MedicalResearch.com Interview with: Anne-Marie Schjerning Olsen, MD, PhD Department of Cardiology Gentofte Hospital, University of Copenhagen Denmark MedicalResearch.com: What is the background for this study? Dr. Olsen: The question addressed in the study was: Do people who have had a myocardial infarction (heart attack) and are who taking drugs (known as antithrombotics) to reduce their risk...
MedicalResearch.com Interview with:
Kari Johansson, PhD
Department of Medicine Solna, Karolinska Institutet
Clinical Epidemiology
Karolinska University Hospital
Stockholm, Sweden
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers.
The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001).
MedicalResearch.com Interview with:
Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009. The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children. Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection.
During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died. Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%). One or more viruses were detected in 1,472 (66%) of these children. Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%). The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period. The highest incidence was among children younger than 2 years old (62.2/10,000). Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia. Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia. Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%). The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests.
MedicalResearch.com Interview with:
Eric Crouch, MD, FAAO, FAAP, FACS
Vice Chair, PEDIGAssociate Professor
Department of Ophthalmology
Eastern Virginia Medical School Assistant Professor
Department of Pediatrics Eastern Virginia Medical School
Chief of Ophthalmology, Children's Hospital of the King's Daughters Norfolk, Virginia
MedicalResearch: What is the background for this study?
Dr. Crouch: In this letter PEDIG is reporting on the improvement in vision during the run-in phase of a study in children 3 years of age to less than 8 years old. During the run-in phase, the children were followed at 6 weeks intervals and served as the baseline for entering into a randomized trial for increasing the amount of patching. The patients were randomized to either 2 hours of prescribed patching or 6 hours of prescribed patching once they completed the run-in phase.
MedicalResearch: What are the main findings?
Dr. Crouch: For amblyopic children, even those who have moderate or severe amblyopia in the 20/100 - 20/400 range, clinicians can start treatment with patching two hours a day.
MedicalResearch.com Interview with:
Dawn Pedrotty, MD, PhD
Cardiovascular Medicine Fellowship
University of Pennsylvania
MedicalResearch: What is the background for this review? What are the main findings?
Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation.
MedicalResearch.com Interview with:
Judith Lichtman, PhD, MPH
Associate Professor (with tenure)
Chair, Department of Chronic Disease Epidemiology
Yale School of Public Health
New Haven, CT 06520-803
Medical Research: What is the background for this study? What are the main findings?
Dr. Lichtman: Heart disease in younger women (18-55 years of age) is relatively rare, and represents less than 5% of all heart disease in women; however, young women who present with a heart attack are twice as likely to die in the hospital as compared with a similarly aged man, and this excess mortality risk continues beyond the index event. Delays in seeking prompt care has been suggested as one potential cause for the excess mortality in young women. We were interested in learning about the recognition of symptoms, perceived risk of heart disease, decision-making process to seek medical care, and interactions with the healthcare system among young women who recently had a heart attack. We found that even though the majority of young women presented with chest pain, they also experienced many other symptoms such as fatigue, nausea, muscle pain, and weakness. They commonly attributed symptoms to non-cardiac conditions because they felt they did not experience the “Hollywood Heart Attack” that is commonly portrayed in the media. Interestingly, despite reporting a strong family history of cardiac disease, and having multiple risk factors, many of the women we spoke with did not perceive they were at risk for heart disease, and many were not working with their physicians to manage their risk factors. They were also concerned about being seen as a hypochondriac if they reported their symptoms. Finally, women reported that the healthcare system was not consistently responsive when they reported their symptoms.
MedicalResearch.com Interview with: Dr Søren Dalsgaard National Centre for Register-based Research Aarhus University Denmark Medical Research: What is the background for this study? What are the main findings? Response: This is the first large-scale prospective study of all-cause-mortality in people with ADHD. The nationwide Danish registers offer unique research possibilities. We followed a cohort of almost...
MedicalResearch.com Interview with:
Professor Stephen Peckham
Director, Centre for Health Services Studies
Professor of Health Policy
Department of Health Services Research and Policy
London School of Hygiene and Tropical Medicine
Director, Policy Research Unit in Commissioning and the Healthcare System University of Kent
Medical Research: What is the background for this study? What are the main findings?
