Medical Research Journals

27 Oct

Posted at 10:42h in Author Interviews, Kidney Disease, Nature
[caption id="attachment_18851" align="alignleft" width="100"]Daniele Zink PhD Institute of Bioengineering and Nanotechnology Singapore Dr. Zink[/caption] MedicalResearch.com Interview with: Daniele Zink PhD Institute of Bioengineering and Nanotechnology Singapore  Medical Research: What is the background for this study? Dr. Zink: The kidney is one of the main target organs for toxic effects of drugs, environmental toxicants and other compounds. Renal proximal tubular cells (PTCs) are frequently affected due to their roles in compound transport and metabolism. Validated and accepted assays for the prediction of PTC toxicity in humans currently do not exist. Recently, we have developed the first and only pre-validated assays for the accurate prediction of PTC toxicity in humans 1, 2. This previous work was performed with human primary renal proximal tubular cells (HPTCs) or embryonic stem cell-derived HPTC-like cells. HPTCs are associated with a variety of issues that apply to all kinds of primary cells, such as cell sourcing problems, inter-donor variability and limited proliferative capacity. Embryonic stem cell-derived cells are associated with ethical and legal issues. These are the main reasons why induced pluripotent stem cell (iPSC)-derived cells are currently a favored cell source for in vitro toxicology and other applications. The problem was that stem cell-based approaches were not well-established with respect to the kidney. Recently, the group of IBN Executive Director Prof. Jackie Y. Ying developed the first protocol for differentiating embryonic stem cells into HPTC-like cells, and my group has contributed to characterizing these cells and publishing the results 3.  In the work published in Scientific Reports ,4we have applied a modified version of this protocol to iPSCs. In this way, we have established the simplest and fastest protocol ever for differentiating iPSCs into HPTC-like cells. The cells can be used for downstream applications after just 8 days of differentiation. These cells can also be applied directly without further purification due to their high purity of > 90%. By using these cells, we have developed the first and only iPSC-based model for the prediction of PTC toxicity in humans. This was achieved by combining our iPSC-based differentiation protocol with our previously developed assay based on interleukin (IL)6/IL8 induction 1, 2 and machine learning methods 5. Machine learning methods were used for data analysis and for determining the predictive performance of the assay. The test accuracy of the predictive iPSC-based model is 87%, and the assay is suitable for correctly identifying injury mechanisms and compound-induced cellular pathways.

26 Oct

Posted at 21:36h in AHA Journals, Author Interviews, Stroke
[caption id="attachment_18708" align="alignleft" width="125"]Shadi Yaghi, MD Assistant Professor of Neurology The Warren Alpert Medical School of Brown University Rhode Island Hospital Stroke Center, Staff Neurologist Dr. Shadi Yaghi[/caption] MedicalResearch.com Interview with: Shadi Yaghi, MD Assistant Professor of Neurology The Warren Alpert Medical School of Brown University Rhode Island Hospital Stroke Center, Staff Neurologist Medical Research: What is the background for this study? What are the main findings? Dr. Yaghi: In this study, we pooled data from 10 stroke centers across the country to investigate the treatment and outcome of post thrombolysis hemorrhage in acute ischemic stroke. This study included 128 patients and showed that the treatments used were not effective in improving the mortality related to this condition.

24 Oct

Posted at 15:16h in Author Interviews, Genetic Research, Kidney Disease, Nature, Stem Cells
[caption id="attachment_18772" align="alignleft" width="140"]Benjamin Freedman, Ph.D. Assistant Professor | University of Washington Department of Medicine | Division of Nephrology Member, Kidney Research Institute Member, Institute for Stem Cell and Regenerative Medicine Seattle WA 98109 Dr. Benjamin Freedman[/caption] MedicalResearch.com Interview with: Benjamin Freedman, Ph.D. Assistant Professor | University of Washington Department of Medicine | Division of Nephrology Member, Kidney Research Institute Member, Institute for Stem Cell and Regenerative Medicine Seattle WA 98109  Medical Research: What is the background for this study? What are the main findings? Dr. Freedman: We are born with a limited number of kidney tubular subunits called nephrons. There are many different types of kidney disease that affect different parts of the nephron. The common denominator between all of these diseases is the irreversible loss of nephrons, which causes chronic kidney disease in 730 million patients worldwide, and end stage renal disease in 2.5 million. Few treatments have been discovered that specifically treat kidney disease, and the therapeutic gold standards, dialysis and transplant, are of limited availability and efficacy. Pluripotent stem cells are a renewable source of patient-specific human tissues for regeneration and disease analysis. In our study, we investigated the potential of pluripotent cells to re-create functional kidney tissue and disease in the lab. Pluripotent cells treated with a simple chemical cocktail matured into mini-kidney 'organoids' that closely resembled nephrons. Using an advanced gene editing technique called CRISPR, we created stem cells with genetic mutations linked to two common kidney diseases, polycystic kidney disease (PKD) and glomerulonephritis. Mini-kidneys derived from these genetically engineered cells showed specific 'symptoms' of these two different diseases in the petri dish.

24 Oct

Posted at 12:51h in Author Interviews, Clots - Coagulation, Heart Disease, JACC
H.A. (Hendrika) van den Ham PharmD Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences Utrecht University The Netherlands.MedicalResearch.com Interview with: H.A. (Hendrika) van den Ham PharmD Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences Utrecht University The Netherlands. Medical Research: What is the background for this study? What are the main findings? Dr. van den Ham: Atrial fibrillation (AF) is associated with a substantial risk of ischemic stroke and thromboembolism. The CHADS2 and the CHA2DS2-VASc risk scores are developed to guide the decision to prescribe anticoagulants. Recently a new clinically-based risk score, the ATRIA study risk score, was developed. We compared the predictive ability of the ATRIA risk score with the CHADS2 and CHA2DS2-VASc risk scores in a large, independent, community-based cohort of Atrial fibrillation patients in the United Kingdom. We found that the ATRIA score more accurately identified low risk patients that the CHA2DS2-VASc score assigned to higher risk categories.  Such reclassification of stroke risk could prevent overuse of anticoagulants in very low stroke risk patients with Atrial fibrillation.

