Author Interviews, BMJ, Nutrition, Weight Research / 29.01.2016

[caption id="attachment_21010" align="alignleft" width="148"]Dr. Monica L. Bertoia, MPH, PhD Instructor in Medicine, Channing Division of Network Medicine Brigham and Women’s Hospital & Harvard Medical School Research Associate, Department of Nutrition Harvard T. H. Chan School of Public Health Boston, MA 02115 Dr. Monica Bertoia[/caption] MedicalResearch.com Interview with: Monica L. Bertoia, MPH, PhD Instructor in Medicine, Channing Division of Network Medicine Brigham and Women’s Hospital & Harvard Medical School 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? Response: Most weight loss studies have focused on one type of flavonoid, the flavan-3-ols found in green tea, and are limited to small numbers of overweight and obese study participants. We examined 7 subclasses of flavonoids and weight change in 124,086 healthy adults who reported their diet and weight repeatedly over up to 24 years.
Abuse and Neglect, Accidents & Violence, Author Interviews, JAMA, Mental Health Research / 29.01.2016

[caption id="attachment_20983" align="alignleft" width="168"]Tracie O. Afifi, PhD Associate Professor of Epidemiology CIHR New Investigator (2013-2018) Departments of Community Health Sciences and Psychiatry College of Medicine, Faculty of Health Sciences University of Manitoba Dr. Tracie Afifi[/caption] MedicalResearch.com Interview with: Tracie O. Afifi, PhD Associate Professor of Epidemiology CIHR New Investigator (2013-2018) Departments of Community Health Sciences and Psychiatry College of Medicine, Faculty of Health Sciences University of Manitoba  Medical Research: What is the background for this study? Dr. Afifi: Recent studies in the US have examined predictors and correlates of suicide among solider, but none of these studies have investigated the potential role that child abuse exposure may play in suicide-related outcomes. In addition no representative military and civilian comparisons from any country have examined possible differences in the prevalence of child abuse exposure and the potential differences in the relationships between child abuse exposure and suicide-related outcomes in these populations. This study uses nationally representative military and civilian samples from Canada. Medical Research: What are the main findings? Dr. Afifi: Child abuse was more prevalent among Regular Forces personnel (47.7%) and Reserve Forces personnel (49.4%) compared to the Canadian general population (33.1%). Child abuse exposure was associated with an increased likelihood of suicidal thoughts, plans, and attempts in military and civilian populations, with associations weaker for many outcomes in military personnel relative to civilians. Deployment-related trauma was associated with past-year suicidal thoughts and suicide plans. However, relative to deployment-related trauma, child abuse exposure had a more robust association with suicide-related outcomes.
Author Interviews, BMJ, Mental Health Research, Pediatrics, Pharmacology / 29.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21081" align="alignleft" width="92"]Tarang Sharma, PhD candidate  Nordic Cochrane Centre, Rigshospitalet University of Copenhagen, Faculty of Health and Medical Sciences, Denmark Tarang Sharma[/caption] Tarang Sharma, PhD candidate  Nordic Cochrane Centre, Rigshospitalet University of Copenhagen, Faculty of Health and Medical Sciences, Denmark Medical Research: What is the background for this study? What are the main findings? Response: These newer antidepressants are some of the most prescribed medications in the world and previous research in the area has suggested an increased suicide risk on these drugs in young people, but only when unpublished clinical study report data is used. Such risk is missing when the published articles are considered due to severe selective reporting and publication bias. In our study we found that the research design of most of the trials was very poor and there were major discrepancies in the reporting, leading to the under-estimation of harms. Despite these problems we still found that both suicidality and aggression were more than doubled in children and adolescents on antidepressants compared to those on placebo.
Author Interviews, Immunotherapy, NEJM, Transplantation, UCSF / 29.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21074" align="alignleft" width="144"]Dr. Flavio Vincenti Dr. Flavio Vincenti[/caption] Dr. Flavio Vincenti, M.D Clinical Professor of Medicine and Surgery Departments of Medicine and Surgery Endowed Chair in Kidney Transplantation University of California, San Francisco San Francisco, CA 94143 Medical Research: What is the background for this study? What are the main findings? Dr. Vincenti: This is a phase 3 study of belacept immunosuppression as compared to cyclosporine based immunosuppression in renal transplant recipients randomly assigned to 2 treatments arms of belatacept and a controlled arm consisting of cyclosporine. The main finding of this study is that Belatacept, a fusion receptor protein that blocks co-stimulation and is administered intravenously on the maintenance of a 4 weekly maintenance therapy, had superior outcomes at 5 and 7 years as compared to patients on a CsA-based regimen. The 7 year data show that patients on either arm of belatacept had a 43 percent risk reduction of deaths or grafts loss as compared to patients treated with cyclosporine. In addition, belatcept patients had significantly better preservation of renal function throughout the 7 years of follow up and had lower incidence of donor specific antibodies. Nephrotoxicity from cyclosporine and donor specific antibodies are important causes of late graft loss.
Author Interviews, Cancer, Colon Cancer, Surgical Research / 29.01.2016