Response: Community water fluoridation remains a controversial public health measure. There have been continued debates about both its effectiveness in the prevention of dental caries and also its safety. Previous studies have suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism few population level studies have been undertaken. In April 2014 Public Health England published a monitoring report that used secondary analysis of routine health statistics to identify whether water fluoridation in England was associated with any adverse health outcomes. While hypothyroidism data is available this was not included in their monitoring report. In England approximately 10% of the population lives in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. Tt examine whether there is a relationship – as suggested in smaller studies – we used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/13 Quality Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner (GP) registered patient numbers, and 2012 practice level Index of Multiple Deprivation scores. We found a positive association between fluoride levels and hypothyroidism. High hypothyroidism prevalence was found to be at least 30% more likely in practices located in areas with fluoride levels in excess of 0.3mg/L. This population study supports earlier hypotheses that fluoride is associated with hypothyroidism. In the UK water is fluoridated at 1ppm (1mg/L) and in areas where water is fluoridated the model predicts that after controlling for other factors, practice populations are significantly more likely to have higher levels of hypothyroidism than those in non-fluoridated areas. Higher levels of fluoride in drinking water, therefore, provide a useful contribution for predicting prevalence of hypothyroidism. For example in contrasting two urban areas we found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).
MedicalResearch.com Interview with: Prof. Peter Nordström Department of Community Medicine and Rehabilitation Geriatrics, Umeå University Umeå, Sweden MedicalResearch: What is the background for this study? What are the main findings? Prof. Nordström: The number of elderly people is increasing, while the number of hospital beds is decreasing in Europe, which may be related to economic constraints...
MedicalResearch.com Interview with:
William E. Evans, Pharm.D.
Member, Pharmaceutical Sciences
St. Jude Children’s Research Hospital
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Evans: We are currently curing over 85 percent of children with acute lymphoblastic leukemia (ALL), the most common cancer in children. While we continue to focus on pushing cure rates closer to 100 percent through the development of new treatments, we are also increasingly focused on reducing the acute and chronic side effects of treatment. This is important to improve the quality of life for patients during treatment and as they become adults after being cured, because some side effects can persist for decades after treatment is completed.
One of the medications that every child with acute lymphoblastic leukemia received 30-40 times during their 2+ years of treatment is vincristine. The major side effect of vincristine is peripheral neuropathy (about 25 percent of patients develop this side effect), which can cause loss of sensation, numbness, neuropathic pain and alter their motor skills including manual dexterity, balance and ability to walk properly. This can have very practical consequences, such as writing, using a smart phone, and the use of eating utensils. It can also alter their gait.
Our main finding is we discovered that an inherited variant of the CEP72 gene enhanced the risk and severity of vincristine neuropathy in two groups of patients we studied. Those children who inherited two copies of the high-risk CEP72 gene (one from each parent, about 16 percent of patients) had a significantly higher likelihood (about 3.5-fold) of developing vincristine neuropathy and had a more severe form of neuropathy (about 2.5-fold higher severity).
The CEP72 gene encodes a protein essential for normal microtubule formation in cells—a critical process for cell division. Vincristine inhibits this same cellular process. The inherited form of CEP72 that increases the risk and severity of vincristine neuropathy is associated with lower expression of the CEP72 protein. When coupled with vincristine treatment, CEP72 increases a cell’s sensitivity to vincristine. We were able to reproduce this in the laboratory by lowering CEP72 expression in human neurons made from induced pluripotent stem cells and in human leukemia cells, increasing the sensitivity of both to vincristine. We also showed that the leukemia cells from patients who inherited two copies of the CEP72 risk allele were more sensitive to vincristine, suggesting it may be possible to treat these patients with a lower dose of vincristine to reduce their neuropathy without compromising the treatment of their leukemia—a possibility we plan to test in our next clinical trial at St. Jude.
MedicalResearch.com Interview with:
Andrew Paul DeFilippis, MD, MSc
Assistant Professor of Medicine University of Louisville
Director, Cardiovascular Disease Prevention
Medical Director, Cardiovascular Intensive Care Unit
Adjunct Assistant Professor of Medicine Johns Hopkins
University of Louisville Jewish Hospital Rudd Heart & Lung Center
Louisville, KY
Michael Joseph Blaha, MD MPH
Director of Clinical Research
Ciccarone Center for the Prevention of Heart Disease
Assistant Professor of Medicine
John Hopkins
MedicalResearch: What is the background for this study?