24 Oct

Posted at 12:29h in Author Interviews, Bipolar Disorder, Kidney Disease, Lancet, Mental Health Research, Pharmacology
MedicalResearch.com Interview with: Dr. Stefan Clos MSc Applied Health Statistics Psychiatrist Murray Royal Hospital Scotland UK Medical Research: What is the background for this study? Dr. Clos: For more than 40 years there has been a debate about the long-term effect of lithium maintenance therapy on renal function. There is a lack of good quality data from randomized clinical trials and two previous meta-analyses from 2010 and 2012 suggest that little evidence exists for a clinically significant reduction in renal function in most patients who are on lithium therapy. However, the two publications point out the poor quality of available study data, emphasising the need for large scale epidemiological studies that control for confounders. Several population-based studies have since attempted to address this problem, but had insufficient ability to adjust for confounders or had limitations because of inappropriate cross-sectional study design or did not include an appropriate comparator group. 

24 Oct

Posted at 11:54h in Anesthesiology, Author Interviews, CHEST, Critical Care - Intensive Care - ICUs, PTSD, Pulmonary Disease
[caption id="attachment_18766" align="alignleft" width="200"]Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo Dr. Jad Kebbe[/caption] MedicalResearch.com Interview with: Jad Kebbe, MD Jacobs School of Medicine and Biomedical Sciences Department of Medicine University of Buffalo Medical Research: What is the background for this study? What are the main findings? Dr. Kebbe: This study proceeded after sensing that post-traumatic stress disorder (PTSD) was a major contributor to ill outcomes in Veterans who are hospitalized in general, and mechanically ventilated in the intensive care unit (ICU) in particular. There is plenty of data depicting the comorbid roles PTSD plays in other medical conditions, leading to an increase in the use of medical services. Furthermore, PTSD affects a Veteran’s adherence to both medical and psychiatric therapies. Having said this, the ICU course could itself negatively affect a pre-existing PTSD, or even lead to the inception of such a condition de novo. However, to date, there has been no study looking at the effect a pre-existing PTSD diagnosis may have on the ICU hospitalization and thereafter. Our study confirmed that PTSD led to an increase in sedative requirements (opiates and benzodiazepines) for Veterans who were mechanically ventilated for more than 24h between 2003 and 2013, and revealed a trend towards an increase in mortality when compared to Veterans not suffering from PTSD. This is why many veterans are trying to claim disability benefits using va benefits and disability lawyer Tennessee to help them fight their case.

24 Oct

Posted at 11:37h in Author Interviews, Infections, NEJM, OBGYNE
Alfredo Mayor Aparicio PhD Associate Research Professor Barcelona Institute for Global HealthMedicalResearch.com Interview with: Alfredo Mayor Aparicio PhD Associate Research Professor Barcelona Institute for Global Health Medical Research: What is the background for this study? What are the main findings? Dr. Mayor: The malaria parasite is a well-adapted pathogen which can persist and reappear in areas where infection is no longer circulating or at very low levels. Prevention of such reinfections and resurgences is critical for the current goal of malaria eradication. However, little is known about the determinants and consequences of malaria declines and resurgences. For this reason, understanding the relationship between malaria transmission, immunity and disease burdens is essential to rationalise malaria interventions aimed at reducing host-parasite encounters. We have described changes in prevalence among pregnant women delivering between 2003 and 2012 at antenatal clinics in Southern Mozambique, and showed that a reduction of malaria-specific immunity associated with drops in transmission is accompanied with an increase the severity of malaria infection among those women becoming infected. These results suggest that success of control and elimination activities may lead through a transitional period where infrequent infections will likely slowdown the rate of acquisition of host defenses and will be thus associated with more deleterious effects during pregnancy, thus requiring more precise diagnosis and surveillance methods, as well as improved prevention.

23 Oct

Posted at 18:14h in Author Interviews, Cancer Research, MD Anderson, Nature
[caption id="attachment_18717" align="alignleft" width="114"]Dihua Yu, M.D., Ph.D. Professor and Deputy Chair Dept. of Molecular and Cellular Oncology Hubert L. and Olive Stringer Distinguished Chair in Basic Science University Distinguished Teaching Professor Co-Director, Center of Biological Pathways Univ. of TX MD Anderson Cancer Center Houston, TX 77030 Dr. Dihua Yu[/caption] MedicalResearch.com Interview with: Dihua Yu, M.D., Ph.D. Professor and Deputy Chair Dept.  of Molecular and Cellular Oncology Hubert L. and Olive Stringer Distinguished Chair in Basic Science University Distinguished Teaching Professor Co-Director, Center of Biological Pathways Univ. of TX MD Anderson Cancer Center Houston, TX 77030 Medical Research: What is the background for this study? What are the main findings? Dr. Yu: Metastasis is the number one cause of cancer-related mortality. Despite the continuous advancement of modern medicine in better controlling primary cancer progress, brain metastasis incidence constantly and steadily increases. Major neoplastic diseases such as melanoma, lung, breast, and colon cancers have high incidences of brain metastases. One-year survival after diagnosis of brain metastasis is less than 20%. Cancer cells dynamically interacts with specific organ microenvironments to establish metastasis as depicted by the “seed and soil” hypothesis. Many research have focused on how tumor cells modulate the metastatic microenvironment, but the reciprocal effect of the organ microenvironment on tumor cells has been overlooked. The brain tissue is very distinct from primary tumor environment for metastatic cancer cells. Brain metastasis frequently manifests in the late stages of cancer, and a long period of dormancy often precedes relapse. This implies that additional regulations imposed by the brain microenvironment are essential for metastatic colonization and outgrowth. Yet it is unclear when and how disseminated tumor cells acquire the essential traits from the brain microenvironment that primes their subsequent metastatic outgrowth.

