Medical Research Journals
04 Mar Study Examines Trajectory of Moderate or Severe Depression
MedicalResearch.com Interview with: [caption id="attachment_22323" align="alignleft" width="180"]
Dr. Katherine Musliner[/caption]
Katherine L. Musliner, PhD
National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
The Lundbeck Foundation Initiative for Integrative Psychiatric Research
Department of Mental Health
The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is great variation among patients with depression in terms of long-term illness course. This variation may be indicative of underlying differences in the cause of the illness, and from a practical perspective, it also has implications for treatment and allocation of public health resources. Our goal was to identify different trajectories of depression course by examining inpatient and outpatient contacts for depression at psychiatric treatment facilities in Denmark (where healthcare is free) during the 10-year period following patients’ initial depression diagnosis.
We found that the majority of patients (77% in our sample) followed a trajectory characterized by a brief period of contact with the psychiatric treatment system and no contact for depression during the remainder of the 10-year follow up period. Patients with more prolonged contact either had a drawn out initial period of contact lasting as long as five years (13%), left depression treatment for several years only to return with a depression diagnosis years later (7%) or exhibited a chronic course (3%).
04 Mar Patients May Benefit From New Combination Therapy For HER2-Negative Metastatic Breast Cancer
MedicalResearch.com Interview with: [caption id="attachment_22319" align="alignleft" width="200"]
Dr. Massimo Cristofanilli[/caption]
Massimo Cristofanilli, MD, FACP
Professor of Medicine
Associate Director of Translational Research and Precision Medicine
Department of Medicine-Hematology and Oncology
Robert H Lurie Comprehensive Cancer Center
Feinberg School of Medicine
Chicago, IL 60611
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Cristofanilli: The majority of breast cancer are estrogen-receptor positive and therefore candidate for treatment with endocrine therapy in the adjuvant and advanced settings. The most significant issue in the management of estrogen-receptor positive metastatic breast cancer is the development of drug resistance. Very few effective options are available for patients that demonstrate progression of disease while on standard endocrine therapy, particularly in premenopausal women and/or women that have even progressed on chemotherapy. The study demonstrated that the combination of fulvestrant with palbociclib, a novel inhibitor of CDK4/6 kinases, significantly improve response to treatment and delays disease progression with minimal toxicity.
03 Mar Task Force Recommends Older Adults Mention Eye Problems To Their Primary Care or Ophthalmologist
MedicalResearch.com Interview with: [caption id="attachment_22300" align="alignleft" width="149"]
Dr. Albert Siu[/caption]
Dr. Albert Siu M.D., M.S.P.H.
Chair of the U.S. Preventive Services Task Force
Chairman and professor of the Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai
Director of the Geriatric Research, Education, and Clinical Center
James J. Peters Veterans Affairs Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Siu: Impaired vision is a serious and common problem facing older adults and can affect their independence, ability to function, and quality of life. When the Task Force reviewed the research around screening older adults for vision impairment in a primary care setting, we concluded that the current evidence is insufficient to assess the balance of benefits and harms. As a result, we issued an I statement, which is consistent with the 2009 final and 2015 draft recommendations.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Siu: Older adults who are having problems seeing should talk to their primary care doctor or an eye specialist. Primary care doctors can explore the various causes of vision problems and do an eye exam to check for refractive error. An eye specialist can do a full eye exam to look for and treat refractive errors and other eye conditions that affect vision, such as cataracts and age-related macular degeneration (AMD). With regards to clinicians, in the absence of clear evidence, they should use their clinical judgment when deciding whether to screen patients who have not reported any concerns about their vision.
03 Mar Genetic Assay Oncotype Dx Helps Clarify Chemotherapy Decisions in HER2 Negative Breast Cancer
Posted at 12:18h
in ASCO, Author Interviews, Biomarkers, Breast Cancer, Chemotherapy, Genetic Research, Journal Clinical Oncology
MedicalResearch.com Interview with:
[caption id="attachment_22296" align="alignleft" width="200"]
Dr. Oleg Gluz[/caption]
Oleg Gluz, MD
West German Study Group
Breast Center Niederrhein
Evangelical Hospital Bethesda
Moenchengladbach, Germany
MedicalResearch.com: What is the background for this study?
Dr. Gluz: PlanB trial is a Phase III chemotherapy study performed in patients with clinically high risk HER2 negative breast cancer. After early amendement, Recurrence Score (Oncotype Dx) as a selection criterion for or against chemotherapy together with central pathology review were included into the study. Patients with very low RS of below 12 and up to 3 positive lymph nodes were recommended to omit chemotherapy based on the low genomic recurrence risk. Chemotherapy was omitted in about 15% of all patients.
For the first time we present prospective data comparing a genomical tool (Oncotype Dx) and an independent central pathology review for grade, ER, PR, and Ki-67 from a large phase III study combined with an exploratory analysis on early relapse risk.