More on Colon Cancer on MedicalResearch.com [caption id="attachment_21070" align="alignleft" width="133"]Samantha Hendren, MD, MPH Associate Professor of Surgery Colorectal Surgery University of Michigan Dr. Samantha Hendren[/caption] MedicalResearch.com Interview with: Samantha Hendren, MD, MPH Associate Professor of Surgery Colorectal Surgery University of Michigan  Medical Research: What is the background for this study? What are the main findings? Response: We studied colorectal cancer nationally, and found that about 1 in 7 colorectal cancer patients in the U.S. (that is, 14.7%) is diagnosed before the age of 50.  We also found that these younger colorectal cancer patients were diagnosed when their cancers were more advanced (higher “stage”, meaning more of them had spread to lymph nodes and/or to other organs).  Part of the reason for this is that these young patients are often diagnosed only after their cancers start to cause symptoms such as anemia, bowel bleeding or a blockage in the colon. The age of 50 is when screening for colorectal cancer is started in the U.S.  This study means that a pretty large proportion of colorectal cancers are  happening in people who are too young to receive screening tests.  To put this in context, breast cancer screening often begins at age 40, and less than 5% of invasive breast cancers occur in women under that age. Our study found that about 15% of colorectal cancers are diagnosed before the screening age of 50. Fortunately, the young patients with colorectal cancer do a little better than you might predict, knowing that they are diagnosed at a worse cancer “stage”.  For the young patients under 50, about 68% survived 5 years, while about 67% of the patients 50 and older survived 5 years.  It looks like patients’ young age helps them in their cancer treatment and survival; our study found that treatment may be a bit more aggressive in the younger patients.
Author Interviews, Brigham & Women's - Harvard, Diabetes, Diabetologia, Sleep Disorders / 29.01.2016

MedicalResearch.com Interview with: Dr. Yanping Li Research Scientist 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. Li: Sleeping difficulty is a common disorder but always lack of attention from both the patients and physicians. Our study finds that women with sleeping difficulty is associated with a higher risk of type 2 diabetes.
Author Interviews, JAMA, Smoking / 29.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21066" align="alignleft" width="100"]John Cunningham, PhD Senior Scientist, Social & Epidemiological Research  Centre for Addiction and Mental Health Toronto, Ontario Dr. John Cunningham[/caption] John Cunningham, PhD Senior Scientist, Social & Epidemiological Research Centre for Addiction and Mental Health Toronto, Ontario  Medical Research: What is the background for this study? What are the main findings? Dr. Cunningham: Nicotine Replacement Therapy (NRT) has been found to improve tobacco cessation success rates in clinical trials where there is accompanying behavioral support. However, population survey data has indicated that people who purchase NRT as part of a quit attempt are no more successful at quitting smoking than people who don’t use NRT as part of their quit attempt. While causal statements about the effectiveness of NRT cannot be made based on the population survey findings, it does raise concerns about the effectiveness of NRT when there is no accompanying behavioral support. Our trial used an interesting design where participants were recruited for a longitudinal survey about their patterns of smoking. As part of this survey, participants were asked if they would be interested in nicotine patches to help them quit smoking, if they were offered for free. Of those participants who said they were interested, a randomized half were actually sent a five-week supply of nicotine patches. The other half of participants were not sent the nicotine patches and were, in fact, unaware that nicotine patches were sent to others in the trial. Participants were followed-up at 8 weeks and 6 months, with those participants receiving free-of-charge nicotine patches being more likely to report current abstinence compared to those participants not sent the free nicotine patches (30-day self-reported abstinence at 6-months was 7.6% versus 3.0% respectively; odds ratio (OR), 2.65; 95% CI, 1.44 - 4.89, p = .002).
Author Interviews, Cancer Research, Genetic Research, PNAS / 28.01.2016

MedicalResearch.com Interview with: [caption id="attachment_21043" align="alignleft" width="150"]Nina Bhardwaj, MD, PhD and Director of Immunotherapy and professor of Hematology and Medical Oncology Dr. Nina Bhardwaj[/caption] Nina Bhardwaj, MD, PhD and Director of Immunotherapy and professor of Hematology and Medical Oncology [caption id="attachment_21044" align="alignleft" width="130"]Benjamin Greenbaum, PhD Assistant Professor The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai Dr. Benjamin Greenbaum[/caption] Benjamin Greenbaum, PhD Assistant Professor The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai   Medical Research: How did the discovery of the group of non-coding RNA molecules in cancer cells that sets off an immune response come about? Dr. Greenbaum: Our work is a collaboration between my lab, which is computational, and the Bhardwaj lab, focused on cancer immunology. I had previously made the observation that certain RNA viruses were avoiding certain motifs, such as CpG dinucleotide containing motifs, and the Bhardwaj lab tested whether those motifs could set off an immune response. Recent work had shown that tumors transcribe unusual RNA with immunological consequences, so we investigated whether the same sort of approaches we had used for viral RNA worked here. Dr. Bhardwaj: It has recently become clear that, due to epigenetic alterations, tumors transcribe non-coding RNAs that are typically silenced. Often such RNA emanates from the “dark matter” genome. Many of these regions consist of repetitive elements and endogenous retroelements that are rarely transcribed in normal tissue. At the same time, due to immunotherapy, understanding the role of the immune system and immune activation in tumors has become critically important. The activation of specific elements of the innate immune system in a tumor may have either beneficial or detrimental effects for patients. Moreover, recent work has suggested that endogenous element activation can lead to improved immunotherapy outcomes. Therefore, it is critically important to understand the nature of innate immune activation in tumors and what triggers are responsible for these responses. We have been developing methods to detect abnormal patterns in viral RNA that may indicate activation of the innate immune system. We have found that patterns of motif usage avoided in the evolution of viruses, such as influenza, indicate RNA features that provoke an innate immune response. The innate immune system is capable of sensing motifs in viruses. We tested directly whether these avoided patterns are immunostimulatory. Medical Research: What are the main findings? Dr. Bhardwaj: We used a novel quantitative approach, derived from methods in statistical physics, to characterize all of the non-coding RNA transcribed by normal tissue and compared them to the non-coding RNA found in tumors. We found that while the non-coding RNA transcribed in normal tissue displays patterns of motif usage consisting with that of coding RNA, the RNA transcribed in tumors, yet rarely found in normal tissue, can have motif usage more typically associated with viral and bacterial genomes. We predicted a handful of such RNA are immunostimulatory and validated this prediction in antigen presenting cells. We then showed that this sensing may come from a subset of the innate immune system associated with pathogen RNA sensing. We called these RNA “i-ncRNA”, for immunostimulatory non-coding RNA.
Author Interviews, Brain Cancer - Brain Tumors, Dermatology, JAMA / 27.01.2016