Response: Atherosclerotic cardiovascular disease is the leading cause of death worldwide. While multiple therapies are available to prevent this common disease, accurate risk assessment is essential to effectively balance the risks and benefits of therapy in primary prevention. For more than a decade, national guidelines have recommended the use of an objective risk assessment tool based on the Framingham Risk Score (FRS) to guide therapy in primary prevention. Recently, the American Heart Association (AHA) and the American College of Cardiology (ACC) developed a new risk score to guide cardiovascular risk-reducing therapy.
We had two main objectives in our study:
1) To compare the performance of the new AHA-ACC risk score with four other commonly used risk scores in a MODERN DAY gender balanced multi-ethnic population.
2) To explore how the use of modern day preventive therapy (aspirin, statins, BP meds and revascularization) impact the performance of the AHA-ACC score.
MedicalResearch: What are the main findings?
Response: We found that the new AHA-ACC atherosclerotic cardiovascular disease (ASCVD) risk score and three Framingham-based risk scores, all derived from cohorts’ decade’s old, overestimated cardiovascular events by 25 – 115%, while the Reynolds Risk score, derived from more modern cohorts, accurately predicted the overall event rate in a modern, multi-ethnic cohort free of baseline clinical cardiovascular disease. Overestimation was noted throughout the continuum of risk and does not appear to be secondary to missed events or use of preventive therapies.
MedicalResearch.com Interview
Professor Nick Franks
Professor of Biophysics and Anaesthetics
Professor William Wisden,
Chair in Molecular Neuroscience
Department of Life sciences
Wolfson Laboratories, Imperial College, South Kensington London
Medical Research: What is the background for this study? What are the main findings?
Profs. Franks and Wisden: We were interested in finding out how a particular type of sedative drug, dexmedetomidine, works in the brain. This drug is increasingly used during intensive care for sedation of patients, but unlike other powerful sedatives, it induces a state whereby the patient can be temporarily woken up. This is a highly useful property because it means patients can be both sedated and responsive during procedures. The drugged sedative state induced by dexmedetomidine struck us as being highly similar to the deep sleep that we all need to have if we have been extensively sleep deprived. If people and animals are kept awake for extended periods of time, they have to sleep. Most people know this from common experience - catching up on lost sleep. But how and why we need to sleep after sleep deprivation is not known. We found that dexmedetomidine-induced sedation and this recovery sleep used the same brain circuits, in a tiny area at the base of the brain called the preoptic hypothalamus. To do this we used a new genetic technique in mice that allowed us to mark or "tag" which neurons in the mouse’s brain were active during sedation or recovery sleep after sleep deprivation. The beauty of this technique is that we could then specifically reactivate these same neurons several days later with a special molecule that only binds to the tagged neurons. This reactivation caused the mice to go into a deep sleep. We concluded that the sedative drug dexmedetomidine copies or hijacks the mechanism used by the brain to respond to sleep deprivation and trigger deep sleep.
MedicalResearch.com Interview with:
Peter Storz, Ph.D.
Associate Professor & Consultant Department of Cancer Biology
Mayo Clinic
Jacksonville, FL 32224
Medical Research: What is the background for this study? What are the main findings?
Dr. Storz: Our study focuses on cellular signaling mechanisms that lead to the initiation of pancreatic cancer. After acquisition of an oncogenic mutation of Kras, pancreatic acinar cells can undergo a transdifferentiation process to a phenotype that gives rise to pancreatic intraepithelial lesions (PanINs). These lesions then can further progress to pancreatic cancer.
MedicalResearch.com Interview with:
Dr. Rebecca E. Amariglio Ph.D.
Massachusetts Alzheimers Disease Research Center
Massachusetts General Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Amariglio: As the field of Alzheimer’s disease moves towards early detection and treatment, new tests that can measure very subtle changes in cognitive functioning are needed. A new instrument developed by the Alzheimer’s Disease Cooperative Study that measures subjective report of memory changes of both the study participant and a study partner (usually a family member) was associated with cognitive decline over four years. Specifically, greater report of memory concerns was associated with worse memory performance over time.
MedicalResearch.com Interview with:
Jari Laukkanen Cardiologist, MD, PhD
Institute of Public Health and Clinical Nutrition
University of Eastern Finland
Kuopio, Finland
Medical Research: What is the background for this study? What are the main findings?