MedicalResearch.com: What are the main findings?
Dr. Gluz: The study has two major findings:
We have found a significant discordance in risk assessment between prognostic tools (grade by local and central lab, Oncotype Dx, Ki-67).
Patients treated by endocrine therapy alone based on very low Recurrence Score had an excellent disease free survival of 97% after 3 years of follow up.
03 Mar Early Breast Cancer Screening Recommended For Survivors of Childhood Hodgkin’s Lymphoma
MedicalResearch.com Interview with: [caption id="attachment_22284" align="alignleft" width="200"]
Dr. David Hodgson[/caption]
David Hodgson, MD, MPH, FRCPC
Associate Professor
University of Toronto
Toronto, ON Canada
MedicalResearch.com: What is the background for this study?
Dr. Hodgson: We know that treatment for childhood Hodgkin lymphoma can cause some side effects that arise years after treatment is finished. In particular, radiotherapy given to the chest of adolescent females increases the risk of developing breast cancer in young adult survivors. But there are very little data about whether the early initiation of breast cancer screening will prevent breast cancer deaths in these survivors, and what kinds of screening is optimal. This is important because less than half of these young survivors are undergoing breast cancer screening, and in some jurisdictions early screening is not covered by insurance.
MedicalResearch.com: What are the main findings?
Dr. Hodgson: Because there has not been, and likely never will be, a large randomized screening trial for these patients, we used all the available information about their breast cancer risk, other health issues and the effectiveness of screening, and created a mathematical model that allows us to estimate the number of breast cancer deaths prevented by starting screening at age 25 for women who had received chest RT as teenagers. We found that one would have to invite about 260 survivors to early mammographic screening to prevent one breast cancer death, which compares favorably to other accepted reasons for breast cancer screening. Using MRI for screening, approximately 80 women would have to be invited to prevent one breast cancer death, because MRI is so much more sensitive than mammography. One of the problems with MRI, however, is that a substantial number of women will have "false positive" tests - abnormal findings that are not really cancer.
01 Mar Combination Degludec/Liraglutide Reduced HgA1C and Insulin Side Effects in Type 2 Diabetes
MedicalResearch.com Interview with: [caption id="attachment_22181" align="alignleft" width="200"]
Dr. John Buse[/caption]
Dr. John Buse MD Ph.D
Professor, Medicine
Director, Diabetes Care Center
Chief, Division of Endocrinology
Executive Associate Dean, Clinical Research
University of North Carolina School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Buse: Degludec is an longer acting basal insulin analog recently approved in the US. Liraglutide is a once-daily GLP-1 receptor agonist. Both are among the most powerful glucose lowering drugs available in the setting of type 2 diabetes. They have very different properties. Degludec is best at lowering fasting glucose. Liraglutide has effects on postprandial glucose as well. The major side effects of degludec are hypoglycemia and weight gain. Liraglutide on the other hand has not an inherent effect to cause hypoglycemia and does promote weight loss. Liraglutide does cause nausea and in fewer patients vomiting in a dose dependent manner. In developing the fixed dose combination the idea was to amplify glucose lowering efficacy and minimize the adverse effects of both components. Prior studies have basically shown that this has been accomplished. In this study we looked at the very common clinical scenario of the patient with type 2 diabetes inadequately controlled on basal insulin glargine and asked the question of whether switching from glargine to IDegLira (the combination product) would do better than continued titration of glargine.
01 Mar Women with Type 1 Diabetes Have Elevated Risk of Some Cancers
MedicalResearch.com Interview with: [caption id="attachment_22195" align="alignleft" width="160"]
Bendix Carstensen[/caption]
Bendix Carstensen
Department of Clinical Epidemiology Steno Diabetes Center
Gentofte
Medical Research: What is the background for this study? What are the main findings?
Response: It has long been known that all diabetes patients have elevated risk of cancer (10-15%). Patients on insulin slightly more (20-25%). Type 1 patients is only a small fraction (10%) of all diabetes patients, but they ALL take insulin. If insulin has a role in cancer occurrence it would be expected to be particularly pronounced in type 1 patients, and increasing by duration.
But it is not, the risk of cancer is 15% elevated (if we disregard prostate, breast and other cancers only occurring in one of the sexes), and there is no increase in the excess risk by duration of insulin use. Breast cancer risk is 10% lower and prostate cancer risk some 40% lower. Overall there is very little increased cancer risk - 1% for men 7% for women.
01 Mar IVC Filters Widely Used in Attempt To Prevent Pulmonary Embolism
MedicalResearch.com Interview with: [caption id="attachment_21981" align="alignleft" width="110"]
Dr. Behnood Bikdeli[/caption]
Behnood Bikdeli MD
Department of Internal Medicine and Center for Outcomes Research and Evaluation (CORE)
Yale University School of Medicine
New Haven, CT 06510
Medical Research: What is the background for this study? What are the main findings?