[caption id="attachment_21019" align="alignleft" width="200"]Alexander Egeberg, MD PhD National Allergy Research Centre, Departments of Dermato-Allergology and Cardiology Herlev and Gentofte University Hospital, University of Copenhagen Hellerup, Denmark Dr. Alexander Egeberg[/caption] MedicalResearch.com Interview with: Alexander Egeberg, MD PhD National Allergy Research Centre, Departments of Dermato-Allergology and Cardiology Herlev and Gentofte University Hospital University of Copenhagen Hellerup, Denmark   Medical Research: What is the background for this study? What are the main findings? Dr. Egeberg: There appears to be an overlap in the pathogenesis of rosacea and glioma, focused around matrix metalloproteinases. Rosacea may be associated with an increased risk of glioma, however, it is important to note that the absolute risk is still low. Whether this is a causal link is not known.
Annals Thoracic Surgery, Author Interviews, Heart Disease, Outcomes & Safety, Surgical Research / 27.01.2016

[caption id="attachment_21014" align="alignleft" width="174"]Dr. Christian McNeely, MD Resident Physician, Division of Cardiothoracic Surgery Barnes-Jewish Hospital/Washington University Medical Center St. Louis, Missosuri Dr. Christian McNeely[/caption] MedicalResearch.com Interview with: Dr. Christian McNeely, MD Resident Physician, Department of Medicine Barnes-Jewish Hospital/Washington University Medical Center St. Louis, Missosuri  MedicalResearch: What is the background for this study? What are the main findings? Dr. McNeely : Since year 2000, 30-day mortality of aortic valve replacement (AVR) in Medicare beneficiaries has improved. Additionally, mechanical valve use in the elderly, which are often avoided in older patients largely because the risk of bleeding complications outweighs the risk of valve deterioration over time, has fallen significantly. Prior research has demonstrated worse outcomes in cardiac surgery for lower volume centers. Therefore, we sought to investigate the longitudinal relationship between institutional volume and outcomes in AVR using the Medicare database, looking at patients only > 65 years over a 10-year period. We found that, in general, mechanical valve use in the elderly decreased with increasing hospital volume. Lower volume hospitals exhibited increased adjusted operative mortality. Importantly, the discrepancy in operative mortality between low and high-volume hospitals diverged during the course of the study such that higher volume centers demonstrated significantly greater improvement over time compared to lower volume centers.
Author Interviews, JAMA, Melanoma / 27.01.2016

[caption id="attachment_20934" align="alignleft" width="133"]DeAnn Lazovich, Ph.D. Associate Professor Division of Epidemiology and Community Health University of Minnesota Minneapolis, MN 55454 Dr. Lazovich[/caption] MedicalResearch.com Interview with: DeAnn Lazovich, Ph.D. Associate Professor Division of Epidemiology and Community Health University of Minnesota Minneapolis, MN 55454 Medical Research: What is the background for this study? What are the main findings? Dr. Lazovich: In Minnesota, as well as nationally, melanoma rates have been increasing more steeply in women than men younger than age 50 years since about the mid-1990s.  Some have speculated that this could be due to women's indoor tanning use, as women use indoor tanning much more than men do.  We had data on indoor tanning for men and women according to their age from a case-control study on indoor tanning and melanoma that was published in 2010.  In that 2010 report, we examined the association for individuals regardless of sex, all ages combined.  In this analysis, we restricted the study to individuals under age 50 years, and looked at the association between indoor tanning and melanoma according to three age groups (less than 30 years, 30-39 years and 40-49 years) for men and women separately.
Author Interviews, JAMA, Smoking / 27.01.2016

[caption id="attachment_21001" align="alignleft" width="125"]Dr-Timothy-B-Baker.jpg Dr. Timothy B. Baker[/caption] MedicalResearch.com Interview with: Timothy Baker, PhD Professor of Medicine University of Wisconsin-Madison School of Medicine and Public Health Medical Research: What is the background for this study? What are the main findings? Dr. Baker: Previous research showed that combination nicotine replacement (the nicotine patch plus the nicotine lozenge or gum) and varenicline are the most effective smoking cessation treatments available, yet they had never been directly compared with one another. This study set out to do that, and compare them with the nicotine patch. The present study shows that three medications which were combined with coaching to quit smoking—a pill called varenicline (Chantix), the nicotine patch alone, and a combination of nicotine-replacement medications—all produced about the same abstinence rates among participants at 6- and 12-months after the quit attempt. We were surprised that the patch by itself produced about the same level of success as the other two more intensive medications.
Annals Internal Medicine, Author Interviews, Biomarkers, Colon Cancer, Kaiser Permanente / 27.01.2016

[caption id="attachment_20998" align="alignleft" width="150"]Douglas A. Corley, MD, PhD Gastroenterologist and Research Scientist III Division of Research Kaiser Permanente Oakland, CA Dr. Douglas Corley[/caption] MedicalResearch.com Interview with: Douglas A. Corley, MD, PhD Gastroenterologist and Research Scientist III Division of Research Kaiser Permanente Oakland, CA  Medical Research: What is the background for this study? What are the main findings? Dr. Corley: Colorectal cancer is a leading cause of cancer death in the United States, so understanding how cancer screening tests for this cancer are used and if they are effective is extremely important. There are two commonly used tests for colorectal cancer screening in the United States: colonoscopy and fecal immunochemical tests (also known as "FIT"). Colonoscopy requires a bowel preparation to clean you out and is invasive but, if normal, it is done infrequently (every ten years). FIT is simple to do at home but, to be most effective, needs to be done every year. This has the advantage of potentially picking up cancers that grow between tests. There are few studies that have looked at how well FIT picks up cancers when used year after year. If a test picks up most cancers, it is said to be very "sensitive" for picking up cancer. Most studies only looked at 1 or 2 years of use for how well FITdetected cancers. It is possible that the first year of use may "clear out" most of the easily detectable cancers and that FIT might not work as well in subsequent years. This very large study over several years at Kaisier Permanente, where we use both colonoscopy and FIT for colorectal cancer screening, looked at whether FIT worked as well at detecting cancer in years 3 and 4 as it did the first time someone used it. We found that the sensitivity was highest in the first year, likely from clearing out cancers that were there for a while and easily detected, but that in subsequent years the sensitivity, though 5-10% lower, remained high. Also, most people who started with FIT continued doing it, suggesting that it is both feasible and effective for colorectal cancer screening.
Author Interviews, Brigham & Women's - Harvard, End of Life Care, JAMA / 27.01.2016