23 Oct

Posted at 17:31h in Author Interviews, Beth Israel Deaconess, CHEST, Education, Pulmonary Disease
[caption id="attachment_18711" align="alignleft" width="116"]Dr. George Cheng MD Beth Israel Deaconess Medical Center Dr. George Cheng[/caption] MedicalResearch.com Interview with: Dr. George Cheng MD Beth Israel Deaconess Medical Center  Medical Research: What is the background for this study? What are the main findings? Dr. Cheng: Since the introduction of flexible bronchoscope in late 1960s, flexible bronchoscopy has gained wide popularity and with over 500,000 procedures being performed in the USA annually.  Bronchoscopy training has been undergoing rapid advancement in recent years.  Virtual bronchoscopy, either web-based training or VR bronchoscopic simulators, were used to teach and to improve performance in bronchoscopy.  However, virtual reality simulators often cost over $100,000 dollars.  Given the prohibitive high cost, recent CHEST expert panel recommended that high fidelity simulators be offered only in regional simulation centers.  Therefore, low cost realistic bronchoscopy training models are an area of need. Recent development in 3D printing and 3D medical modeling has allowed clinicians to utilize CT scans to create physical models.  This approach can be used to create affordable 3D printed, anatomically accurate bronchoscopy training models.  However, the 3D printed tracheobronchial model has never been evaluated as a bronchoscopy simulation tool.  We aimed to address this question with our study. The 3D printed bronchoscopy model was generated from flexible nylon material and stained to match the airway mucosa coloration.  Participants of varies training levels performed bronchoscopy on both standard and 3D printed bronchoscopy model, graded each on a sliding scale from 0-100.  Overall, clinicians preferred the 3D printed model regardless of their level of training.

23 Oct

Posted at 16:23h in AHA Journals, Author Interviews, Kidney Disease, Stroke, Technology

[caption id="attachment_18704" align="alignleft" width="149"] Dr. Charuhas Thakar[/caption] MedicalResearch.com Interview with: Charuhas V. Thakar, MD, FASN Professor of Medicine Director, Division of Nephrology and Hypertension University of Cincinnati Cincinnati, OH  45267  Medical Research: What is the background for this study? What are the main findings? Dr. Thakar: This study confirms the association between Acute Kidney Injury (AKI) and mortality in Stroke...

23 Oct

Posted at 13:04h in Author Interviews, Brigham & Women's - Harvard, JAMA, Prostate Cancer, Race/Ethnic Diversity, Surgical Research
[caption id="attachment_18619" align="alignleft" width="120"]Dr. Quoc-Dien Trinh MD Assistant Professor of Surgery Harvard Medical School Brigham and Women's Hospital Boston, MA 02115 Dr. Quoc-Dien Trinh[/caption] MedicalResearch.com Interview with: Dr. Quoc-Dien Trinh MD Assistant Professor of Surgery Harvard Medical School  Brigham and Women's Hospital Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Trinh:  Blacks who undergo radical prostatectomy, e.g. surgical removal of the prostate for cancer, are more likely to experience complications, emergency room visits, readmissions compared to their non-hispanic White counterparts. As a result, the 1-year costs of care for Blacks is significantly higher than non-hispanic Whites. Interestingly, despite these quality of care concerns, the survival of elderly Blacks and Whites undergoing prostatectomy is the same. Medical Research: What should clinicians and patients take away from your report? Dr. Trinh: A possible interpretation of our findings is that the biological differences in tumor aggressiveness among Blacks  (e.g. Blacks have more aggressive prostate cancer than Whites) may have been exaggerated, and that the perceived gap in survival is a result of lack of access or cultural perceptions with regard to surgical care for prostate cancer or other factors that differentiate who makes it to the operating table.

22 Oct

Posted at 17:41h in Author Interviews, NEJM, Orthopedics
[caption id="attachment_18483" align="alignleft" width="109"]Søren Thorgaard Skou PT, PhD Postdoc Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark Clinical Nursing Research Unit Aalborg University Hospital Søren Thorgaard Skou[/caption] MedicalResearch.com Interview with: Søren Thorgaard Skou PT, PhD Postdoc Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark Clinical Nursing Research Unit Aalborg University Hospital  Medical Research: What is the background for this study? What are the main findings? Response: Total knee replacement has been performed for decades. The number of procedures are increasing and is expected to reach 1 million procedures per year in the US alone in the near future, highlighting the associated future economic burden. However, no studies have compared it to non-surgical alternatives, even though this is important to investigate its effectiveness. We found that in patients with knee osteoarthritis eligible for total knee replacement, treatment with total knee replacement followed by non-surgical treatment (exercise, education, dietary advice, use of insoles, and pain medication) were associated with greater pain relief and functional improvement after 12 months than the non-surgical treatment alone. However, both groups had clinically relevant improvements, and patients who underwent total knee replacement had more serious adverse events. Furthermore, most patients who were assigned to receive non-surgical treatment alone did not undergo total knee replacement within the 12 months.

22 Oct

Posted at 17:34h in Author Interviews, BMJ, Dental Research, Pediatrics, Smoking
[caption id="attachment_18683" align="alignleft" width="95"]Dental Cavity Wikipedia Dental Cavity
Wikipedia[/caption] MedicalResearch.com Interview with: Koji Kawakami, MD, PhD Professor and Chair, Department of Pharmacoepidemiology and Clinical Research Management Graduate School of Medicine and Public Health Director, Science for Innovation Policy Unit, Center for Promotion of Interdisciplinary Education and Research Kyoto University Kyoto city Kyoto Japan Medical Research: What is the background for this study? What are the main findings? Dr. Kawakami: The prevalence of caries in deciduous teeth in developed countries remains high, while established measures for caries prevention in young children is limited to sugar restriction, oral fluoride supplementation and fluoride varnish. In this study of 76920 children in Japan, exposure to tobacco smoke at 4 months of age, which was experienced by half of all children of that age, was associated with an increased risk of caries in deciduous teeth by approximately 2-fold. Medical Research: What should clinicians and patients take away from your report? Dr. Kawakami: Our findings would support extending public health and clinical interventions to reduce secondhand smoke. For example, the chance of education on the harm of secondhand smoke would increase if dentists become aware of the caries risk due to secondhand smoke as well as tobacco smoking of their patients.