Dr. Laukkanen: We have been studying many risk factors for cardiovascular disease (CVD) in the general population, and especially exploring protective factors of sudden cardiac death. In our qualified and well defined data on the KIHD prospective study, there were also many questionnaires about other health habits such as the use of sauna (how much, how often, temperature and so on). It was very logical to investigate further sauna use and the risk sudden cardiac death/CVDSs, because sauna is a part of our culture here in Finland. In this country, we have tradition to trust, that its healthy habit, although there are not previous studies showing the value of sauna in the prevention of cardiovascular disease. So we have to study this kind of health habit and CVVs in Finland based on our common traditions...
MedicalResearch.com Interview with:
Dr. Wei Zheng, MD, PhD
Division of Epidemiology, Department of Medicine,
Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center,
Vanderbilt University School of Medicine, Nashville, Tennessee
Medical Research: What is the background for this study? What are the main findings?
Dr. Wei Zheng: Substantial progress has been made in the diagnosis and treatment of cancer, resulting in a steady improvement in cancer survival. However, the degree of improvement by age, race and sex remains unclear. We quantified the differences in the improvement of cancer survival by race, age, and sex over the last two decades.
We used cancer diagnosis and follow-up data from more than 1 million cancer patients, collected in nine SEER registries, to investigate trends in improved survival for seven major cancers in the United States by age, race, and sex between 1990 and 2010. We found that elderly patients experienced a smaller improvement in survival for cancers of the colon/rectum, breast, prostate, lung, and liver than their younger counterparts. In particular, the age-related disparities were most pronounced for those cancers with the greatest advancements in diagnosis and treatment over the past two decades, including cancers of colon/rectum, breast and prostate. African Americans experienced poorer survival than whites for all cancers. Because of a greater improvement in prostate cancer survival in African Americans than for whites, the racial difference in the survival of this cancer decreased during the study period. For ovarian cancer, however, the survival rate declined in African Americans but slightly increased in whites, leading to a wider racial gap in the survival of this deadly cancer. No apparent disparities in survival improvement by sex were noted.
MedicalResearch.com Interview with:
Matthew Buman PhD Asst Professor
SNHP Exercise & Wellness
Arizona State University
Medical Research: What is the background for this study? What are the main findings?
Dr. Buman: A lack of physical activity is a known risk factor for insomnia, poor sleep, and obstructive sleep apnea. In addition to physical activity, sedentary behavior has emerged as an important behavior. Sedentary behavior is not just the lack of physical activity, but actually refers to the time someone spend sitting. This behavior has been shown to, independent of physical activity, be related to many poor health outcomes including cardiovascular disease, diabetes, and even premature death. This is the first study to examine whether there is a relationship between excess sitting and insomnia, poor sleep, and risk for obstructive sleep apnea.
We found, after adjusting for physical activity and body weight (among other confounding factors), that total daily sitting was associated with poor sleep quality but not other sleep metrics or OSA risk. However, we also examined sitting while watching television and found a significant relationship between this type of sitting and a host of sleep quality metrics as well as risk for OSA. In a subsequent analysis we found that despite the independent relationship between sitting while watching television with OSA risk, those that were physically active were protected from this negative impact.
MedicalResearch.com Interview with:
Jennifer L. Cook, MD FAHA
Assistant Professor of Medicine | Heart Failure and Transplantation
Medical Director Left Ventricular Assist Device Program
Medical University of South Carolina
Charleston, SC 29425
Medical Research: What is the background for this study? What are the main findings?
Dr. Cook: Although the incidence of heart failure is similar in men and women, women are more likely to die from it. Despite this fact a common misperception persists that men are at greater risk. Although advanced therapies such as mechanical support are as effective in women as in men, women are less likely to receive mechanical support. In clinical trials investigating mechanical support as a bridge to transplant less than 30% of patients were women. In trials investigating mechanical support for patients ineligible for heart transplant even fewer were women, less than 20%. .
Medical Research: What should clinicians and patients take away from your report?
Dr. Cook: It has been shown that women with heart failure are more likely to remain under the care of a primary physician instead of being referred for specialized cardiovascular care. The explanation for this pattern is not understood. It is important to raise awareness and emphasize the high risk of heart failure mortality among women.