Response: The idea of closing the path of inferior vena cava (IVC) to prevent blood clots migrating to the pulmonary circulation and causing a pulmonary embolism (PE) has been around for over 150 years. We were aware than many practitioners might think of IVC filters for that reason, and specifically with the introduction of retrievable filters in recent years; that have made it more palatable for referring physicians.
However, there is a paucity of high-quality data to suggest the efficacy of IVC filters. The two existing large trials did not show a mortality benefit from use of filters, and the guidelines have very narrow indications for use of IVC filters in patients who have already had a pulmonary embolism.
Having said that, we wondered whether despite the absence of high-quality comparative effectiveness data, filters might be commonly used in patients with PE, particularly among older adults who are a vulnerable population (at higher risk of PE, at higher risk of PE complications; but also less likely to receive other advanced therapies for PE).
Our study common use of IVC filters among older adults in the US; with over 75% relative increase in use of IVC filters from 1999 to 2010 (from ~5000 patients with PE in 1999 to ~9000 patients with PE in 2010). We also noted wide regional variations in the use of IVC filters (e.g. highest in the South Atlantic and lowest in the Mountain region). Such differences fundamentally persisted over time. In addition, we noted declining short-term and 1-year mortality rates in patients with pulmonary embolism over time, irrespective of whether or not they received an IVC filter.
01 Mar Gene Expression Profile Can Indicate Aggressive Prostate Cancer
MedicalResearch.com Interview with [caption id="attachment_22239" align="alignleft" width="169"]
Dr. Dingxiao Zhang[/caption]
Dr. Dingxiao Zhang Ph.D
Department of Epigenetics and Molecular Carcinogenesis
University of Texas MD Anderson Cancer Center
Smithville, TX 78957, USA
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Zhang: Prostate cancer (PCa) is a heterogeneous malignancy harboring phenotypically and functionally diverse subpopulations of cancer cells. To better understand PCa cell heterogeneity, it is crucial to dissect the biology of normal prostate epithelial lineages. The background for the current study is to annotate the gene expression profiles of normal prostate epithelial cells, through which we hope to gain insight on Prostate cancer subtypes and the cellular heterogeneity in PCa. The prostate gland mainly contains basal and luminal cells constructed as a pseudostratified epithelium. Annotation of prostate epithelial transcriptomes provides a foundation for discoveries that can impact disease understanding and treatment. In this study, we have performed a genome-wide transcriptome analysis of human benign prostatic basal and luminal epithelial populations using deep RNA sequencing.
One of our major findings is that the differential gene expression profiles in basal versus luminal prostate epithelial cells account for their distinct functional properties. Specifically, basal cells preferentially express gene categories associated with stem cells, MYC-transcriptional program, neurogenesis, and ribosomal RNA (rRNA) biogenesis regulated by Pol I. Consistent with this profile, basal cells functionally exhibit intrinsic stem-like and neurogenic properties with enhanced rRNA transcription activity. Of clinical relevance, the basal cell gene expression profile is enriched in advanced, anaplastic, castration-resistant, and metastatic prostate cancers.
Therefore, we link the cell-type specific gene signatures to aggressive subtypes of prostate cancer and identify gene signatures associated with adverse clinical features.
01 Mar Study Identifies Predictors of Treatment-Resistant Schizophrenia
[caption id="attachment_22242" align="alignleft" width="150"]
Theresa Wimberley[/caption]
MedicalResearch.com Interview with:
Theresa Wimberley
PhD student
National Centre for Register-based Research
School of Business and Social Sciences
Aarhus University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Approximately 30% of patients with schizophrenia suffer from treatment-resistant schizophrenia, i.e. they do not respond to first-line antipsychotic treatment. Identification of high-risk patients as early as possible is crucial in order to optimize treatment and improve prognosis. In a large population-based cohort of patients diagnosed with schizophrenia we found the following candidate predictors of treatment resistance:
- younger age at diagnosis,
- living in less urban areas,
- paranoid schizophrenia subtype,
- a history of psychiatric hospital admission,
- personality disorder,
- suicide attempt, and
- psychotropic drug use. Additionally, as opposed to other studies using treatment-based proxies for treatment-resistant schizophrenia, this study not only considered clozapine users as treatment resistant. We extended the proxy definition to include patients eligible for clozapine, as clozapine is considered to be under-prescribed. We found similar results regardless of definition used.
29 Feb Fewer Pediatric Abusive Head Trauma In States With Paid Family Leave
MedicalResearch.com Interview with: [caption id="attachment_16316" align="alignleft" width="200"]
Dr. Joanne Klevens[/caption]
Dr. Joanne Klevens, MD, PhD, MPH
Division of Violence Prevention
US Centers for Disease Control and Prevention
Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.