22 Oct

Posted at 17:02h in Author Interviews, Infections, Lancet, Outcomes & Safety, Respiratory
[caption id="attachment_18646" align="alignleft" width="125"]Yuichiro Shindo, M.D., Ph.D. Visiting Researcher Department of Anesthesiology Washington University School of Medicine St. Louis, MO Assistant Professor Institute for Advanced Research, Nagoya University, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine Showa-ku, Nagoya Japan Dr. Yuichiro Shindo[/caption] MedicalResearch.com Interview with: Yuichiro Shindo, M.D., Ph.D. Assistant Professor Institute for Advanced Research, Nagoya University, Department of Respiratory Medicine, Nagoya University Graduate School of Medicine Showa-ku, Nagoya Japan Medical Research: What is the background for this study? What are the main findings? Dr. Shindo: Appropriate initial antibiotic treatment is essential for the treatment of pneumonia.  However, many patients may develop adverse outcomes, even if they receive appropriate initial antibiotics.  To our knowledge, there have been no studies that clearly demonstrated the risk factors in patients who receive appropriate antibiotic treatment.  If these factors are clarified, we can identify those patients with pneumonia for whom adjunctive therapy other than antibiotic treatment can prove beneficial in terms of improved outcomes.  This study aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotic treatment and elucidate potential candidates for adjunctive therapy. In this study, the 30-day mortality in 579 pneumonia patients who received appropriate initial antibiotics was 10.5%.  The independent risk factors included albumin < 3.0 mg/dL, nonambulatory status, pH < 7.35, respiration rate ≥ 30/min, and blood urea nitrogen ≥ 20 mg/dL.  The 30-day mortality for the number of risk factors was 0.8% (0), 1.2% (1), 16.8% (2), 22.5% (3), and 43.8% (4–5).

22 Oct

Posted at 10:48h in ADHD, Author Interviews, Mental Health Research, Nature, NYU/NYMC
[caption id="attachment_18640" align="alignleft" width="300"]Michael M. Halassa, MD, PhD, Assistant professor Departments of Psychiatry and Neuroscience and Physiology The Neuroscience Institute Depts. of Psychitatry Langone Medical Center New York, NY 10016 Dr. Michael Halassa[/caption] MedicalResearch.com Interview with: Michael M. Halassa, MD, PhD, Assistant professor Departments of Psychiatry and Neuroscience and Physiology The Neuroscience Institute Depts. of Psychitatry Langone Medical Center New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Halassa:  Attention is a vital aspect of our daily life and our minds are not merely a reflection of the outside world, but rather a result of careful selection of inputs that are relevant. In fact, if we indiscriminately open up our senses to what’s out there, we would be totally overwhelmed. Selecting relevant inputs and suppressing distractors is what we call attention, and as humans we are able to attend in a highly intentional manner. Meaning, we choose what to pay attention to, and we do so based on context. If you’re driving and getting directions from your GPS, you’ll be intentionally splitting your attention between your vision and hearing. Now, in one context, you might have just updated the GPS software, so you know it’s reliable; this would allow you to intentionally pay attention more to the voice coming from the GPS. In another context, the GPS software may be outdated making voice instructions unreliable. This context would prompt you to direct your attention more towards using visual navigation cues and less to the GPS voice. How the brain intentionally and dynamically directs attention based context is unknown. The main strength of our study is that we were able to study context-dependent attention in mice. Mice are unique models because they provide genetic tools to study brain circuits. Meaning, we can turn circuits on and off very precisely in the mouse, and in a way we cannot do in other experimental animals. The inability to do these types of manipulations has been the major roadblock for progress in understanding what brain circuits mediate attention and its intentional allocation. Because we couldn’t train mice to drive and listen to the GPS, we decided to do something much simpler. Based on context (the type of background noise in the experimental enclosure), a mouse had to select between conflicting visual and auditory stimuli in order to retrieve a milk reward. Mice love milk; it turns out, and will work tirelessly to do well on getting it. Each trial, the mouse is told ‘you need to pick the light flash’ or ‘you need to pick the auditory sweep’; these stimuli appeared on either side of the mouse randomly so the animal really had to pay attention in order to get its reward. It also had to take the context into account. We found that mice did this task, and as humans would do, they were reliant on the prefrontal cortex for determining the appropriate context. The major finding was that the prefrontal cortex changed the sensitivity of the brain to incoming stimuli (meaning, made the visual stimulus brighter when the mouse cared about vision and made the auditory stimulus louder when the mouse cared about hearing), by influencing activity in the thalamus. The thalamus is the major early relay station in the brain. The prefrontal cortex does that by instructing the brain’s switchboard, known as the thalamic reticular nucleus (TRN) to control how much visual or auditory information the thalamus was letting through. So in a sense, we discovered that executive function, represented by the prefrontal cortex, can talk to ‘attentional filters’ in the thalamus to determine what ultimately is selected from the outside environment to build our internal world.