MedicalResearch.com Interview with:
Dr. Bill Hesselmar
University of Gothenburg
Sweden
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Hesselmar: The hygiene hypothesis is the background for this study, and the hypothesis states that children’s immune system need to be stimulated by bacteria and microbes to mature in a proper way prevent the children from developing immune mediated diseases such as allergies. There are increasing support for the hygiene hypothesis, with less allergies found in children from milieus with a rich microbial exposure such as: growing up on a farm or in a developing country, in children with many siblings, and after vaginal delivery as compared to caesarean section. Even though these findings are interesting from a theoretical point of view, they can’t be use in primary prevention since you can’t recommend anyone to live by a farm. We are investigating if there are harmless “microbial sources” in different daily life-situations that are good enough to stimulate children’s immune system. So far we have observed two such possible sources, the sharing of children’s pacifier (Pediatrics 2013) and hand dishwashing (this study). These are, however, only observational data – we have only found an association between hand dishwashing and a lower risk of allergy, we don’t know for sure that the lower risk of allergy was just because of the hand dishwashing. So far we regard it as an “interesting observation”, which need to be confirmed in new studies before any general conclusions could be made.
The main findings was a lower risk of allergy (Odds Ratio 0,57) in children from hand dishwashing families as compared to children from families who use machine dishwashing.
MedicalResearch.com Interview with:
Claire Duvernoy, MD
Chief, Cardiology Section
VA Ann Arbor Healthcare System
Professor of Medicine
University of Michigan Health System Ann Arbor, MI
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Duvernoy: We wanted to look at the indications and outcomes for women veterans undergoing cardiac catheterization procedures as compared with men veterans, given that we know that there are significant gender differences in the non-veteran population between women and men undergoing cardiac catheterization.
MedicalResearch.com Interview with:
Chwee Teck (C.T.) LIM PhD
Provost’s Chair Professor, Deputy Head, Department of Biomedical Engineering & Department of Mechanical Engineering
Principal Investigator, Mechanobiology Institute
Faculty Fellow, Singapore-MIT Alliance for Research & Technology (SMART) National University of Singapore
Medical Research: What is the background for this study? What are the main findings?
Professor Chwee Teck Lim: Epithelial cells have a natural tendency to close gaps and this feature plays a crucial role in many biological processes such as embryological development and wound healing. For example, skin does consist of epithelial cells that when wounded, will elicit closure to initiate healing. How epithelial cells close such gaps has always fascinated researchers from across many disciplines. It is generally accepted that two major mechanisms exist that underlie such a closure. The first is a "cell-crawling" mechanism wherein cells at the edge of the gap actively send protrusions or lamellipodia and use them as footholds to migrate over the gap. However, such a migration requires that the gap is conducive for cells to attach and form adhesions or footholds. The second mechanism is based on a coordinated contraction of multiple bundles of cellular cytoskeletal components (bundles of actin) in a manner similar to that of a "purse-string".
Despite many studies, it has always been difficult to understand and characterize these processes separately since most often they co-exist. In this study, we show that keratinocyte monolayers have a tendency to close circular non-adhesive gaps (gaps that have been coated with a polymer that does not allow cells to adhere or form foot-holds) through contraction of bundles of actin within cells at the edge of the gap. We find that such as closure is strongly affected by the size of the gap (gaps more than 150 um in diameter have a tendency to close only partially), curvature of the gap (gaps with high curvature show better closure), and strength of intercellular adhesion (poor intercellular adhesion completely inhibits closure of non-adhesive gaps).
MedicalResearch.com Interview with:
Almudena Zapatero MD PhD
Senior Consultant Dpt Radiation Oncology
Instituto Investigación Sanitaria IIS-IP
Hospital Universitario de la Princesa
Madrid
Medical Research: What is the background for this study? What are the main findings?
Dr. Zapatero: There is a significant body of evidence from randomized trials showing a significant improvement in clinical outcome with the combination of androgen deprivation and conventional-dose radiotherapy (≤70 Gy) in patients with high-risk and intermediate-risk prostate cancer. However, the optimal duration the optimum duration of androgen deprivation in the setting of high-dose radiotherapy remained to be determined.
The results of our trial (DART01/05) show that 2 years of adjuvant androgen deprivation is superior to 4 months androgen deprivation when combined with plus high-dose radiotherapy in terms of biochemical control, freedom from metastasis and overall survival, particularly in patients with high-risk prostate cancer.
MedicalResearch.com Interview with:
Ann Caroline Raldow, M.D.
Brigham and Women's Hospital
Resident in Radiation Oncology
Medical Research: What is the background for this study? What are the main findings?