29 Feb Hospitals Should Engage Patients and Families in Safety Efforts
MedicalResearch.com Interview with: [caption id="attachment_22185" align="alignleft" width="180"]
Dr. Alisa Khan[/caption]
Dr. Alisa Khan, MD MPH
Division of General Pediatrics
Boston Children’s Hospital
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
Medical Research: What is the background for this study? What are the main findings?
Dr. Khan: Medical errors, or mistakes in the process of caring for patients, occur frequently. While methods of detecting errors have improved, parents and families are not typically included in routine hospital safety monitoring systems. We found that nearly 1 in 11 parents reported their child had experienced a safety incident during hospitalization. Most of these reports were confirmed to be medical errors when reviewed by physicians, and many were not otherwise documented in the patient’s medical record.
29 Feb Oxygen Saturation Poor Predictor of Return Visits For Infant Respiratory Infections
Posted at 16:41h
in Author Interviews, Emergency Care, Infections, JAMA, Pediatrics, Pulmonary Disease, Respiratory
MedicalResearch.com Interview with:
[caption id="attachment_22065" align="alignleft" width="150"]
Dr. Suzanne Schuh[/caption]
Suzanne Schuh, MD, FRCP(C), ABPEM
The Hospital for Sick Children affiliated with the
University of Toronto
Medical Research: What is the background for this study?
Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home.
The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home.
29 Feb History of Fainting Raises Risk of Motor Vehicle Accidents
MedicalResearch.com Interview with: Anna-Karin Numé MD, PhD student Copenhagen University Gentofte Hospital Department of Cardiology Cardiovascular Research Hellerup Denmark Medical Research: What is the background for this study? Dr. Numé: While it is obvious that a loss of consciousness while driving a car is very dangerous, what is not known is whether individuals who have had an episode of fainting (syncope) have a significantly higher risk of having car crashes in the future. Because about one third of patients with syncope are likely to have a recurrence, physicians face a difficult judgment about whether patients with syncope are fit to drive. Medical Research: What are the main findings? Dr. Numé: In this nationwide study of patients with syncope, having a history of syncope were associated with a 2-fold-higher risk of later motor vehicle crashes requiring medical attention at an emergency department or hospital compared with the general population – a risk that remained elevated throughout a follow-up of 5 years. This risk was small in absolute terms, yet raises important questions about policies towards driving.29 Feb Minimal Benefit of Flibanserin for Female Hypoactive Sexual Desire Disorder
MedicalResearch.com Interview with: [caption id="attachment_22058" align="alignleft" width="200"]
Dr. Loes Jaspers[/caption]
Loes Jaspers MD, PhD scientist
Dept. of Epidemiology
Erasmus University Medical Center
Rotterdam, the Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Jaspers: In August 2015, the U.S. Food and Drug Administration approved flibanserin as a medical treatment for women with hypoactive sexual desire disorder (HSDD). The approval was accompanied by considerable attention in the media. Some people were positive about the approval, while others questioned whether benefits outweigh the risks. That is why we systematically reviewed eight clinical trials (five published and three unpublished) that included 5,914 women to examine the efficacy and safety of the medication for treatment of hypoactive sexual desire disorder.
We found that women taking flibanserin experienced one-half additional satisfying sexual event per month, and that they experienced 2-4 times more side-effects, such as dizziness, sleepiness, nausea, and tiredness, compared to placebo. The overall improvement that women reported while taking the drug was low. It ranged from ‘minimal improvement’ to ‘no change’.
The quality of the evidence was graded using established and transparent guidelines, the Grades of Recommendation, Assessment, Development and Evaluation approach (GRADE), which have been adopted by leading scientific organizations globally. Although the studies reviewed were randomized clinical trials, the quality of the evidence was very low, particularly because of limitations in design, the indirectness of evidence, and more favorable efficacy outcomes in published compared with unpublished studies.
27 Feb Glaucoma Drops May Boost Effectiveness of anti-VEGF Injections for Macular Degeneration
MedicalResearch.com Interview with: [caption id="attachment_22149" align="alignleft" width="180"]
Dr. Jason Hsu[/caption]
Jason Hsu, MD
Retina Service, Wills Eye Hospital
Assistant Professor of Ophthalmology
Thomas Jefferson University
Mid Atlantic Retina
Medical Research: What is the background for this study? What are the main findings?
Dr. Hsu: There are some patients with the wet type of age-related macular degeneration (AMD) who have persistent swelling in the retina despite regular, repeated eye injections with the anti-vascular endothelial growth factor (anti-VEGF) medications (e.g., Avastin, Lucentis, and Eylea). I had postulated that if we could decrease the turnover of fluid inside the eye, it might allow the injected medicine to stay in the eye for a longer period of time. I chose dorzolamide-timolol (brand name: Cosopt), a commonly available prescription eye drop used for glaucoma, since it is a very potent aqueous suppressant. By slowing down the production of eye fluid, I theorized it might decrease the outflow of fluid and medicine from the eye.