MedicalResearch.com Interview with: Joel Weissman, PhD, Deputy Director and Zara Cooper, MD, MSc Associate Surgeon Center for Surgery and Public Health Brigham and Women’s Hospital Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: A major priority for providers of end-of-life care is balancing the intensity of a patient’s treatment with quality of life. Previous studies have looked at the intensity of end-of-life care for the general population, but not whether physicians, the group most familiar with end-of-life care, receive more or less intense end-of-life care compared to non-physicians. Research from the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital found that for 3 of 5 end-of-life care intensity measures, physicians received significantly less intensive end-of-life care than the general population.  The findings are published in the January 19, 2016 issue of JAMA, in a special themed issue focusing on end-of-life care. The analysis included non-health maintenance organization Medicare beneficiaries aged 65 years or older who died between 2004 and 2011 in Massachusetts, Michigan, Utah, and Vermont, and was based on availability of electronic death records and ability to link to Medicare. Researchers used data from these records to look at 5 validated measures of end-of-life care intensity during the last 6 months of life: surgery, hospice care, intensive care unit (ICU) admission, death in the hospital, and expenditures. They then compared these measures between physicians and the general population (excluding other health care workers and lawyers), physicians vs. lawyers, who are presumed to be socioeconomically and educationally similar, and lawyers vs. the general population. There were 2,396 deceased physicians, 2,081 lawyers, and 666,579 people included in the analysis. Overall, physicians were less likely to die in a hospital compared with the general population (27.9 percent vs. 32 percent, respectively), less likely to have surgery (25.1 percent vs. 27.4 percent), and less likely to be admitted to the ICU (25.8 percent vs. 27.6 percent). Physicians were less likely to die in a hospital compared to lawyers (27.9 percent vs. 32.7 percent, respectively), but did not differ significantly in other measures.
Asthma, Author Interviews, JAMA, OBGYNE, Vitamin D / 27.01.2016

More on Asthma on MedicalResearch.com [caption id="attachment_19464" align="alignleft" width="133"]Professor of Pediatrics Hans Bisgaard, MD, DMSc Copenhagen Prospective Studies on Asthma in Childhood Herlev and Gentofte Hospital, University of Copenhagen, Denmark. Prof. Bisgaard[/caption] MedicalResearch.com Interview with: Hans Bisgaard, MD, DMSc Professor of Pediatrics The Faculty of Health Sciences University of Copenhagen Head of the Copenhagen Prospective Studies on Asthma in Childhood University  of Copenhagen and Naestved Hospital MedicalResearch: What is the background for this study? What are the main findings? Dr. Bisgaard: Vitamin D deficiency has become a common health problem in westernized societies, possibly caused by a more sedentary indoor lifestyle and decreased intake of vitamin D containing foods. Vitamin D possesses a range of immune regulatory properties, and it has been speculated that vitamin D deficiency during pregnancy may affect fetal immune programming and contribute to asthma pathogenesis. Asthma often begins in early childhood and is the most common chronic childhood disorder. Observational studies have suggested that increased dietary vitamin D intake during pregnancy may protect against wheezing in the offspring, but the preventive effect of vitamin D supplementation to pregnant women is unknown. In our double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort we supplemented 2800 IU/d of vitamin D3 during the third trimester of pregnancy compared with 400 IU/d in the control group. Although the maternal supplementation did not result in a statistically significant reduction of risk of persistent wheeze in the offspring through age 3 years, the interpretation of the study is limited by a wide confidence interval that includes a clinically important protective effect.
Author Interviews, HIV, PLoS / 26.01.2016

[caption id="attachment_21005" align="alignleft" width="200"]Julian Falutz, MD Director, HIV Metabolic Clinic MUHC,  Coordinator of Chronic Viral Illness Service, HIV and Aging Clinic McGill University Health Center Dr. Julian Falutz[/caption] MedicalResearch.com Interview with: Julian Falutz, MD Director, HIV Metabolic Clinic MUHC, Coordinator of Chronic Viral Illness Service, HIV and Aging Clinic McGill University Health Center Medical Research: What is the background for this study? What are the main findings? Dr. Falutz: The long-term use of antiretroviral therapy (ART) in HIV-infected patients is associated with body composition changes, including visceral adipose tissue (VAT) accumulation. HIV-infected patients with excess VAT may be at increased risk of type 2 diabetes, cardiovascular diseases, and mortality. Tesamorelin is a synthetic analog of human growth hormone-releasing factor, also known as growth hormone-releasing hormone (GHRH), which is indicated for the treatment of excess abdominal fat in HIV-infected patients with lipodystrophy. The objectives of our paper were to 1) evaluate the utility of patient characteristics and validated disease-risk scores, including indicator variables for the metabolic syndrome and the Framingham Risk Score (FRS), as predictors of  visceral adipose tissue reduction during tesamorelin therapy, and 2) to explore the characteristics of patients who reached a threshold of VAT <140 cm2, a level associated with lower risk of adverse health outcomes, after 6 months of treatment with tesamorelin. The basis of the report was a pooled analysis of the two pivotal, randomized Phase 3 trials of tesamorelin in 806 HIV-infected patients with excess abdominal fat. Our results indicate that presence of metabolic syndrome, high triglycerides, and white race are associated with a greater likelihood of responding to 6 months of tesamorelin treatment. The most robust response appears to be in subjects with VAT above 140 cm2, as well as those in the overweight range for body mass index (BMI) measures.
Asthma, Author Interviews, Brigham & Women's - Harvard, JAMA, Vitamin D / 26.01.2016

