Author Interviews, Cancer Research, End of Life Care, JAMA / 12.11.2014

Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical SchoolMedicalResearch.com Interview with: Ziad Obermeyer, MD, MPhil Emergency Medicine, Brigham & Women's Hospital Assistant Professor, Harvard Medical School Medical Research: What is the background for this study? What are the main findings? Dr. Obermeyer: More patients with cancer use hospice today than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. We examined how hospice affects health care utilization and costs and found that, in a sample of elderly Medicare patients with advanced cancer, hospice care was associated with significantly lower rates of both health care utilization and total costs during the last year of life. Patients who did not enroll in hospice had considerably more aggressive care in their last year of life—most of it related to acute complications like infections and organ failure, and not directly related to cancer-directed treatment. Hospice and non-hospice patients had similar patterns of health care utilization until the week of hospice enrollment, when care began to diverge. Ultimately, non-hospice patients were five times more likely to die in hospitals and nursing homes. These differences in care contributed to a statistically-significant difference in total costs of $8,697 over the last year of life ($71,517 for non-hospice and $62,819 for hospice). (more…)
AHA Journals, Author Interviews, Diabetes, Heart Disease, Metabolic Syndrome, Weight Research / 12.11.2014

Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director, Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health, LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, LouisianaMedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA Assistant professor & Director Chronic Disease Epidemiology Lab Adjunct assistant professor, School of Public Health LSU Health Sciences Center Pennington Biomedical Research Center, Baton Rouge, Louisiana Medical Research: What is the background for this study? What are the main findings? Dr. Hu: Many previous studies had small samples, and thus lacked adequate statistical power when the analysis was focused on those who are extremely obese (BMI ≥40 kg/m2). In addition, most epidemiological studies only use a single measurement of BMI at baseline to predict risk of all-cause mortality, which may produce potential bias. The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2. (more…)
Author Interviews, Dartmouth, Lung Cancer, NEJM / 07.11.2014

William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756MedicalResearch.com Interview with: William C. Black, MD Professor of Radiology Department of Radiology Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014. (more…)
Author Interviews, Cancer Research, Case Western, Dental Research, JAMA / 07.11.2014

MedicalResearch.com Interview with: Brendan J. Perry, BSc, MBBS Princess Alexandra Hospital Brisbane, Queensland, Australia MedicalResearch: What is the background for this study? What are the main findings? Dr. Brendan J. Perry: Oral cavity cancer is usually attributed to the “Five S’s” - smoking, spirits (alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice. This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth. In recent years, dentists have been recommending clients to get removable denture nyc to tackle down on discomfort. We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor. (more…)
Author Interviews, Gender Differences, PLoS / 07.11.2014

MedicalResearch.com Interview with: Prof. Roberto Lent Diretor, Instituto de Ciências Biomédicas Centro de Ciências da Saúde, Bloco K, sala 2-35 Universidade Federal do Rio de Janeiro Rio de Janeiro, Brasil Medical Research: What is the background for this study? What are the main findings? Prof. Lent: Our group has been studying the absolute numbers of cells in the human brain, using a novel technique that we have developed. We have done it for the whole male brain, and arrived at a figure of 86 billion neurons and 85 billion glial cells, 15% less than the round number that became a neuromyth (one hundred billion neurons). We did it also for the demented brain, in this case working with females, and showed that it is dementia that is associated with a loss of neurons, because people with alzheimer, but no dementia, displayed normal numbers of neurons. The present paper focuses on sexual dimorphism in the olfactory bulb, and revealed that women have around 40% more neurons and glial cells than men, what correlates with their superior performance in many olfactory abilities. (more…)
Author Interviews, JAMA, Metabolic Syndrome, Weight Research / 07.11.2014

MedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology (Nuclear Medicine and Cardiothoracic Imaging Divisions), University of Michigan, Ann Arbor, Michigan and Dr. Ravi Shah MD Cardiology Division, Department of Medicine Massachusetts General Hospital, Boston, Massachusetts Medical Research: What is the background for this study? What are the main findings? Response: Prior studies in Framingham, MESA and other cohorts have demonstrated that obesity is an important risk factor for the metabolic syndrome. However, the observations that many non-obese individuals develop metabolic syndrome and diabetes and, conversely, that not all obese individuals develop these complications has motivated the search for better markers of risk than BMI. More recently, it has been shown that the location of adipose tissue is an important factor. The amount of visceral fat, which is thought to be more harmful from a metabolic perspective, can be accurately quantified with CT imaging. In many prior studies, waist circumference has been used as an approximate measure of visceral adiposity. For this study, we analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA). We found that the amount of visceral fat (as quantified by CT) was an important predictor of metabolic syndrome, even after adjusting for weight, waist circumference, gender, race, smoking, exercise, serum lipids and glucose. Each additional 100 cm2/m of height of visceral fat was associated with a 29% increase in the risk of developing metabolic syndrome. In contrast, subcutaneous fat burden (also quantified by CT) was a much weaker predictor. One of the very novel findings of our study arises from an analysis of subjects who had multiple CTs longitudinally in MESA. Using these data, we found that change in visceral fat burden was associated with a corresponding 5% increase in the risk of metabolic syndrome. In part, this is because very small changes in weight could result in very large changes in visceral fat. (more…)
Author Interviews, Genetic Research, Nature, NYU / 06.11.2014

Leslie Mitchell, PhD New York University Langone Medical Center Boeke Lab, Institute for Systems Genetics NY NY, 10016MedicalResearch.com Interview with: Leslie Mitchell, PhD New York University Langone Medical Center Boeke Lab, Institute for Systems Genetics NY NY, 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: One of our major interests is building synthetic chromosomes. Typically we construct synthetic chromosomes using a bottom-up approach, first designing the sequence in silico and then synthesizing and piecing together the DNA to build the designer molecule. While eukaryotic chromosomes are usually linear in structure, oftentimes we build our designer synthetic chromosomes as circular molecules to take advantage of cloning technologies available in E. coli, an organism that tolerates only circular chromosomes. We developed the telomerator as a means by which to convert circular synthetic chromosomes into linear molecules, which more closely resemble the native chromosomes found in eukaryotic cells. We discovered that the telomerator is an extremely effective tool for generating linear derivatives of circular synthetic chromosomes. There are two main reasons for this.
  • First, the action of the telomerator can be assessed using a simple phenotypic assay so it is easy to differentiate cells that encode linear synthetic chromosomes from those with the circular format.
  • Second, the telomerator encodes ‘telomere seed sequences’ that are exposed and recognized by the cell upon linearization, thus the ends of a newly linearized chromosome are protected, which ensures its stability over generations. We put the telomerator to the test by integrating it in 54 different positions on a circular synthetic yeast chromosome called synIXR (Dymond et al. 2011). In 51 of the 54 positions we could successfully linearize the synIXR chromosome and recover viable cells, however many of the different linear derivatives conferred growth defects. We determined the mechanism underlying both the growth defects and lethality associated with linearization to be telomere position effect. In other words, when essential genes were re-positioned near telomeres their reduction in expression due to subtelomeric silencing was detrimental to the cell.
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Author Interviews, NEJM, Rheumatology / 06.11.2014

Professor Paul Emery Arthritis Research UK Professor of Rheumatology Director - Leeds Musculoskeletal Biomedical Research Unit, LTHT Director – Leeds Institute of Rheumatic and Musculoskeletal Medicine University of LeedsMedicalResearch.com Interview Professor Paul Emery Arthritis Research UK Professor of Rheumatology Director - Leeds Musculoskeletal Biomedical Research Unit, LTHT Director – Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds Medical Research: What is the background for this study? What are the main findings? Professor Emery: Joint damage and functional disability are common in people who suffer from rheumatoid arthritis (RA), even in those with early disease. We know that early aggressive treatment with biologics, such as the anti-TNF agent etanercept, results in rapid remission in many patients with moderate-to-severe rheumatoid arthritis, which can help reduce the risk of joint destruction and disability long term. However, we don’t yet know whether remission achieved with biologic therapy can be maintained after doses are reduced or therapy is withdrawn. The PRIZE trial, a “state-of-the-art” biologic treatment trial conducted in adults with early untreated rheumatoid arthritis, was designed to fill this knowledge gap. The trial included three phases:
  • 1) induction therapy with full-dose combination etanercept-methotrexate therapy;
  • 2) maintenance therapy with a reduced-dose etanercept-methotrexate regimen, methotrexate alone, or no treatment; and
  • 3) complete treatment withdrawal. After clinical remission was induced, remission was shown to be effectively maintained with the reduced-dose combination regimen but not with the biologic-free regimens.Significantly more patients who had received the reduced-dose regimen were in remission after therapy was withdrawn than patients who received no therapy after remission induction. Interestingly, however, after remission was induced with the full-dose combination regimen, no substantial progression of joint damage on x-ray was seen in patients receiving the reduced-dose regimen, methotrexate only, or no treatment.
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Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease, NIH / 05.11.2014