Our study was a small, nonrandomized, exploratory pilot study. We enrolled 10 patients with wet AMD who had persistent retinal swelling despite chronic, fixed interval anti-VEGF injections. We kept patients on the exact same anti-VEGF medication and continued to see them at the exact same interval that they had been on before study enrollment. Once enrolled, the only difference is that we had them start using dorzolamide-timolol eye drops twice a day for the course of the study. The results were fairly striking with the retinal thickness decreasing from around 420 microns to 334 microns at the final visit. This decrease in swelling was significant at the first study visit after starting the drops and remained significant throughout the course of the study.
27 Feb Alcohol-Containing Antiseptics During Facial Surgery Can Cause Corneal Damage
MedicalResearch.com Interview with: [caption id="attachment_22143" align="alignleft" width="160"]
Dr. Yu-Chih Hou[/caption]
Yu-Chih Hou, MD
Department of Ophthalmology
National Taiwan University Hospital
Taipei, Taiwan
MedicalResearch: What is the background for this study?
Dr. Yu-Chih Hou: We have encountered 3 patients with right eye pain and corneal edema after left orofacial surgery under general anesthesia since December 6. 2010. The first patient underwent a left tongue tumor excision by an ENT doctor. Postoperative day one, corneal epithelial defect and edema with mild anterior chamber reaction were noted in the right eye. Because his presentation was different from corneal abrasion which was the most common eye injury after general anesthesia, we suspected this ocular complication could be due to toxic reaction to antiseptic. Although corneal edema decreased, corneal endothelial cell density decreased and cataract developed later in the first patient. Two months later, the second patient had a similar toxic keratopathy but with severe corneal edema in his right eye after wide tumor excision of left lower gingival cancer by dentist surgeons. We found the antiseptic they used contained alcohol. We recommended not to use alcohol-containing antiseptics in oral surgery. Unfortunately, more severe toxic keratopathy occurred in the third patient after a left nasal tumor excision by other ENT doctor one year later. Because these severe ocular complications may occur again, it raised us to do detail study and we found all antiseptics they used contained alcohol. We hope to prevent occurrence of this toxic keratopathy in nonocular surgery by reporting our findings to other clinicians.
26 Feb Young Adults, Southeners, Drink Most Sugar-Sweetened Beverages
MedicalResearch.com Interview with: [caption id="attachment_22125" align="alignleft" width="180"]
Dr. Sohyun Park[/caption]
Sohyun Park, PhD
Epidemiologist
Epidemiology and Surveillance Team
Obesity Prevention and Control Branch
Division of Nutrition, Physical Activity, and Obesity
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Dr. Park: The 2013 BRFSS provides the most recent state data for this behavior using a short screener which showed that about 1 in 3 adults consumed sugar-sweetened beverages (SSBs) at least once per day, and SSB intake differed by state and by certain subgroups.
The main findings of the study showed the following among the 23 states and DC surveyed the prevalence of adults who consumed sugar-sweetened beverages at least once daily was:
- Aged 18-24 years (43.3%)
- Men (34.1%)
- Non-Hispanic Blacks (39.9%)
- Unemployed (34.4%)
- Had less than a high school education (42.4%)
- Adult sugar-sweetened beverages intake was highest in Mississippi (47.5%), followed by Louisiana (45.5%) and West Virginia (45.2%).
- The prevalence of sugar-sweetened beverages intake one or more times per day among younger adults (18–24 years) was 2.3 times the prevalence among the older adults (aged 55 years and older)—43.3% versus 19.1%, respectively.
26 Feb Diabetics Need To Find ‘Sweet Spot’ For Blood Pressure Control
MedicalResearch.com Interview with: [caption id="attachment_22121" align="alignleft" width="200"]
Dr-Mattias-Brunström[/caption]
Mattias Brunström, MD PhD student
Department of Public Health and Clinical Medicine
Umeå University Hospital
Umeå, SE Sweden
Medical Research: What is the background for this study? What are the main findings?
Dr. Brunström: Current guidelines differ in their recommendations on blood pressure treatment targets for people with diabetes. We did a systematic review and meta-analysis of 49 studies, including almost 74 000 patients, to investigate the effect of treatment at different blood pressure levels. We found that treatment reduced the risk of death, stroke, myocardial infarction and heart failure if systolic blood pressure before treatment was above 140 mm Hg. However, if systolic blood pressure was below 140 mm Hg, treatment increased the risk of cardiovascular death.
