with primary depression, is unknown for patients with heart failure and (comorbid) depression.
MedicalResearch.com Interview with: [caption id="attachment_25754" align="alignleft" width="350"] from left to right:Aimee Payne, MD, PhD – co-senior authorChristoph Ellebrecht, MD – first authorMichael Milone, MD, PhD – co-senior author[/caption] Aimee S. Payne, M.D., Ph.D. Albert M. Kligman Associate Professor of Dermatology University of Pennsylvania Philadelphia, PA 19104 MedicalResearch.com: What is the background for this study? What are...
Dr. Mark Mercola[/caption]
Mark Mercola, Ph.D.
Professor, Development, Aging and Regeneration Program, Sanford-Burnham-Prebys Medical Discovery Institute
La Jolla, California 92037
Professor, Stanford Cardiovascular Institute and Stanford University School of Medicine
Stanford, CA, 94305,
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Heart disease, especially after heart attack (myocardial infarction) is a major cause of death worldwide, accounting for over 13% of all human mortality. There is a major search for ways to treat the immediate cause or lessen the effect of a heart attack. One way researchers have considered is to boost the blood vessels that nourish the heart muscle. The heart muscle is nourished by many small blood vessels. We found a normal protein that acts as a high level regulator of blood vessel formation in the heart. This protein, known as RBPJ, suppresses the factors that make vessels grow. Therefore, we found that inhibiting this protein made more vessels, and consequently protected the hearts from the damage of a heart attack.
Dr. Jason R. Gotlib[/caption]
Jason R. Gotlib, MD
The Clinical Investigator Pathway
Hematology Division
Stanford University Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background is that advanced forms of systemic mastocytosis, which are blood cancers characterized by accumulation of abnormal mast cells in the bone marrow and additional organs, represent a group of orphan diseases with a large unmet need. Approximately 90% of patients harbor the acquired KIT D816V mutation, a mutated receptor tyrosine kinase on the surface of mast cells which a primary driver of disease pathogenesis. Only 1 drug is approved for patients with one form of advanced systemic mastocytosis, termed ‘aggressive systemic mastocytosis, or ‘ASM’. This therapy is imatinib (Gleevec), but it is only approved for patients without the KIT D816V mutation, or with KIT mutation status unknown because the KIT D816V mutation is resistant to imatinib. Therefore, this drug may only be useful for approximately 10% of patients. Other drugs that have been used off-label for systemic mastocytosis (but are not approved for this indication) include interferon-alpha or cladribine, which show some activity, but their evaluation to date has been primarily limited to small case series which are usually retrospective in nature, and include mixed populations of systemic mastocytosis patients who have both early stage disease without organ damage (e.g. indolent systemic mastocytosis) and and advanced stage patients, as included in this trial, who have one or more findings of organ damage. Also, those trials employed differing response criteria and no central adjudication of eligibility and response assessments was undertaken.
Midostaurin is a multikinase inhibitor with activity against both wild-type KIT, but most importantly, KIT D816V (in contrast to imatinib). Prior work demonstrated that cell lines transformed with the KIT D816V mutation can be inhibited at relatively low concentrations of midostaurin. These concentrations could also be achieved in vivo (e.g. at concentrations achievable in the blood of patients). Cell lines transformed by KIT D816V could not be inhibited by imatinib.
Dr. Philip Bejon[/caption]
Philip Bejon, Ph.D.
Professor of Tropical Medicine, Director of the Wellcome-KEMRI-Oxford Collaborative Research Programme, Group Head / PI, Consultant Physician and Unit Director
Kilifi, Kenya
MedicalResearch.com: What is the background for this study?
Response: According to the latest World Health Organisation (WHO) estimates more than 400,000 people died from malaria in 2015, with over 90% of these deaths occurring in sub-Saharan Africa. The vast majority who die are children under 5, and almost all cases are caused by the P. falciparum strain of malaria transmitted by female Anopheles mosquitoes.
RTS,S, which protects only against P. falciparum, was developed by GlaxoSmithKline with support from the PATH Malaria Vaccine Initiative (MVI) and with grant funds from the Bill & Melinda Gates Foundation to MVI. In July 2015, it received a positive opinion from the European Medicines Agency.