MedicalResearch.com Interview with: Anita Kohli, MS, MD Clinician Investigator, Clinical Monitoring Research Program (CMRP) Leidos Biomedical Research, Inc. formerly SAIC-Frederick, Inc. National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? What are the main findings? Dr. Kohli: We previously treated 60 patients with sofosbuvir and ribavirin for 24 weeks. Patients who relapsed after treatment were offered re-treatment with another regimen of directly acting antivirals alone. 13 patients who relapsed were treated with sofosbuvir and ledipasvir for 12 weeks. All patients achieved SVR12. This is the first report of re-treating patients who failed a regimen including sofosbuvir with another regimen incorporating this same antiviral. (more…)
AHA Journals, Author Interviews, Heart Disease / 05.11.2014

MedicalResearch.com Interview with: Dr. Bilal Iqbal MD Royal Brompton and Harefield NHS Foundation Trust Harefield Hospital Middlesex United Kingdom. Medical Research: What is the background for this study? What are the main findings? Dr. Iqbal: The optimal strategy for revascularization of bystander coronary disease at the time of PPCI is unknown. Certainly, this has been the focus of recent debate and randomized controlled trials. We evaluated a strategy of culprit vessel versus multivessel intervention at the time PPCI in the real world setting. We conducted an observational analysis of 3984 consecutive patients with STEMI undergoing Primary percutaneous coronary intervention (PPCI) who had multivessel disease. We excluded patients with cardiogenic shock and patients with bystander LMS disease, which may potentially dictate staged surgical intervention. When analysing all-cause mortality at 1 year, we found that a strategy of culprit vessel intervention only at the time of PPCI was associated with increased survival at 1 year. (more…)
Author Interviews, Heart Disease, JAMA / 05.11.2014

Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART ProgramMedicalResearch.com Interview with: Thomas M. Maddox MD MSc Cardiology, VA Eastern Colorado Health Care System Associate Director, VA CART Program Associate Professor, Department of Medicine University of Colorado School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Maddox: Nonobstructive coronary artery disease (CAD) is atherosclerotic plaque that would not be expected to obstruct blood flow or result in anginal symptoms (such as chest pain). Although such lesions are relatively common, occurring in 10 percent to 25 percent of patients undergoing coronary angiography, their presence has been characterized as “insignificant” or “no significant CAD" in the medical literature.  However, this perception of nonobstructive coronary artery disease may be incorrect, because prior studies have noted that the majority of plaque ruptures and resultant myocardial infarctions (MIs; heart attacks) arise from nonobstructive plaques. Despite the prevalence of nonobstructive CAD identified by coronary angiography, little is known about its risk of adverse outcomes, according to background information in the article. During the study period, 37,674 patients underwent elective coronary angiography for indications related to CAD; of those, 22.3 percent had nonobstructive CAD and 55.4 percent had obstructive CAD.  Within 1 year, 845 patients died and 385 were rehospitalized for myocardial infarction. The researchers found that the 1-year myocardial infarction risk progressively increased by the extent of coronary artery disease, rather than abruptly increasing between nonobstructive and obstructive CAD.  Patients with nonobstructive CAD had an associated risk of MI that was 2-to 4.5-fold greater than among those with no apparent coronary artery disease. Similar observations were seen with 1-year mortality and the combined outcome of 1-year myocardial infarction and death. (more…)
Author Interviews, Emergency Care, PLoS / 05.11.2014