21 Oct

Posted at 17:32h in Author Interviews, Cannabis, Columbia, JAMA
Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032MedicalResearch.com Interview with: Deborah S. Hasin, Ph.D. Professor of Epidemiology Columbia University New York, New York 10032 Medical Research: What is the background for this study? What are the main findings? Dr. Hasin: This study is based on data from two large-scale national surveys conducted over an eleven-year period that are designed to provide information on many health-related conditions in U.S. adults, including use of marijuana and other substances, changes over time in the prevalence of marijuana users, changes over time in the prevalence of disorders such as marijuana abuse and dependence, and the correlates and predictors of those disorders. The main findings of the study are that between 2001-2002 and 2012-2013, the prevalence of marijuana users in the United States adult general population more than doubled, from 4.1% to 9.5%, while the prevalence of adults with marijuana use disorder (abuse or dependence) also increased substantially, from 1.5% to 2.9% of American adults. About three in ten adult marijuana users met criteria for a marijuana use disorder. The findings are consistent with other studies showing increases in rates of marijuana-related harms over the same general time period. This may be to do with how accessible marijuana has become, for example you can even find a purple lotus menu on various websites. This is perfectly safe and fun, but can develop into an addiction later in life.

21 Oct

Posted at 00:48h in Author Interviews, CDC, JAMA, OBGYNE, Vaccine Studies
MedicalResearch.com Interview with: Dr.Lakshmi Sukumaran MD, MPH Immunization Safety Office, Centers for Disease Control and Prevention Department of Pediatrics, Emory University School of Medicine Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Dr. Sukumaran: Pertussis (whooping cough) is a vaccine-preventable disease that has been increasing in incidence over the past decade in the United States. Newborns and infants are at increased risk of pertussis-related hospitalization and death compared with older children and adults. The Advisory Committee on Immunization Practices (ACIP) recommends that pregnant women receive a tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) during each pregnancy to protect her infant from pertussis disease, regardless of prior immunization status. However, there is limited data on the safety of repeated Tdap vaccines in pregnant women. Our study evaluated medically attended (associated with doctor visit or hospitalization) adverse events in mothers, such as fever, allergy and local reactions, and adverse birth outcomes, such as prematurity and low birth weight in newborns, in women receiving Tdap in pregnancy who had received a prior tetanus-containing vaccine. We found no significant differences in rates of these adverse outcomes in women who received Tdap in pregnancy following a prior tetanus-containing vaccine less than 2 years before, 2 to 5 years before, and more than 5 years before.

21 Oct

Posted at 00:38h in Author Interviews, BMJ, Cancer Research, Occupational Health
[caption id="attachment_18543" align="alignleft" width="95"]David Richardson PhD Associate Professor Epidemiology Gillings School of Global Public Health UNC Dr. David Richardson[/caption] MedicalResearch.com Interview with:, David Richardson PhD Associate Professor Epidemiology Gillings School of Global Public Health UNC Medical Research: What is the background for this study? Dr. Richardson:  The International Nuclear Workers Study (INWORKS) combines three cohorts from France, the United Kingdom, and the United States of America. INWORKS follows on from an earlier 15-Country Study but focuses on the three countries that provided the majority of the most informative data on early nuclear workers (1940’s onward). The use of data from just 3 countries, instead of 15, reduces the organisational requirements – and therefore financial burden – associated with the greater number of countries but the cohort selection (of the three main contributing countries) means that the power of the INWORKS study is not a concern. INWORKS uses information from the French, UK and US cohorts that has been updated since the 15-Country study was published. The overall purpose of the study is to improve the understanding of health risks associated with protracted, low-level exposure to ionising radiation.

21 Oct

Posted at 00:31h in Author Interviews, Geriatrics, PLoS
[caption id="attachment_18621" align="alignleft" width="133"]Prof. Dr. med. Andreas Stuck Chefarzt Geriatrie Geriatrische Universitätsklinik Inselspital, Bern Prof. Andreas Stuck[/caption] MedicalResearch.com Interview with: Prof. Dr. med. Andreas Stuck Chefarzt Geriatrie Geriatrische Universitätsklinik Inselspital, Bern Medical Research: What is the background for this study? Prof. Stuck: The number of older persons increases worldwide. Unfortunately, many older persons cannot enjoy the benefits of increased life expectancy because they develop disability or die prematurely. In the search for an effective preventive method, we developed a novel intervention consisting of health risk assessment combined with individualized health counseling, and tested whether this novel intervention actually works. In a trial among more than 2000 older persons, we allocated persons randomly to a group receiving and a group not receiving this intervention, and compared long-term outcomes between these groups. Medical Research: What are the main findings? Prof. Stuck: We found that older participants who received the novel intervention, improved their risk factor profile, and subsequently, had a significantly improved survival as compared to the participants who had not received the intervention. From earlier studies it was known that health risk assessment can improve short term health risks in older people, but our study is the first to explore long-term health outcomes.

21 Oct

Posted at 00:20h in Author Interviews, Breast Cancer, JAMA, Mammograms, UC Davis
[caption id="attachment_18491" align="alignleft" width="75"]Diana Miglioretti, PhD Diana Miglioretti, PhD[/caption] MedicalResearch.com Interview with: Diana L. Miglioretti, PhD Dean's Professor in Biostatistics Department of Public Health Sciences UC Davis School of Medicine Davis, CA  95616 Medical Research: What is the background for this study? What are the main findings? Dr. Miglioretti: Screening mammography intervals remain under debate in the United States. The US Preventive Services Task Force recommends biennial (every other year) screening, whereas other organizations recommend annual screening. To help inform their updated screening guidelines, the American Cancer Society guideline development group requested that the US Breast Cancer Surveillance Consortium conduct a study comparing cancer outcomes among women screened annually vs. biennially. Prior studies conducted by the consortium used wide intervals for defining annual and biennial mammograms. We wanted to evaluate cancer outcomes for women who more closely adhere to screening intervals. Our goal was to determine if women diagnosed with cancer following biennial screening have tumors with less favorable prognostic characteristics compared to women diagnosed after annual screening. We evaluated outcomes separately by age and by menopausal status because evidence suggests that younger women and premenopausal women may have more aggressive tumors and thus may benefit from more frequent screening. We found from this study that premenopausal women diagnosed with invasive breast cancer following biennial versus annual screening mammography were more likely to have tumors with less-favorable prognostic characteristics (e.g., later stage, larger size). For example, women with an invasive breast cancer diagnosed after a biennial screen had a 28% increased risk of a stage IIB or higher tumor, a 21% increased risk of being diagnosed with a tumor >15 mm, and an 11% higher risk of being diagnosed with a tumor with any less-favorable prognostic characteristic compared women diagnosed with breast cancer following an annual mammogram. In contrast, we found postmenopausal women not using hormone therapy and women 50 years of age or older had similar proportions of tumors with less-favorable prognostic characteristics regardless of screening interval. Relative risk estimates were close to one with no significant differences between biennial and annual screeners. Among postmenopausal women using hormone therapy at the time of the mammogram and women age 40-49, results were less clear. Relative risk estimates for biennial versus annual screeners were consistently above one, but were not as large as for premenopausal women and were not statistically significant.