Earlier this year, the WHO recommended further evaluation of the four-dose regimen of RTS,S in a pilot implementation programme in sub-Saharan Africa, to address several knowledge gaps before the vaccine might be rolled out more widely.
Dr. Tami Rowen[/caption]
Tami Rowen MD MS
Obstetrics, Gynecology and Reproductive Sciences
UCSF
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study sought to answer the question of which women are engaging in genital grooming and understand their motivations. Prior studies have been limited by geography and age thus our goal was to provide a nationally representative sample of women.
Dr. Thomas Valley[/caption]
Thomas Valley, MD, MSc
Fellow, Pulmonary and Critical Care
University of Michigan
Ann Arbor, MI 48109-2800
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Hospitalizations for cardiovascular condition such as acute myocardial infarction (AMI) and heart failure (HF) are incredibly common and costly. Yet, about 20% of hospitalized patients with these conditions receive substandard care. We assessed whether there was an association between the quality of care a hospital provided for AMI or heart failure and how frequently a hospital used the ICU. We found that hospitals with the highest rates of ICU use for AMI or HF delivered worse quality of care and had higher 30-day mortality for these conditions.
Dr. June Robinson[/caption]
June K. Robinson, MD
Research Professor of Dermatology
Northwestern University Feinberg School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: More than 1 million patients with a history of melanoma live in the US. They are at risk to develop a second melanoma. The risk is elevated for up to 20 years and is 10 times greater than the risk of a first melanoma in the general population.
This is the first randomized clinical trial to examine partner- assisted skin self-examination (SSE) . A 30 minute structured training intervention was provided to the melanoma patients and their partners with reinforcement every 4 months .
The 494 pairs in the intervention performed significantly more skin self-examination than those in the control group at 4,12 and 24 months after the education and skills training. The pairs were accurate in finding early melanoma and did not have unnecessary visits to the dermatologists.
MedicalResearch.com Interview with: [caption id="attachment_25672" align="alignleft" width="130"] Dr. Tyler VanderWeele[/caption] Dr. Tyler J. VanderWeele Tyler J. VanderWeele, PhD, Department of Epidemiology Harvard T. H. Chan School of Public Health, Boston, MA 02115 MedicalResearch.com: What is the background for this study? Response: Suicide is one of the ten leading causes of death in the United States, and in...
Dr. Audrey Chang[/caption]
MedicalResearch.com Interview with:
Dr. Audrey Chang, PhD
Kamm-Stull Lab
UT Southwestern Medical Center
AudreyN.Chang@UTSouthwestern.edu
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The heart is a singular kind of muscle that contracts and relaxes continuously over a lifetime to pump blood to the body’s organs. Contractions depend on a motor protein myosin pulling on actin filaments in specialized structures. Heart contraction is improved when myosin has a phosphate molecule attached to it (phosphorylation), and a constant amount of phosphorylation is essential for normal heart function. The amount of phosphorylation necessary for optimal cardiac performance is maintained by a balance in the activities of myosin kinase enzymes that add the phosphate and an opposing phosphatase enzyme that removes the phosphate. If the amount of phosphorylation is too low, heart failure results. Animal models with increased myosin phosphorylation have enhanced cardiac performance that resist stresses that cause heart failure.
In this recent study reported in PNAS, a new kinase that phosphorylates myosin in heart muscle, MLCK4, was discovered and its crystal structure reported, a first for any myosin kinase family member. Compared to distinct myosin kinases in other kinds of muscles (skeletal and smooth), this cardiac-specific kinase lacks a conserved regulatory segment that inhibits kinase activity consistent with biochemical studies that it is always turned on. Additionally, another related myosin kinase found only in heart muscle (MLCK3) contains a modified regulatory segment, allowing partial activity enhanced by the calcium modulator protein, calmodulin. Thus, both myosin kinases unique to cardiac muscle provide phosphate to myosin in normal beating hearts to optimize performance and prevent heart failure induced by stresses.