Anna Alassaad Pharmacist, PhD Student, Department of Medical Sciences, Uppsala University Uppsala, Sweden, Uppsala University Hospital, Uppsala, SwedenMedicalResearch.com Interview with: Anna Alassaad Pharmacist, PhD Student, Department of Medical Sciences, Uppsala University Uppsala, Sweden, Uppsala University Hospital, Uppsala, Sweden Medical Research: What is the background for this study? What are the main findings? Response: The main findings from our study are that patients with a low number of prescribed drugs benefited more from a comprehensive clinical pharmacist intervention than patients with a higher number of drugs. There was no difference in effect between the patients with higher and lower levels of inappropriate prescribing, as measured by two validated tools for inappropriate prescribing. Clinical pharmacist interventions have in several studies shown positive effects on inappropriate prescribing and clinical outcomes. Since the concomitant use of a large number of drugs is associated with an increased risk of adverse drug events, it is often assumed that patients receiving a larger number of drugs would benefit most from interventions aiming to improve the quality of drug use. However, differences in the effects of clinical pharmacist intervention between different subgroups of patients have rarely been analyzed. We have, in a randomized controlled trial, previously demonstrated that a clinical pharmacist intervention at an acute internal medicine hospital ward reduces emergency department visits by 47%, revisits to hospital by 16%, and drug-related readmissions by 80% for patients aged 80 years or older. We aimed to investigate whether there was any difference in treatment effect of the clinical pharmacist interventions on number of subsequent revisits to the emergency department between the patients with less than five drugs and those with five or more drugs on admission to hospital. We also explored whether the effect of the intervention was consistent for patients with a high or low level of inappropriate prescribing. (more…)
Author Interviews, JAMA, Pediatrics, Weight Research / 05.11.2014

MedicalResearch.com Interview with: Angela Alberga, PhD Eyes High Postdoctoral Fellow Werklund School of Education University of Calgary Ronald J. Sigal, MD, MPH, FRCPC Professor of Medicine, Kinesiology, Cardiac Sciences and Community Health Sciences Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary Health Senior Scholar, Alberta Innovates-Health Solutions Member, O'Brien Institute of Public Health, Libin Cardiovascular Institute and Julia McFarlane Diabetes Research Centre Medical Research: What are the main findings of the study? Response: The Healthy Eating, Aerobic and Resistance Training in Youth study examined the effects of exercise on body composition and cardiometabolic risk markers in adolescents with obesity. A total of 304 overweight or obese adolescents were randomized to four groups. The first group performed resistance training involving weight machines and some free weights; the second performed only aerobic exercise on treadmills, elliptical machines and stationary bikes; the third underwent combined aerobic and resistance training; and the last group did no exercise training. All four groups received nutritional counseling. In analyses involving all participants regardless of adherence, each exercise program reduced percent body fat, waist circumference and body mass index to a similar extent, while the diet-only control group had no changes in these variables. In participants who exercised at least 2.8 times per week, we found that combined aerobic and resistance training produced greater decreases in percentage body fat, waist circumference, and body mass index than aerobic training alone. Waist circumference decreased close to seven centimeters in adherent participants randomized to combined aerobic plus resistance exercise, versus about four centimeters in those randomized to do just one type of exercise, with no change in those randomized to diet alone. (more…)
Author Interviews, CMAJ, Diabetes, Electronic Records / 04.11.2014

Dr. Tim A. Holt PhD MRCP FRCGP NIHR Academic Clinical Lecturer University of Oxford Department of Primary Care Health Sciences Radcliffe Observatory Quarter Woodstock Road OxfordMedicalResearch.com Interview with: Dr. Tim A. Holt PhD MRCP FRCGP NIHR Academic Clinical Lecturer University of Oxford Department of Primary Care Health Sciences Radcliffe Observatory Quarter Woodstock Road Oxford Medical Research: What is the background for this study? Dr. Holt: Undiagnosed diabetes is a serious and very costly problem. Early diagnosis is important to reduce risk of long term complications. A structured approach to management at the practice level involves electronic diabetes registers, enabling audit of care, automated recall, and screen reminders. Such registers depend on the presence of an electronic code for diabetes in the record.  (more…)
Author Interviews, BMJ, Circadian Rhythm, Cognitive Issues, Metabolic Syndrome, Occupational Health / 04.11.2014