[caption id="attachment_20929" align="alignleft" width="120"]Augusto A. Litonjua, MD, MPH Associate Professor Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 USA Dr. Augusto Litonjua[/caption] MedicalResearch.com Interview with: Augusto A. Litonjua, MD, MPH Associate Professor Channing Division of Network Medicine and Division of Pulmonary and Critical Care Medicine Department of Medicine Brigham and Women's Hospital Harvard Medical School Boston, MA 02115 USA  Medical Research: What is the background for this study? What are the main findings? Response: Vitamin D deficiency has been hypothesized to contribute to the asthma and allergy epidemic.  Vitamin D has been shown to affect lung development in utero. However, observational studies have shown mixed results when studying asthma development in young children. Since most asthma cases start out as wheezing illnesses in very young children, we hypothesized that vitamin D supplementation in pregnant mothers might prevent the development of asthma and wheezing illnesses in their offspring.  We randomly assigned 881 pregnant women at 10 to 18 weeks' gestation and at high risk of having children with asthma to receive daily 4,000 IU vitamin D plus a prenatal vitamin containing 400 IU vitamin D (n = 440), or a placebo plus a prenatal vitamin containing 400 IU vitamin D (n = 436). Eight hundred ten infants were born during the study period, and 806 were included in the analyses for the 3-year outcomes. The children born to mothers in the 4,400 IU group had a 20% reduction in the development of asthma or recurrent wheeze compared to the children born to mothers in the 400 IU group (24% vs 30%, respectively; an absolute reduction of 6%).  However, this reduction did not reach statistical significance (p=0.051).
Aging, Author Interviews, Autism, Mental Health Research, PLoS, Schizophrenia / 25.01.2016

[caption id="attachment_20922" align="alignleft" width="127"]Dr. Richard Deth PhD Professor of Pharmacology Department of Pharmaceutical Sciences Nova Southeastern University Dr. Richard Deth[/caption] MedicalResearch.com Interview with: Dr. Richard Deth PhD Professor of Pharmacology Department of Pharmaceutical Sciences Nova Southeastern University Medical Research: What is the background for this study? Dr. Deth: Vitamin B12 plays a crucial role in regulating and promoting methylation reactions (the attachment of a carbon atom to molecules), including DNA methylation. Recent research has identified methylation of DNA and consequential changes in gene expression as crucial factors in brain development, as well as in memory formation and maintenance of brain function during aging. More specifically, the cause(s) of neurodevelopmental disorders such as autism remain obscure, although numerous studies have demonstrated oxidative stress and low plasma levels of the antioxidant glutathione (GSH) in autism.  Medical Research: What are the main findings? Dr. Deth: We found that brain levels of vitamin B12, especially the methylation-regulating form known as methylB12, decrease significantly with age, even though blood levels don’t show a similar decrease. Importantly, much lower levels of methylB12 were found in subjects with autism and schizophrenia compared to normal subjects of a similar age. Animal studies showed that impaired GSH formation is associated with decreased brain B12 levels.
Author Interviews, BMJ, Cancer Research, Heart Disease, Pharmacology / 24.01.2016

More on Heart Disease on MedicalResearch.com [caption id="attachment_20895" align="alignleft" width="104"]Prof. Ian Wong Prof. Ian Wong[/caption] MedicalResearch.com Interview with: Professor Ian C K Wong Fellow of Royal Pharmaceutical Society Fellow of Royal College of Paediatrics and Child Health (Honorary) Fellow of the Higher Education Academy Chair in Pharmacy Practice Head of Research Department of Practice and Policy UCL School of Pharmacy London  Medical Research: What is the background for this study? What are the main findings? Dr. Wong: Previous studies had showed an increased cardiovascular risk associated with clarithromycin (a widely used antibiotic) but the duration of effect remained unclear. Therefore, we conducted this study to investigate the duration of cardiovascular adverse effect provided that the risk exists after patients receiving clarithromycin in Hong Kong. We used three study designs to examine the  association (temporal relationship) between clarithromycin and cardiovascular adverse outcomes such as myocardial infarction, arrhythmia, stroke, cardiac mortality at different time points.

We found that there was an increased short-term risk of myocardial infarction, arrhythmia and cardiac mortality associated with clarithromycin in all study designs. However, no long-term risk was observed. In every 1000 patients, there was 1.90 extra myocardial infarction events in current use of CLARITHROMYCIN when compared with the use of amoxicillin.

Author Interviews, Breast Cancer, Cancer Research, JAMA, Prostate Cancer / 23.01.2016