26 Feb Stem Cells Vary Widely Depending on Location and Donor Age
MedicalResearch.com Interview with: [caption id="attachment_22010" align="alignleft" width="133"]
Dr. Andrew Jaffe[/caption]
Dr. Andrew Jaffe PhD
Investigator, Lieber Institute for Brain Development
Assistant Professor
Wendy Klag Center for Autism and Developmental Disabilities
Johns Hopkins Bloomberg School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Jaffe: Significant investments are being made worldwide in precision medicine, with much of the investment concentrated in the curation of stem cell lines for the generation of new tissues and organs. The most popular cell types for generating patient-specific stem cells are skin-derived and therefore receive potentially the highest amount of environmental exposure.
In our study, we were interested in characterizing the genomic variability in fibroblast cells from two locations in the body across the lifespan. The two locations were the scalp, which is exposed to the environment, and the dura mater, which is the membrane under the skull and is largely protected from environmental insult. While the fibroblast cells from these two locations look indistinguishable under a microscope, we found widespread epigenetic and expression differences between the cells related to where they came from in the body and also related, to a lesser extent, to the age of the donor.
As the field of personalized medicine continues to grow, this evidence necessitates further exploration into the epigenetic patterns in stem cells used for new tissue and organ generation. Additional research is required to determine which cells to cultivate and when, as researchers question how much epigenetic memory is actually erased when creating stem cell models.
26 Feb Women At Greater Risk of PAD
Posted at 16:55h
in AHA Journals, Author Interviews, Heart Disease, PAD, Surgical Research, University of Pennsylvania
[caption id="attachment_20701" align="alignleft" width="180"]
Dr. Grace Wang[/caption]
MedicalResearch.com Interview with:
Dr. Grace Wang MD FACS
Assistant Professor of Surgery
Division of Vascular and Endovascular Surgery
Hospital of the University of Pennsylvania
Medical Research: What is the background for this study?
Dr. Wang: PAD is a major source of morbidity and mortality resulting in functional impairment, limb loss, as well as death. Despite epidemiologic studies which have contributed to our understanding of PAD prevalence and its association with traditional atherosclerotic risk factors, there have been conflicting studies published on the incidence of PAD and differences in treatment outcomes in women versus men. Patients with chronic kidney disease (CKD) are at particularly high risk for PAD. We set out to to define how the incidence of peripheral arterial disease (PAD) in chronic kidney disease (CKD) differs according to sex and age.
26 Feb Regardless of Ethnicity, Women Have Worse Outcomes From Acute Coronary Syndromes
Posted at 16:44h
in AHA Journals, Author Interviews, Gender Differences, Heart Disease, Race/Ethnic Diversity, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_21794" align="alignleft" width="180"]
Karin Humphries[/caption]
Karin H Humphries, MBA, DSc | Scientific Director
BC Centre for Improved Cardiovascular Health
UBC-HSF Professor in Women's Cardiovascular Health
Vancouver, BC
Medical Research: What is the background for this study?
Response: Prior studies have shown that among patients with obstructive coronary artery disease (CAD), women have higher short- and long-term mortality rates as compared to men. Furthermore, a few studies have highlighted the existence of ethnic differences in the incidence of acute myocardial infarction (AMI) and outcomes following an AMI event. However, the joint contribution of sex and ethnicity on outcomes of patients with obstructive coronary artery disease remains unknown.
Our primary objective was to extend these findings by examining the joint impact of sex and ethnicity on long-term adverse outcomes of all patients with angiographic evidence of obstructive CAD presenting with myocardial ischemia.
Our study included a population-based cohort of patients ≥ 20 years of age who underwent coronary angiography for acute coronary syndromes (ACS) or stable angina in British Columbia, Canada with angiographic evidence of ≥ 50% stenosis in any epicardial artery.
26 Feb Symptoms of Anxiety and Heart Disease May Overlap in Women
Posted at 16:39h
in AHA Journals, Author Interviews, Heart Disease, Mental Health Research, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_21884" align="alignleft" width="133"]
Dr.Kim Lavoie[/caption]
Dr. Kim Lavoie, Ph.D.
CIHR New Investigator, FRQS Chercheur-Boursier Co-Director,
Montreal Behavioural Medicine Centre
Professor, Dept. of Psychology University of Quebec at Montreal Director, Chronic Disease Research Division, Hôpital du Sacré-Coeur de Montreal Adjunct Professor, Faculty of Medicine, University of Montreal
Associate Researcher, Montreal Heart Institute
Chair, Health Psychology and Behavioral Medicine Section
Canadian Psychological Association
Medical Research: What is the background for this study?
Dr. Lavoie: We were interested in looking at whether rates of ischemia in men and women were different as a function of whether or not you had pre-existing heart disease (we would expect those with existing heart disease to have more ischemia because it’s a major marker of disease) or a comorbid anxiety or mood disorder (we expected anx/mood disorders would be associated with higher rates of ischemia because they reflect clinical levels of chronic stress, which has been linked to higher rates of ischemia in previous studies).