Dr. Raldow: Active surveillance (AS) means monitoring the course of prostate cancer (PC) with the expectation to start treatment if the cancer progresses. Men who enter an AS program are able to defer and possibly avoid the side effects of prostate cancer treatment.
According to the National Comprehensive Cancer Network (NCCN) guidelines, active surveillance is currently considered as an initial treatment approach for men with low-risk PC and a life expectancy of at least 10 years. However, no direct comparison has been made between favorable intermediate-risk and low-risk PC with regard to PC-specific mortality or all-cause mortality following treatment with high-dose radiation therapy such as brachytherapy, where radioactive seeds are placed inside the prostate to kill the cancer. We therefore assessed whether the risks of prostate cancer-specific mortality and all-cause mortality following brachytherapy were increased in men with favorable intermediate-risk versus low-risk prostate cancer. The study consisted of more than 5,000 men who were treated with brachytherapy at the Prostate Cancer Foundation of Chicago.
After a median follow-up of 7.69 years, there were no significant differences in prostate cancer-specific mortality and all-cause mortality between men with low-risk and favorable intermediate-risk prostate cancer, suggesting that men with favorable intermediate-risk prostate may also be candidates for AS.
MedicalResearch.com Interview with:
Karim Chamie MD
Department of Urology
Ronald Reagan UCLA Medical Center
UCLA Medical Center, Santa Monica
Medical Research: What is the background for this study? What are the main findings?
Response: Active surveillance has been shown to be safe and effective. There are multiple longitudinal studies that have demonstrated the safety of active surveillance for men with indolent prostate cancer. In this context, we sought out to determine national practice patterns for localized prostate cancer. Moreover, we wanted to identify patient, tumor, and physician factors that influence treatment decision. What we found was that the vast majority of patients undergo radiation therapy, regardless of patient age and health or severity of tumor. Instead, by far the most significant predictor of whether a patient undergoes radiation therapy is whether they have been referred to a radiation oncologist. On the other hand, surgeons significantly incorporate patient age and health and tumor severity when considering radical prostatectomy (surgery).
MedicalResearch.com Interview with:
Thomas W. Buford, PhD
Assistant Professor, Division of Clinical Research
Department of Aging and Geriatric Research, University of Florida College of Medicine
Director, Health Promotion Center
University of Florida Institute on Aging
Medical Research: What is the background for this study? What are the main findings?
Dr. Buford: This study was a cross-sectional analysis of data collected from over 1000 older adults upon their entry into the Lifestyle Interventions and Independence for Elders (LIFE) study. Briefly, participants were recruited into the LIFE Study who were over 70 years of age, sedentary, and had mobility limitations. The objective of this study was to examine, at baseline prior to their participation in the study interventions, the association between daily physical activity habits and risk of major cardiovascular events (i.e. heart attack and coronary-related death). The study utilized accelerometers, devices designed to identify and quantify human movement, to measure participant’s daily activity. Predicted risk of cardiovascular events was determined using a risk score established in the Framingham Heart Study. As identified by accelerometry measures, participants spent on average 70% of their waking hours being sedentary. The major finding of the study, however, was that even extremely low-level activity was associated with an improved cardiovascular risk profile. For every 25-30 minutes a participant was sedentary per day, predicted risk was 1 percent higher. Conversely, But activity identified as slightly above sedentary — which could be light housework or slow walking — was associated with higher levels of the more beneficial kind of cholesterol, HDL, in people with no history of heart disease.
MedicalResearch.com Interview with:
Katherine M. Keyes, Ph.D.
Assistant Professor of Epidemiology
Columbia University
Mailman School of Public Health
New York, NY 10032
Medical Research: What is the background for this study? What are the main findings?
Dr. Keyes: The Monitoring the Future study is an annually conducted survey of 8th, 10th, and 12th grade high school students in the United States, covering a wide range of adolescent health behaviors. The same questions on adolescent sleep were queried every year since 1991, allowing us to examine historical trends in the amount of sleep adolescents report. We found that there have been substantial decreases in the proportion of adolescents who report 7 or more hours of sleep on a regular basis, across all age groups and across all demographic groups. In the most recent years, after age 15, less than half of adolescents report regularly getting 7 or more hours of sleep every night. Given the importance of sleep in both the short and the long term for adolescent health, these findings suggest substantial public health concern.