More on Cancer Research on MedicalResearch.com [caption id="attachment_20801" align="alignleft" width="142"]MedicalResearch.com Interview with: Firas Abdollah, M.D., F.E.B.U. (Fellow of European Board of Urology) Urology Fellow with the Center for Outcomes Research, Analytics and Evaluation Vattikuti Urology Institute at Henry Ford Hospital in Detroit Dr. Firas Abdollah[/caption] MedicalResearch.com Interview with: Firas Abdollah, M.D., F.E.B.U. (Fellow of European Board of Urology) Urology Fellow with the Center for Outcomes Research, Analytics and Evaluation Vattikuti Urology Institute at Henry Ford Hospital in Detroit  MedicalResearch: What is the background for this study? What are the main findings? Dr. Abdollah: Cancer screening aims to detect tumors early, before they become symptomatic. Evidence suggests that detection and treatment of early-stage tumors may reduce cancer mortality among screened individuals. Despite this potential benefit, screening programs may also cause harm. Notably, screening may identify low-risk indolent tumors that would never become clinically evident in the absence of screening (overdiagnosis), subjecting patients to the harms of unnecessary treatment. Such considerations are central to screening for prostate and breast cancers, the most prevalent solid tumors in men and women, respectively. These tumors are often slow growing, and guidelines recommend against screening (non-recommended screening) for these tumors in individuals with limited life expectancy, i.e. those with a life expectancy less than 10 years. Unfortunately, our study found that this practice is not uncommon in the US. Using a nationwide representative survey conducted in 2012, we found that among 149,514 individuals 65 years or older, 76,419 (51.1%) received any prostate/breast screening. Among these, 23,532 (30.8%) individuals had a life expectancy of less than 10 years. These numbers imply that among the screened population over 65 years old, almost one in three individuals received a non-recommended screening. This corresponds to an overall rate of non-recommended screening of 15.7% (23,532 of 149,514 individuals). Another important finding of our study was that there were important variations in the rate of non-recommended screening from state to state; i.e. the chance of an individual older than 65 to receive a non-recommended screening varies based on his/her geographical location in United States. Finally, on a state-by-state level, there was a correlation (40%) between non-recommended screening for prostate and breast cancer, i.e. states that are more likely to offer non-recommended screening for prostate cancer are also more likely to offer non-recommended screening for breast cancer, and vice versa.
Author Interviews, Heart Disease, JACC / 23.01.2016

[caption id="attachment_20856" align="alignleft" width="133"]Frank J. Rybicki, MD, PhD Professor, Chair and Chief, Department of Radiology The University of Ottawa, Faculty of Medicine and The Ottawa Hospital Editor-in-Chief, 3D Printing in Medicine Dr. Frank Rybicki[/caption] MedicalResearch.com Interview with: Frank J. Rybicki, MD, PhD Professor, Chair and Chief, Department of Radiology The University of Ottawa, Faculty of Medicine and The Ottawa Hospital Editor-in-Chief, 3D Printing in Medicine Medical Research: What is the background for this document? Dr. Rybicki: This document represents a conglomeration of the approach to appropriateness of three large medical professional groups. The American College of Radiology Appropriateness Criteria® are evidence based guidelines to assist referring physicians to order the most appropriate imaging test for a wide range of clinical scenarios. The Appropriateness Criteria are divided by organ section, and while they include emergent imaging studies, there is not a single publication to provide imaging guidance for patients who present to the emergency room with chest pain. The American College of Cardiology Appropriate Use Criteria provides evidence based data for a very large gamut of cardiovascular conditions. These guidelines include emergent cardiovascular imaging; however the Appropriate Use Criteria are divided by modality and like the ACR have not specially addressed this important, high risk patient population. The American College of Emergency Physicians, a key stakeholder group that represents referring physicians, has developed a large number of guidelines but also has not organized this group of imaging recommendations. Thus, the background of this document was a joint effort among all three societies to update, harmonize, and publish contemporary guidelines that can be readily incorporated into clinical practice but also provide standards for a large fraction of patients who come to the emergency room with chest pain who require imaging to evaluate for a life threatening diagnosis. Medical Research: What types of chest pain conditions are covered by these guidelines? Dr. Rybicki: Based on the background as noted above, the Writing Group for this important document included cardiologists, emergency physicians, and radiologists. Since the group was charged with describing common clinical scenarios seen in contemporary practice, there are four entry points for chest pain conditions. They are as follows:
  1. Suspected Non-ST Segment Elevation Acute Coronary Syndrome
  2. Suspected Pulmonary Embolism
  3. Suspected Acute Syndrome of the Aorta
  4. Patients for Whom a Leading Diagnosis is Problematic or not Possible 
Annals Internal Medicine, Author Interviews, Menopause, Pain Research / 23.01.2016

[caption id="attachment_20875" align="alignleft" width="133"]Acupuncture-Wikipedia-Image Acupuncture Presure[/caption] MedicalResearch.com Interview with: Carolyn EeMBBS Department of General Practice University of Melbourne Carlton, Victoria, Australia Medical Research: What is the background for this study? What are the main findings? Response: Hot flushes affect up to 90% of women during the menopause and beyond, and women are turning to complementary therapies. Our randomised sham-controlled trial found no difference between real and sham acupuncture (given with a blunt needle) for hot flushes, with both groups improving by around 40% at the end of treatment.
Accidents & Violence, Author Interviews, JAMA, Surgical Research, UCSF / 22.01.2016

[caption id="attachment_20845" align="alignleft" width="140"]Dr. Rachael Callcut M.D., M.S.P.H Assistant Professor of Surgery Division of General Surgery UCSF Dr. Rachael Callcut[/caption] MedicalResearch.com Interview with: Dr. Rachael Callcut M.D., M.S.P.H Assistant Professor of Surgery Division of General Surgery UCSF Medical Research: What is the background for this study? What are the main findings? Dr. Callcut: San Francisco General Hospital (SFGH) responded on July 6, 2013 to one of the larger multiple casualty events in the history of our institution.  Asiana Airlines flight 214 crashed on approach to San Francisco International Airport with 307 people on board.  192 patients were injured and SFGH received the highest total of number of patients of area hospitals. The majority of data that is available on disaster response focuses on initial scene triage or initial hospital resources required to respond to these types of major events.  Our paper focuses on some additional considerations for optimizing disaster response not typically included in literature on these events including nursing resources, blood bank needs, and radiology studies. As an example, over 370 hours of nursing overtime were needed just in the first 18 hours following the disaster to care for patients.  This type of information in traditionally not been included in disaster planning, but clearly was a critical element of providing optimum care to our patients.
Author Interviews, HPV, JAMA / 22.01.2016