Medical Research: What are the main findings?
Dr. Lavoie: Overall, we found that men have higher rates of ischemia than women, and that anxiety or mood disorders overall aren't associated with higher or lower risk of ischemia (in those with or without previously diagnosed heart disease).
HOWEVER, what we did find that was interesting and perhaps new, was that if you looked within women, those without previously diagnosed heart disease AND anxiety disorders (which including things like panic disorder and generalized anxiety - panickers and worriers) had higher rates of ischemia compared to those without anxiety disorders. This suggests higher rates of ischemia among women without heart disease, which seems counter-intuitive because you would expect those WITH disease to have more ischemia. The fact that anxiety disorders were present in those without previously diagnosed heart disease - and they were the ones with more ischemia, suggests that these women likely HAD heart disease that just hadn't been diagnosed up yet, and that the reason might have been because of their anxiety disorder, which can mask many symptoms of heart disease because many of them overlap (e.g., fatigue, decreased energy, heart palpitations, sweating, chest discomfort, hyperventilation, and fear/worry). This could lead physicians to misinterpret symptoms of real heart disease as those of anxiety - but this only appears to be the case in women according to our study, suggesting a possible sex/gender bias here.
26 Feb Multiple Pregnancies May Raise Metabolic Syndrome Risk in Latina Women
Posted at 16:29h
in Author Interviews, JACC, Metabolic Syndrome, OBGYNE, Race/Ethnic Diversity, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_21829" align="alignleft" width="150"]
Dr. Catherine Vladutiu[/caption]
Catherine J. Vladutiu, PhD, MPH
Research Assistant Professor, Department of Obstetrics & Gynecology
Adjunct Assistant Professor, Department of Epidemiology
Chapel Hill, NC
Medical Research: What is the background for this study?
Dr. Vladutiu: During pregnancy, women experience physiological changes and are at risk of pregnancy-related complications, some of which are associated with a higher risk of cardiovascular health outcomes in later life. Physiologic adaptations occurring across successive pregnancies may be associated with an even higher risk of adverse cardiovascular outcomes. Previous studies have found an association between higher parity (i.e., number of live births) and the metabolic syndrome (MetS). However, no studies have examined this association in a Hispanic/Latina population. Hispanic women have a higher prevalence of the MetS than non-Hispanic women. Latinos are also the fastest growing minority population in the U.S. and Hispanic/Latina women report higher fertility and birth rates than their non-Hispanic counterparts.
26 Feb CVD Risk in Women Also Raises Risk of Diabetes, Hypertension and High Cholesterol
Posted at 16:06h
in AHA Journals, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_21826" align="alignleft" width="166"]
Dr. Mercedes Sotos Prieto[/caption]
Mercedes Sotos Prieto, PhD
Research Associate, Department of Nutrition
Harvard T.H. Chan School of Public Health
Boston, MA, 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Sotos-Prieto: Given that CVD remains the leading cause of death in the US, the prevention of risk factor development through healthy lifestyle factors, or primordial prevention, is of paramount importance to minimize the long-term risk of CVD. However, the prevalence of these healthy behaviors among US adults remains low.
The Healthy Heart Score is a 20-year CVD risk prediction model based on modifiable lifestyle factors and we have shown previously that this score effectively predicted the 20-year risk of CVD in mid-adulthood. Whether this risk score is associated with clinically-relevant CVD risk factors is unknown. Therefore, in this study we analyzed the association between the Healthy Heart Score and incidence of clinical CVD risk factors, including diabetes, hypertension, and hypercholesterolemia among 69,505 U.S women in the Nurses’ Health Study II during 20 years of follow-up. The Healthy Heart Score is based on the 9 most critical lifestyle factors that best estimate CVD risk including: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits, vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats. The Healthy Heart Score estimates the 20 –year CVD risk, thus a higher score reflected a higher predictive CVD risk. Over 20 years, we documented 3,275 incident cases of diabetes, 17,420 of hypertension, and 24,385 of hypercholesterolemia.
Our main findings showed that women with higher predicted CVD risk based on the Healthy Heart Score (highest quintile vs. lowest) had significantly greater risk of developing each clinical risk factor individually. Specifically, women with a higher predictive CVD risk had an 18-fold higher risk of type 2 diabetes, 5-fold higher risk of hypertension, and 3-fold higher risk of hypercholesterolemia over 20-years. Further, a higher predictive CVD risk was associated with a 53-fold greater risk of developing a high CVD risk profile (defined as the diagnosis of all 3 clinical risk factors) and this association was most pronounced among women who were younger, did not smoke, and had optimal weight
26 Feb Young Women With CAD Need Repeat Procedures More Often Than Men
Posted at 15:59h
in AHA Journals, Author Interviews, Gender Differences, Heart Disease, University of Pennsylvania, Women's Heart Health
MedicalResearch.com Interview with:
[caption id="attachment_21844" align="alignleft" width="148"]
Dr. Robert Wilensky[/caption]
Dr. Robert L. Wilensky MD
Director, Interventional Cardiology Research
Director, Interventional Cardiology Training Program
Professor of Medicine Hospital of the University of Pennsylvania
Medical Research: What is the background for this study?