Dr. Philip Tucker Department of Psychology | Yr Adran Seicoleg College of Human and Health Sciences | Coleg y Gwyddorau Dynol ac lechyd Swansea University | Prifysgol Abertawe Singleton Park | Parc Singleton Swansea | Abertawe Medical Research: What is the background for this stuMedicalResearch.com Interview with: Dr. Philip Tucker Department of Psychology | Yr Adran Seicoleg College of Human and Health Sciences | Coleg y Gwyddorau Dynol ac lechyd Swansea University | Prifysgol Abertawe Singleton Park | Parc Singleton Swansea | Abertawe Medical Research: What is the background for this study? What are the main findings? Dr. Tucker: Shift work, like jet-lag, is known to disrupt workers’ normal circadian rhythms (i.e. their body clocks) and their social life. It is also associated with greater risk of developing ulcers, cardiovascular disease, metabolic syndrome, breast cancer and reproductive problems. Several studies have also shown that shift workers experience heightened fatigue and sleepiness, particularly at night, and this may affect job performance and safety. However, very little is known about the long-term consequences of shift work on cognitive abilities. We followed a large sample of shift workers and non-shift workers over 10 years, testing their cognitive performance every 5 years. We found that the shift workers’ cognitive performance was lower than that of the day workers.  The difference was greatest for those who had worked shifts for more than 10 years. The shift workers’ cognitive function recovered after they quit shift work, but this recovery took at least 5 years from time that they stopped working shifts. The effects could not be attributed to poorer sleep quality among shift workers. Rather, it seems likely that the findings reflect the disruption of the shift workers’ circadian rhythms, which as been shown by other researchers to have an impact on brain structures involved in cognition and mental health over the lifespan. (more…)
Author Interviews, Heart Disease, JAMA, University of Pittsburgh / 04.11.2014

Yuting Zhang, Ph.D. Associate Professor and Director Pharmaceutical Economics Research Group University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management.MedicalResearch.com Interview with: Yuting Zhang, Ph.D. Associate Professor and Director Pharmaceutical Economics Research Group University of Pittsburgh Graduate School of Public Health Department of Health Policy and Management. Medical Research: What are the main findings of the study? Dr. Zhang: Patients with atrial fibrillation who take the blood thinner dabigatran are at greater risk for major bleeding and gastrointestinal bleeding than those who take warfarin, indicating that greater caution is needed when prescribing dabigatran to certain high-risk patients. High-risk groups include those who are 75 and older; African Americans; those with chronic kidney disease; and those with seven or more co-existing medical problems. (more…)
Author Interviews, Cancer, Cancer Research, Psychological Science / 04.11.2014

Linda E. Carlson, Ph.D., R.Psych. Enbridge Research Chair in Psychosocial Oncology Alberta Innovates-Health Solutions Health Scholar Professor, Department of Oncology, Faculty of Medicine Adjunct Professor, Department of Psychology, Faculty of Arts University of Calgary Clinical Psychologist, Director of Research Department of Psychosocial ResourcesMedicalResearch.com Interview with: Linda E. Carlson, Ph.D., R.Psych.                Enbridge Research Chair in Psychosocial Oncology Alberta Innovates-Health Solutions Health Scholar Professor, Department of Oncology, Faculty of Medicine Adjunct Professor, Department of Psychology, Faculty of Arts University of Calgary Clinical Psychologist, Director of Research Department of Psychosocial Resources Medical Research: What is the background for this study? What are the main findings? Dr. Carlson: We have been investigating the effects of cancer support programs including the two in this study, Mindfulness-based cancer recovery, an 8-week group program in which patients learn mindfulness meditation and gentle yoga, and supportive-expressive therapy, a 12-week program where patients share difficult emotions in a supportive group environment. We know there is psychological benefit of these programs, but what about effects in the body? Telomeres are the protective caps on the end of chromosomes (like the tips on shoelaces) that protect them from damage and degredation. They are longest when we are young and naturally get shorter as we age. Shorter telomere's are associated with higher risk for many diseases, including cancer, and people with higher stress levels tend to have shorter telomeres. This is the first study to investigate whether short psychosocial interventions can affect telomere length in cancer pateints. We randomly assigned breast cancer survivors with cancer-related distress, feelings such as anxiety, fear, worry, and depression, to either mindfulness-based cancer recovery, supportive expressive therapy or a control group that just had a minimal intervention. We took blood samples before and after the groups (or at equal time points for those in the control condition) and measured the length of the telomeres. Women in both of the active support groups maintained the length of their telomeres over time, but the telomere length of women in the control group became shorter. This is the first controlled study to show that short-term interventions can actually have some effect on cellular aging in the telomeres. (more…)
Author Interviews, Autism, JAMA / 03.11.2014