21 Oct

Posted at 00:09h in Author Interviews, Heart Disease, JAMA, OBGYNE, Pediatrics
Nathalie Auger MD MSc FRCPC Crémazie Est Montréal, Québec MedicalResearch.com Interview with: Nathalie Auger MD MSc FRCPC Crémazie Est Montréal, Québec  Medical Research: What is the background for this study? What are the main findings? Dr. Auger: Congenital heart defects are the most common defects found in infants, but the causes are for the most part unknown. Only about 15-20% can be linked to a clear cause, such as a genetics or maternal infection.  Recently, certain imbalances of angiogenic signaling proteins that control blood vessel development have been identified in individuals with congenital heart defects. Similar imbalances in the same biomarkers have been observed in women with preeclampsia, a serious complication of pregnancy that occurs in 3-5% of pregnant women. Because of this similarity, we sought to determine the relationship that preeclampsia has with the presence of congenital heart defects in infants. What we found was that there was a significant association between preeclampsia and congenital heart defects. In particular, preeclampsia that was diagnosed before 34 weeks of pregnancy was significantly associated with critical and noncritical heart defects and seemed to be the driving factor. There was increased risk for defects involving all general structures of the heart, although the absolute risk of congenital heart defects was low (16.8 per 1,000 infants).

21 Oct

Posted at 00:04h in Author Interviews, Brain Injury, JAMA
Dr-Davinia-Fernandez-Espejo.jpgMedicalResearch.com Interview with: Dr Davinia Fernández-Espejo PhD School of Psychology University of Birmingham Birmingham  Medical Research: What is the background for this study? What are the main findings? Dr. Fernández-Espejo: We have previously shown that a number of patients who appear to be in a vegetative state are actually aware of themselves and their surroundings, and simply unable to show it with their external behavior. In a prior study we demonstrated that a patient who had been repeatedly diagnosed as vegetative state for 12 years was not only fully aware but able to create memories. Notably, this patient was capable to modulate their brain activity in a functional magnetic resonance imaging (fMRI) scanner to answer questions about their condition and preferences for care. In the present study we identified the reason for the dissociation between these patients’ retained awareness and their inability to respond with intentional movement. First, we used fMRI to demonstrate that a functional connection between the thalamus and the motor cortex is essential for a successful execution of voluntary movements. Second, we used diffusion tensor tractography, a technique that allows reconstructing and assessing white matter pathways in the brain, to identify damage to such connection (i.e. thalamus and motor cortex) in a paradigmatic patient who produced repeated evidence of covert awareness across multiple examinations, despite clinically appearing as being in a vegetative state.

20 Oct

Posted at 23:57h in Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Health Care Systems, JAMA
MedicalResearch.com Interview with: Hannah Neprash PhD student Health Policy program Harvard University. Medical Research: What is the background for this study? Response: Hospitals are increasingly employing or purchasing physician practices. This trend started before the Affordable Care Act, as our study documents, but there is a concern that these trends may accelerate as providers reorganize to meet the challenges of new payment models that hold providers accountable for the entire spectrum of patient care, spanning inpatient and outpatient settings. It’s not clear how this change in provider market structure should affect spending. It could lead to lower spending, if care is better coordinated, reducing waste and unnecessary utilization. But, it could also lead to higher spending if larger provider groups have more market power and can negotiate higher prices with insurers. Medical Research: What are the main findings? Response: We used Medicare claims to quantify the share of physicians in major metropolitan markets that were owned or employed by a hospital. Most markets saw an increase in physician-hospital integration from 2008 to 2012. The average market saw a 3% increase in physician-hospital integration; the 75th percentile market saw a 5% increase; and the 95th percentile market saw a 15% increase. An increase in physician-hospital integration equivalent to the 75th percentile was associated with a $75 per person (or 3%) increase in annual outpatient spending among a non-elderly commercially insured population. This was driven by price increases – as we found no change in utilization. We did not find a similar association between physician-hospital integration and inpatient hospital spending. This is likely because hospital markets were already less competitive than physician markets at the beginning of our study period. When a hospital system buys a physician practice, the hospitals might not gain much bargaining power against an insurer in negotiating prices for inpatient care, but the hospital’s bargaining power could be used to negotiate higher fees for the outpatient physician practice.  That is, an insurer may not be persuaded by the threat of excluding the physician practice from its network, but the threat of excluding the entire hospital system from the insurer’s network is likely to carry more weight.