MedicalResearch.com Interview with: [caption id="attachment_25649" align="alignleft" width="200"] Dr. Jing Luo[/caption] Jing Luo, MD, MPH Program on Regulation, Therapeutics, and Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Department of Medicine Brigham and Women’s Hospital and Harvard Medical School Boston, Massachusetts MedicalResearch.com: What is the background for this study? Response: Until recently, the cholesterol lowering drug atorvastatin was the highest selling...
Dr. Dan Barouch[/caption]
Dan Barouch, M.D., Ph.D.
Professor of Medicine
Harvard Medical School
Ragon Institute of MGH, MIT, and Harvard
Director, Center for Virology and Vaccine Research
Beth Israel Deaconess Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We showed that two vaccines, a DNA vaccine and a purified inactivated virus vaccine, both provided complete protection against Zika virus challenge in mice. To the best of our knowledge, this is the first demonstration of Zika vaccine protection in any animal model.
Dr. Jian Min Niu[/caption]
Dr. Jian-Min Niu
Department of Obstetrics
Guangdong Women and Children Hospita
Guangzhou , China
MedicalResearch.com: What is the background for this study?
Response: Physiological alteration leads to the question of whether the criteria for the diagnosis of gestational hypertension are suitable because the current criteria (systolic BP [SBP] ≥140 mm Hg and diastolic BP [DBP] ≥90 mm Hg) are derived from the non-pregnant population. The optimal blood pressure levels in pregnant women remain an open question. Recent studies have demonstrated associations between prehypertension before pregnancy and hypertensive disorders during pregnancy and gestational diabetes mellitus. To our knowledge, the association between prehypertension during pregnancy and postpartum cardiovascular risk has not been addressed.
Dr. Phillip Coffin[/caption]
Phillip O. Coffin, MD, MIA
Director of Substance Use Research
San Francisco Department of Public Health
Assistant Professor, Division of HIV, ID & Global Health
University of California, San Francisco
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: San Francisco has a longstanding naloxone distribution program that primarily works out of syringe exchange programs and is temporally associated with a substantial decline in opioid overdose death due to heroin or involving injection drug use. Over 90% of opioid overdose deaths from 2010-2012 were due to prescription opioids in the absence of heroin, and most of those decedents were prescribed opioids in primary care settings. Based on these data, as well as anecdotal reports from sites such as U.S. Army Fort Bragg in North Carolina - where providing naloxone to pain patients appeared to be associated with a radical decline in opioid overdose admissions to the emergency department - we implemented a naloxone prescribing program in the safety net primary care clinics.
We recommended that providers offer naloxone to all patients who used opioids on a regular basis, or were otherwise at risk for experiencing or witnessing an opioid overdose, although we only measured outcomes related to patients who were prescribed opioids for chronic pain. We also recommended that providers avoid the term "overdose" as that term does not properly reflect the epidemiology of opioid poisoning and is interpreted by many to mean intentionally consuming a large amount of opioids; instead we recommended saying things like: "Opioids can cause bad reactions where you stop breathing or can't be woken up." Providers prescribed mostly the jerry-rigged nasal device, with the atomizer and a brochure dispensed at clinic and the naloxone picked up at the patients' usual pharmacies, to approximate real-world medical practice.
Dr. Yongjun Wang[/caption]
Dr. Yongjun Wang
Principal Investigator
No. 6 Tiantanxili
Dongcheng District, Beijing, China
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Clopidogrel requires conversion to an active metabolite by hepatic cytochrome p450 (CYP) iso-enzymes to exert an antiplatelet effect, and polymorphisms of the CYP2C19 gene have been identified as strong predictors of clopidogrel nonresponsiveness. However, data are limited regarding the association between CYP2C19 genetic variants and clinical outcomes of clopidogrel-treated patients with minor stroke or transient ischemic attack.
The main findings of this study is that the combined treatment of clopidogrel and aspirin compared with aspirin alone reduced the risk of a new stroke only in the subgroup of patients with minor ischemic stroke or TIA who were not carriers of the CYP2C19 loss of function alleles.
Dr. Peter Morris[/caption]
Peter E. Morris, MD, FACP, FCCP
Chief, Division of Pulmonary, Critical Care and Sleep Medicine
University of Kentucky
Lexington, KY
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: ICU survivors demonstrate weakness. It has been postulated that interventions to promote early rehabilitation strategies might be linked to improved functional outcomes for ICU survivors.