[caption id="attachment_20757" align="alignleft" width="125"]Ilir Agalliu, M.D., Sc.D. Assistant Professor, Department of Epidemiology & Population Health and Department of Urology Albert Einstein College of Medicine Jack and Pearl Resnick Campus Bronx, NY Dr. Ilir Agalliu[/caption] More on HPV on MedicalResearch.com  MedicalResearch.com Interview with: Ilir Agalliu, M.D., Sc.D. Assistant Professor, Department of Epidemiology & Population Health and Department of Urology Albert Einstein College of Medicine Jack and Pearl Resnick Campus Bronx, NY Medical Research: What is the background for this study? Dr. Burk: We performed this study since we had previously detected an unusually high prevalence of HPV types found on the skin and skin cancers in the oral cavity in addition to HPV16 and other high-risk (HR) types (as defined by their association with cervix cancer) (see Journal of Infectious Diseases 204:787, 2011). We wished to determine if these types were associated with risk of head and neck cancers (HNSCCs). In addition, we wished to determine if HPV detection preceded the diagnosis of HNSCCs and might serve as a biomarker. Currently there are no good screening tests for HNSCC. Dr. AgalliuTo-date, there have been no prospective studies examining the temporal relationship between oral HPV detection and risk of head and neck squamous cell carcinoma (HNSCC). In this manuscript we examined prospectively associations between detection of a wide spectrum of oral HPVs (alpha, beta and gamma) with incident HNSCC in a nested case-control study among ~100,000 participants who provided mouthwash samples in the American Cancer Society-CPS II cohort and the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. Dr. Agalliu: Oral HPV16 detection, which preceded cancer development on average for 4 years, was associated with a 22-fold increased risk for incident oropharyngeal cancer. Detection of other oral HPVs (beta1 HPV5, and gamma11 and 12 species) were associated with a 3.3 to 5.5-fold higher risk of  head and neck squamous cell carcinoma after adjustment for smoking, alcohol and HPV16. Associations of beta and gamma HPVs, which have been identified in the skin, with risk of HNSCC suggest a broader role for HPVs in HNSCC etiology.
Author Interviews, Cancer Research, PNAS / 21.01.2016

[caption id="attachment_20795" align="alignleft" width="149"]Dr. Elizabeth Murchison Menzies Institute for Medical Research University of Tasmania Save the Tasmanian Devil Program Tasmanian Department of Primary Industries, Parks, Water and the Environment Hobart Australia Department of Veterinary Medicine University of Cambridge, Cambridge UK Dr. Murchison[/caption] MedicalResearch.com Interview with: Dr. Elizabeth Murchison Menzies Institute for Medical Research University of Tasmania Save the Tasmanian Devil Program Tasmanian Department of Primary Industries, Parks, Water and the Environment Hobart Australia Department of Veterinary Medicine University of Cambridge, Cambridge UK Medical Research: What is the background for this study? Dr. Murchison: Transmissible cancers are cancers that can be transmitted between individuals by the transfer of living cancer cells. Transmissible cancers emerge only very rarely in nature, and until now only three examples were known. One of the three known naturally occurring transmissible cancers affects Tasmanian devils, the world’s largest carnivorous marsupial. This disease, which causes disfiguring facial tumours, was first observed in the late 1990s, and since then the disease has spread widely through the Tasmanian devil population. This transmissible cancer first emerged as a cancer in a single individual Tasmanian devil that probably lived about 30 years ago; this devil’s cancer cells have continued to survive by transmitting between hosts by biting. Medical Research: What are the main findings? Dr. Murchison: In late 2014, routine monitoring of the Tasmanian devil population led to the discovery of a male devil with facial tumours that resembled the known Tasmanian devil transmissible facial cancer. However, genetic analysis of this tumour indicated that the tumour in this devil was derived from a second transmissible cancer that was genetically unrelated to the first transmissible cancer in this species. Indeed, the genetic profile of this second cancer indicated that it had originally emerged from a male animal. This second cancer has subsequently been found in nine additional devils in the same part of Tasmania.
Asthma, Author Interviews, Lancet, Pharmacology / 20.01.2016

[caption id="attachment_19464" align="alignleft" width="133"]Professor of Pediatrics Hans Bisgaard, MD, DMSc Copenhagen Prospective Studies on Asthma in Childhood Herlev and Gentofte Hospital, University of Copenhagen, Denmark. Prof. Bisgaard[/caption] More on Asthma on MedicalResearch.com MedicalResearch.com Interview with: Hans Bisgaard, MD, DMSc Professor of Pediatrics The Faculty of Health Sciences University of Copenhagen Head of the Copenhagen Prospective Studies on Asthma in Childhood University  of Copenhagen and Naestved Hospital Medical Research: What is the background for this study? Dr. Bisgaard: Childhood asthma is often preceded by recurrent asthma-like symptoms in relation to airway infections in the first years of life. Bacteria and viruses are equally associated with the risk of episodes of asthma-like symptoms in these children, suggesting antibiotics as a potential treatment for such episodes. Medical Research: What are the main findings? Dr. Bisgaard: Our study demonstrates a clinically significant shortening of symptom duration by 63% after intervention. The effect size increased with early initiation of treatment, showing a reduction in episode duration of 83% if treatment was initiated before day 6 of the episode. Azithromycin was effective in shortening the episodes even though no pathogenic bacteria was detected. This study is, to our knowledge, the first randomized trial of azithromycin treatment of acute episodes of asthma-like symptoms in young children with a history of recurrent episodes.
Author Interviews, JAMA, Nursing, Outcomes & Safety, Surgical Research, University of Pennsylvania / 20.01.2016