20 Oct

Posted at 23:47h in Author Interviews, Heart Disease, JACC
Jerry D. Estep, MD, FACC, FASE Associate Professor of Clinical Cardiology Houston Methodist Institute of Academic Medicine Section Head of Heart Transplant & Mechanical Circulatory Support, Division of Heart Failure Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston MethodistMedicalResearch.com Interview with: Jerry D. Estep, MD, FACC, FASE Associate Professor of Clinical Cardiology Houston Methodist Institute of Academic Medicine Section Head of Heart Transplant & Mechanical Circulatory Support, Division of Heart Failure Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston Methodist   Medical Research: What is the background for this study? What are the main findings? Dr. Estep: Data for left ventricular assist devices (LVADs) in non-inotrope-dependent advanced heart failure (HF) patients are limited. The risk-benefit tradeoff of LVADs versus optimal medical management (OMM) in this patient cohort is not well understood.  ROADMAP is the first prospective, nonrandomized, observational study comparing LVAD support to OMM in advanced, ambulatory HF patients who are not dependent on intravenous inotropic support, and meet the FDA-approved indications for LVAD destination therapy.  The main  5 findings from the ROADMAP Study include the following: 1) LVAD patients were more severely ill, with more INTERMACS profile 4 compared to OMM patients (65% LVAD vs. 34% OMM, p < 0.001); 2) more LVAD patients met the primary endpoint of survival on original therapy with improvement in 6 minute walk distance of at least 75 meters at 12 months (39% LVAD vs. 21% OMM; [OR: 2.4 [95% CI: 1.2 to 4.8]; p = 0.012) with differences in the primary endpoint primarily due to the use of delayed LVADs in the OMM group; 3) on the basis of as-treated (event free) analysis, 12-month survival (freedom from death, urgent transplant, or delayed LVAD) was greater for LVAD versus OMM (80 ± 4% vs. 63 ± 5%, p = 0.022); 4) adverse events (AEs) were higher in LVAD patients, at 1.89 events/patient-year (eppy), primarily driven by bleeding (1.22 eppy), than with OMM, at 0.83 eppy, primarily driven by worsening HF (0.68 eppy);  and 5) health-related quality of life and depression improved from baseline more significantly with LVADs than with OMM (Δvisual analog score [VAS]: 29 ± 25 vs. 10 ± 22, p < 0.001 and ΔPHQ9: -5 ± 7 vs. -1 ± 5, p < 0.001).

20 Oct

Posted at 00:59h in Author Interviews, Baylor University Medical Center Dallas, Biomarkers, BMJ, Cancer Research
Ajay Goel, Ph.D. Investigator/Professor Director, Center for Gastrointestinal Research Director, Center for Epigenetics, Cancer Prevention and Cancer Genomics Baylor Research Institute and Charles A. Sammons Cancer Center Baylor University Medical Center Dallas, TX 75246MedicalResearch.com Interview with: Ajay Goel, Ph.D. Investigator/Professor Director, Center for Gastrointestinal Research Director, Center for Epigenetics, Cancer Prevention and Cancer Genomics Baylor Research Institute and Charles A. Sammons Cancer Center Baylor University Medical Center Dallas, TX 75246 Medical Research: What is the background for this study? What are the main findings? Dr. Goel: Colorectal cancer (CRC) remains one of the most common and lethal malignancies worldwide, and is the second leading cause of cancer-related deaths in the United States. Although there are some improvements in cancer treatments, such as development of novel chemotherapeutic drugs and technical advances in invasive treatment for metastatic lesion, there is a clear need for prognostic biomarkers that can identify high-risk patients, who can benefit from intensive post-treatment surveillance protocols for early detection of recurrence. Small nucleolar RNAs (snoRNAs) are one of the largest groups of single-stranded small ncRNAs, and in the past, snoRNAs were recognized for housekeeping functions due to their roles in rRNA maturation, while causing a relatively low impact on cellular homeostasis. However, recent evidence has revealed a new and previously unrecognized role of snoRNAs in the control of cell fate and oncogenesis in various cancers. The main finding of this study is to firstly demonstrate the clinical impact of snoRNA expression as a predictive biomarker of recurrence and poor prognosis in patients with Colorectal cancer. This study for the first time showed that higher levels of SNORA42 were associated with overall and disease-free survival, and emerged as a risk factor for the return of cancer in another part of the body. It was also correlated with high risk of recurrence and shorter survival in a smaller sample of bowel cancer patients in early stages of their disease.

19 Oct

Posted at 15:04h in Author Interviews, BMJ, End of Life Care
MedicalResearch.com Interview with: Barbara Gomes BSc MSc PhD  Research Fellow King's College London, Cicely Saunders Institute Dept Palliative Care, Policy & Rehabilitation London UK Medical Research: What is the background for this study? Dr. Gomes: We knew from our previous research that most patients with advanced cancer would prefer to die at home, but many do not achieve this. In many countries, an undesired hospital death is still the most common. We wondered whether this was because the quality of death was better in hospital than at home, so we examined the existing evidence and found out that the studies contradicted each other; some suggested that dying in hospital was better than at home and some found it was worse. Therefore, we decided to examine three things:
  • Whether people who died at home experienced more or less pain and peace than those who died in hospital;
  • whether the family carers of people who died at home experienced more or less grief;
  • The factors needed to enable death at home.
We wanted to find ways to improve care for patients and families facing serious life limiting illness, to more closely meet their preferences and needs and to empower them. Medical Research: What are the main findings? Dr. Gomes: We found that patients who died at home experienced more peace in their last week of life than those who died in hospital. There was no difference in pain levels. And grief was less intense for relatives of patients who died at home, both around the time of death and at questionnaire completion (which was about 4-10 months after the patient died). We also developed a model that explained well why some patients die at home whilst others die in hospital. Four factors are almost essential; they were present in more than 91% of home deaths:
  1. Home death preference by the patient;
  2. Home death preference by their relative;
  3. Receipt of home palliative care in the last three months of life;
  4. Receipt of district/community nursing in the last three months of life.
In addition, patients who died in hospital were less likely to have had Marie Curie nursing (these nurses care for people at home in the last few months or weeks of their lives, with the core service being one-to-one overnight nursing); only seven patients who received care from these nurses died in hospital. Importantly, patients who discuss preferences, have home visits from their GP and whose relatives take more days off work also had greater odds of dying at home. The study shows these elements of support need to be in place in order to meet patient preference and ensure the best possible outcomes.