Dr. Wilensky: We wanted to evaluate whether young women, under the age of 50 years, had an increased risk for recurrent ischemic events after percutaneous coronary intervention (PCI) compared to young men or older women.
Medical Research: What are the main findings?
Dr. Wilensky: Despite having less severe coronary artery disease, had an increased risk of repeated events, generally need for repeat PCI in either the exact location of the original procedure or within the artery that underwent the procedure. This despite the finding that young women were treated with the same medications as young men.
26 Feb Chemotherapy Plus Radiation Demonstrated Control of Liver Metastases in Colon Cancer
Posted at 00:20h
in Author Interviews, Cancer Research, Colon Cancer, Journal Clinical Oncology, Radiation Therapy
MedicalResearch.com Interview with:
[caption id="attachment_22068" align="alignleft" width="133"]
Dr. Guy van Hazel[/caption]
Dr Guy van Hazel
Clinical Professor of Medicine,
School of Medicine and Pharmacology,
University of Western Australia
Medical Research: What is the background for this study? What are the main findings?
Dr. van Hazel: The SIRFLOX study is based on original work by Dr Bruce Gray and myself almost two decades ago, when we studied the combination of Selective Internal Radiation Therapy (SIRT) with Y-90 resin microspheres – which was absolutely new at the time – with hepatic artery chemotherapy. This study showed an increase in liver control with the addition of SIRT [Gray B et al. Ann Oncol 2001; 12: 1711–1720.].
We then proceeded to initiate a trial comparing systemic SIRT plus 5-FU/LV according to the Mayo Clinic regimen compared to the Mayo Clinic regimen alone, but unfortunately this had to be abandoned because new chemotherapy became available which made it unethical to offer the control arm. However, in those patients who were treated up to that point with SIRT plus 5-FU/LV [van Hazel G et al. J Surg Oncol 2004; 88: 78–85.] we did see a very high response rates compared to the control arm, with an impressive survival of 29 months. We subsequently did a phase l/ll study of modified FOLFOX6 with or without SIRT and again found very high response rates [Sharma R et al. J Clin Oncol 2007; 25: 1099–1106.]. This led us to launch the SIRFLOX study in 2007.
25 Feb More Young Women Getting BRCA Breast Cancer Genetic Testing
MedicalResearch.com Interview with: [caption id="attachment_22015" align="alignleft" width="175"]
Dr. Shoshana Rosenberg[/caption]
Dr. Shoshana Rosenberg ScD, MPH
Department of Medical Oncology
Dana-Farber Cancer Institute
Boston, Massachusetts
Medical Research: Why would BRCA testing rates have increased among younger women with cancer?
Dr. Rosenberg: There has been increasing awareness surrounding genetic testing for breast cancer in more recent years, likely contributing to the trend that we saw over time in our cohort. This has included more media attention, most notably Angelina Jolie’s sharing her story in 2013.
Medical Research: Is this increase in testing a good thing?
Dr. Rosenberg: Young women who are diagnosed with breast cancer should be getting tested so the fact that an increasing proportion of women have been undergoing BRCA testing in recent years indicates patients (and the physicians who treat them) are following recommendations.
25 Feb Study Finds Aspirin Safe For People Waiting To Have Coronary Artery Surgery
MedicalResearch.com Interview with: [caption id="attachment_22006" align="alignleft" width="120"]
Prof. Paul Myles[/caption]
Professor Paul Myles MBBS, MPH, MD, FCARCSI, FANZCA, FRCA
Director, Dept of Anaesthesia and Perioperative Medicine
Alfred Hospital and Monash University, Melbourne, Australia
Medical Research: What is the background for this study? What are the main findings?
Dr. Myles: When we set up this study 10 years ago there was marked variation in practice for people taking aspirin waiting for coronary artery bypass surgery. About half were being told that they must stop their aspirin 5-7 days before surgery, and the other half were told that they should stay on their aspirin. This variation existed across different countries, different cities, and even within a single hospital. Doctors had varied opinions because reliable medical research was sparse; the evidence was contradictory. We thus designed a definitive clinical trial in which half the patients were randomly assigned to receive aspirin and the other half received a placebo. Our study has shown that aspirin is safe (i.e. it does not increase the bleeding risk). We also found that there does not appear to be a benefit during and after surgery, but in view of the clear benefits that exist in daily life, including the preoperative waiting period, we recommend that people should stay on their aspirin if they are having coronary artery surgery.