More on Nursing Research on MedicalResearch.com MedicalResearch.com Interview with: [caption id="attachment_20725" align="alignleft" width="178"]Jeffrey H. Silber, M.D., Ph.D. The Nancy Abramson Wolfson Professor of Health Services Research The Children's Hospital of Philadelphia Professor of Pediatrics and Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine Professor of Health Care Management, The Wharton School Director, Center for Outcomes Research The Children's Hospital of Philadelphia Philadelphia, PA 19104 Dr. Jeffrey Silber[/caption] Jeffrey H. Silber, M.D., Ph.D. The Nancy Abramson Wolfson Professor of Health Services Research Professor of Pediatrics and Anesthesiology & Critical Care,  The University of Pennsylvania Perelman School of Medicine Professor of Health Care Management The Wharton School Director, Center for Outcomes Research The Children's Hospital of Philadelphia Philadelphia, PA 19104  Medical Research: What is the background for this study? Response: We wanted to test whether hospitals with better nursing work environments displayed better outcomes and value than those with worse nursing environments, and to determine whether these results depended on how sick patients were when first admitted to the hospital. Medical Research: What are the main findings? Response: Hospitals with better nursing work environments (defined by Magnet status), and staffing that was above average (a nurse-to-bed ratio greater than or equal to 1), had lower mortality than those hospitals with worse nursing environments and below average staffing levels. The mortality rate in Medicare patients undergoing general surgery was 4.8% in the hospitals with the better nursing environments versus 5.8% in those hospitals with worse nursing environments. Furthermore, cost per patient was similar. We found that better nursing environments were also associated with lower need to use the Intensive Care Unit. The greatest mortality benefit occurred in patients in the highest risk groups.
Anesthesiology, Author Interviews, Frailty, JAMA, Surgical Research / 20.01.2016

More on Frailty on MedicalResearch.com MedicalResearch.com Interview with: [caption id="attachment_20747" align="alignleft" width="150"]Dr. Daniel I McIsaac Dr. Daniel McIsaac[/caption] Dr. Daniel I McIsaac, MD, MPH, FRCPC Assistant Professor of Anesthesiology Department of Anesthesiology The Ottawa Hospital, Civic Campus Ottawa, ON Medical Research: What is the background for this study? Dr. McIsaac: Older age is a well-known risk factor for adverse outcomes after surgery, however, many older patients have positive surgical outcomes. Frailty is a syndrome that encompasses the negative health attributes and comorbidities that accumulate across the lifespan, and is a strong discriminating factor between high- and low-risk older surgical patients.  By definition, frail patients are “sicker” than non-frail patients, so their higher rates of morbidity and mortality after surgery aren’t surprising. However, frailty increases in prevalence with increasing age, so as our population ages we expect to see more frail people presenting for surgery.  Our goal was to evaluate the impact of frailty on postoperative mortality at a population-level, and over the first year after surgery to provide insights that aren’t available in the current literature, which largely consists of single center studies limited to in-hospital and 30-day outcome windows.
Author Interviews, Heart Disease, Infections, JACC / 20.01.2016

MedicalResearch.com Interview with: François Delahaye, MD, PhD Department of Cardiology Hôpital Louis Pradel, Hospices Civils de Lyon Université Claude Bernard Lyon, France Medical Research: What is the background for this study? Response: Infective endocarditis (IE) is a severe disease, with an in-hospital mortality rate of about 20%. Five percent to 10% of patients will have additional episodes of IE. Thus, looking for and treating the portal of entry (POE) of IE is particularly important. The POE of the present episode must be identified in order to treat it. The potential POE of a new episode must be searched for in order to eradicate it and thus lower the risk for a new IE episode. Yet published research on this topic is nonexistent. The search for and treatment of the POE are not even mentioned in the guidelines on IE. We thus undertook a study of the performance of a systematic search for the portal of entry of the present episode of IE and of a potential new episode of Infective endocarditis. Patients were systematically seen by a stomatologist, an ear, nose, and throat specialist, and a urologist; women were systematically seen by a gynecologist; patients were seen by a dermatologist when there were cutaneous and/or mucous lesions. Colonoscopy and gastroscopy were performed if the microorganism came from the gastrointestinal tract in patients ≥ 50 years of age and in those with familial histories of colonic polyposis. Treatment of the portal of entry was systematically considered. Medical Research: What are the main findings? Response: The POEs of the present Infective endocarditis episodes were identified in 74% of the 318 included patients. The most frequent portal of entry was cutaneous (40% of identified POEs). It was mainly (62% of cutaneous POEs) associated with health care and with intravenous drug use. The second most frequent POE was oral or dental (29%). A dental infectious focus was more often involved (59% of oral or dental POEs) than a dental procedure (12%). POEs were gastrointestinal in 23% of patients. Colonic polyps were found in one-half of the patients and colorectal adenocarcinomas in 14%. Performance was good regarding the search for an oral or dental or a colonic potential POE, which were found in 53% and 40% of patients, respectively.
Author Interviews, JAMA, Neurological Disorders, Parkinson's / 20.01.2016

[caption id="attachment_20653" align="alignleft" width="132"]Professor Carl E Clarke Professor of Clinical Neurology and Honorary Consultant Neurologist Department of Neurology City Hospital Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK Prof. Carl Clarke[/caption] More Interviews on Neurological Disorders on MedicalResearch.com MedicalResearch.com Interview with: Professor Carl E Clarke Professor of Clinical Neurology and Honorary Consultant Neurologist Department of Neurology City Hospital Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK Medical Research: What is the background for this study? Dr. Clarke: Parkinson's disease causes problems with activities of daily living that are only partially treated by medication and occasionally surgery. Physiotherapy and occupational therapy services like Ck Physio are traditionally used later in the disease, but it is unclear whether they are clinically and cost-effective in Parkinson's disease. Medical Research: What are the main findings? Dr. Clarke: We performed a large pragmatic randomised trial to evaluate the clinical and cost-effectiveness of individualized physiotherapy and occupational therapy in Parkinson's disease. The PD REHAB trial was a multicenter, open label, parallel group, controlled efficacy trial. 762 patients with mild-moderate Parkinson’s disease were recruited from 38 sites across the United Kingdom. For patients with mild to moderate Parkinson disease, there were no clinically meaningful benefits in activities of daily living or quality of life associated with physiotherapy and occupational therapy.