18 Oct

Posted at 23:42h in Author Interviews, Brigham & Women's - Harvard, Heart Disease, JACC, Pediatrics
[caption id="attachment_18531" align="alignleft" width="300"]Ashley Winning, ScD, MPH Postdoctoral Research Fellow Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Dr. Ashley Winning[/caption] MedicalResearch.com Interview with: Ashley Winning, ScD, MPH Postdoctoral Research Fellow Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Medical Research: What is the background for this study?  Dr. Winning: Several studies have found associations between psychological distress and heart disease and diabetes; however, much of the research has measured distress and disease risk in adulthood and we can’t tell how long people have been distressed or how far-reaching the effects of distress are. Some work has shown that childhood distress is associated with adult health, indicating that distress may start to affect health even earlier in life than we thought. However most of the research has measured distress at a single point in time so we have not been able to answer questions regarding effects of persistent distress or if effects on health are less bad if people become less distressed over time. Medical Research: What are the main findings? Dr. Winning: Distress at any period in the life course was associated with increased cardiovascular and metabolic disease risk in adulthood (age 45). Not surprisingly, those with high levels of distress in both childhood and adulthood had the greatest cardiometabolic risk. The most striking finding is that high levels of childhood distress (measured in childhood) predicted heightened adult disease risk, even when there was no evidence that these high levels of distress persisted into adulthood.

17 Oct

Posted at 22:43h in Author Interviews, Diabetes, JAMA, Surgical Research
MedicalResearch.com Interview with: Jan Peter Yska, PharmD Medical Centre Leeuwarden Department of Clinical Pharmacy & Clinical Pharmacology Leeuwarden The Netherlands Medical Research: What is the background for this study? Dr. Yska: Many patients with morbid obesity have known type 2 diabetes mellitus. Bariatric surgery effectively prevents and treats type 2 diabetes. A growing number of studies suggests that surgical treatment for obese patients may be considered an additional treatment option for the management of type 2 diabetes. However, an observational study on the remission of type 2 diabetes, using strict criteria for remisson of diabetes, after different types of bariatric surgery, based on data from general practice has not been carried out yet. Medical Research: What are the main findings? Dr. Yska: Our study included 569 obese patients with type 2 diabetes who had different types of weight-loss surgery and 1,881 similar diabetic patients who didn’t have surgery. This study confirms that bariatric surgery is successful in treating diabetes mellitus type 2. Per 1,000 person years 94.5 diabetes remissions were found in patients who underwent bariatric surgery, compared to 4.9 diabetes remissions in matched controls. A strict definition of remission of diabetes was used, much stricter than in other studies: patients should have stopped all diabetic medications with an HbA1c < 6.0% after at least 6 months of follow-up. Diabetic patients who underwent bariatric surgery had an 18-fold increased chance of diabetes remission, compared to diabetic patients who did not undergo surgery, with the greatest effect size observed for gastric bypass (adj. RR 43.1), followed by sleeve gastrectomy (adj. RR 16.6), and gastric banding (adj. 6.9). The largest decrease in  HbA1c and blood glucose levels was observed in the first two years after bariatric surgery.

17 Oct

Posted at 19:49h in AHA Journals, Author Interviews, Weight Research
Dr. Eric J. Belin de Chantemèle PhD Georgia Regents University Augusta Georgia MedicalResearch.com Interview with: Dr. Eric J. Belin de Chantemèle PhD Georgia Regents University Augusta Georgia  Medical Research: What is the background for this study? What are the main findings? Response:  Obesity is currently a worldwide epidemic and a major risk factor for cardiovascular disease including among others hypertension, endothelial dysfunction, atherosclerosis and coronary artery disease. Despite decades of research, the mechanisms linking obesity to cardiovascular disease still remain incompletely understood. Obesity is commonly associated with increased levels of the mineralocorticoid hormone aldosterone. Excessive amounts of aldosterone promote hypertension, vascular and heart disease but also lead to inflammation, and facilitate the development of diabetes. The present study aimed at deciphering the origin of these high aldosterone levels. We have been the first to demonstrate that the adipocyte derived hormone leptin controls the level of expression of the enzyme producing aldosterone: aldosterone synthase (CYP11B2), in the adrenal glands, and leptin stimulates the release of aldosterone. This was demonstrated in different mouse models as well as in cultured human adrenocortical cells. We also demonstrated that leptin-mediated aldosterone production promotes the development of cardiovascular disease, notably impairs endothelium-dependent relaxation in major arteries and promotes the development of cardiac fibrosis. Both endothelial dysfunction and cardiac fibrosis are precursors of major cardiovascular disease.

16 Oct

Posted at 13:23h in Author Interviews, BMJ, Lipids
[caption id="attachment_18498" align="alignleft" width="164"]Jamie Gaida, PhD Assistant Professor Discipline of Physiotherapy University of Canberra Dr. Jamie Gaida[/caption] MedicalResearch.com Interview with: Jamie Gaida, PhD Assistant Professor Discipline of Physiotherapy University of Canberra Medical Research: What is the background for this study? What are the main findings? Dr. Gaida: Cholesterol is essential for life but having too much circulating in your blood increases cardiovascular disease risk. A growing collection of evidence indicates that metabolic health (i.e. cholesterol and diabetes) is linked to musculoskeletal injuries. Tendons connect muscle to bone, and tendinopathy is condition where a person feels pain when using their tendons. People with Achilles tendinopathy experience pain when walking or when running, which limits their ability to be physically active. Tendinopathy also affects other tendons throughout the body, such as the rotator cuff tendons of the shoulder. This research identified all published research on the link between cholesterol levels and tendinopathy. We used a statistical technique called meta-analysis to combine these studies, which showed that cholesterol levels are linked to tendinopathy. However, the most interesting finding was that the pattern of cholesterol changes seen with tendinopathy matched the pattern of cholesterol changes that increase cardiovascular disease risk. It seems that what is bad for you heart is bad for your tendons.