This study was based upon findings from a quality improvement endeavor that linked early rehabilitation with indications of shortened hospital stays for ICU survivors.
Dr. Jochen Gensichen[/caption]
Jochen Gensichen, MD, MSc, MPH
Institute of General Practice and Family Medicine
[caption id="attachment_25560" align="alignleft" width="133"]
Dr. Konrad Reinhart[/caption]
Konrad Reinhart, MD
Center of Sepsis Control and Care
Jena University Hospital
Friedrich-Schiller-University
School of Medicine
Jena, Germany
MedicalResearch.com: What are the main findings?
Response: Sepsis survivors face multiple long-term sequelae which result in increased primary care needs as a basic support in medication, physiotherapy or mental health. Process of care after discharge from the intensive care unit often is fragmented.
Dr. Laura Cappelli[/caption]
Laura C. Cappelli, M.D
Johns Hopkins University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We had been referred several patients with inflammatory arthritis or dry mouth and dry eyes after being treated with immune checkpoint inhibitors. When searching the literature for information on how to evaluate and treat these patients, we realized that there was minimal information available. We wanted to describe our experience and inform the medical community about these events so that recognition could increase.
Dr. Gregory Marcus[/caption]
Dr. Gregory M. Marcus MD
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: Conduction system disease, or blockages in the electrically system (as opposed to blockages in the blood vessels, of which most are well-aware), is a common condition responsible for both heart failure in many patients as well as the need for pacemaker implantation. Although treatments for the disease are available, there are no known means to prevent it. This is important as the primary treatment, a pacemaker, can itself cause problems (including procedural complications, a long-term risk of infection with repeated battery changes, and even a greater risk of heart failure). In addition, predictors of what types of individuals are at risk for developing conduction disease has largely remained unknown.
Based on the fact that the majority of conduction disease is due to fibrosis, or scarring, of the conduction system, we sought to test the hypothesis that a common drug for high blood pressure with anti-fibrotic properties, Lisinopril, might reduce the risk of new conduction system disease. We took advantage of the fact that more than 20,000 patients with hypertension were randomized to three common high blood pressure drugs that work via different mechanisms in the ALLHAT trial: Lisinopril, amlodipine, and chlorthalidone. We found that participants randomly assigned to Lisinopril were statistically significantly less likely to develop conduction disease. In addition, our analyses revealed several risk factors for the development of conduction disease: older age, male sex, diabetes, smoking, a thicker heart, and white race (compared to black race).
Dr. Lu Qi[/caption]
Lu Qi, MD, PhD, FAHA
HCA Regents Distinguished Chair and Professor
Director, Tulane University Obesity Research Center
Department of Epidemiology
Tulane University
School of Public Health and Tropical Medicine
New Orleans, LA 70112
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prenatal malnutrition and other stresses may cause small newborn babies, who are more likely develop type 2 diabetes and other chronic diseases during adulthood. However, whether such relation is causal remains to be determined. Genetic associations provide a new approach to provide evidence for such causality.
Dr. Gilbert Gonzales[/caption]
Gilbert Gonzales, PhD, MHA
Assistant Professor
Department of Health Policy
Vanderbilt University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Using data from one of the largest, most representative health surveys, we found lesbian, gay and bisexual adults were more likely to report substantially higher rates of severe psychological distress, heavy drinking and smoking, and impaired physical health than straight adults.
Dr. Gregory Marcus[/caption]
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?
Response: Multiple epidemiologic studies have demonstrated that alcohol consumption likely increases the risk for atrial fibrillation and reduces the risk for myocardial infarction. However, the results have been conflicting, they generally all rely on self-report of alcohol consumption (which is known to be unreliable, particularly in those that drink more heavily), and there is almost certainly confounding related to an individual’s choice to consume alcohol (which in most settings is ubiquitously available). In addition, the relationship between alcohol and heart failure remains poorly understood, with evidence suggesting there may be both harmful and beneficial effects. Finally, the relationship between alcohol consumption and these various cardiovascular diseases (atrial fibrillation, myocardial infarction, and heart failure) have not been examined within the same cohort of individuals in a simultaneous fashion.