dr_stefan_hansenMedicalResearch.com Interview with: Stefan Nygaard Hansen PhD Student, MSc Stat Section for Biostatistics Department of Public Health Aarhus University Denmark Medical Research: What are the main findings of the study? Response: The main finding of our study is that 60% of the observed increase in autism prevalence among children born 1980-1991 in Denmark can be explained by changes in the way diagnoses are established and changes in the subsequent registration to national health registries. In 1994, the diagnostic criteria used by clinicians to establish psychiatric diagnoses was changed. This meant the recognition of autism as a spectrum of disorders but it also meant changes in the specific symptoms that form the basis of the autism diagnosis. In 1995, the national health registries in Denmark, which are often used in Danish health research, began to also include diagnoses given in connection with outpatient consultations whereas before 1995 only diagnoses given in connection with hospitalization was reported to the registries. This could mean that we after 1995 see more of the mild autism diagnoses since they may not require hospitalization. (more…)
Author Interviews, JAMA, McGill, Mental Health Research / 03.11.2014

Frank J. Elgar, PhD Associate Professor of Psychiatry Canada Research Chair in Social Inequalities in Child Health Institute for Health and Social Policy, McGill University Montreal, Quebec, CanadaMedicalResearch.com Interview with: Frank J. Elgar, PhD Associate Professor of Psychiatry Canada Research Chair in Social Inequalities in Child Health Institute for Health and Social Policy, McGill University Montreal, Quebec, Canada Medical Research: What are the main findings of the study? Dr. Elgar: Our study addressed two questions. The first was whether cyberbullying has unique links to adolescent mental health, or is an extension of traditional (face-to-face) bullying. We measured various forms of bullying and found that cyberbullying does indeed have a unique impact on mental health. Our second question about protective factors in the home environment.  We examined the frequency of family dinners as potential a moderating factor - understanding, of course, that dinners are a proxy of various family characteristics that benefit adolescents, such as communication, support, and parental monitoring. We found that teens who were targeted by cyberbullying but had ate dinner with their families more often had significantly better mental health outcomes as a result. (more…)
Author Interviews, General Medicine, Leukemia, NEJM, Transplantation / 03.11.2014

John E. Wagner, M.D. Principal Investigator Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children's Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455MedicalResearch.com Interview with: John E. Wagner, M.D. Principal Investigator Professor Director, Division of Blood and Marrow Transplantation Department of Pediatrics McKnight Presidential Endowed Chair Hageboeck Family / Children's Cancer Research Fund Endowed Chair University of Minnesota Minneapolis, MN 55455 Medical Research: What is the background for this study? What are the main findings? Dr. Wagner: Earlier studies of umbilical cord blood transplantation (UCB) in children with hematological malignancies demonstrated a survival rate of approximately 50%.  While single UCB transplant was very effective despite HLA mismatch, few adults had access to umbilical cord blood as a treatment option due to the cell dose requirement of 2. 5 x 10^6 nucleated cells per kilogram recipient body weight.  For this reason, at the University of Minnesota we explored the co-transplantation of two partially HLA matched umbilical cord blood units in adults as a straightforward strategy to achieving the cell dose requirement.  Early results were remarkable with survival rates higher than that observed in children.  This in turn led to the design of the BMT CTN 0501 study, a randomized trial comparing single versus double umbilical cord blood transplantation in children aged 2-21 years with hematological malignancies.  All patients received a uniform conditioning regimen of fludarabine, cyclophosphamide and total body irradiation and GVHD prophylaxis of cyclosporine A and mycophenylate mofetil.  224 patients were randomized. There were four major findings:
  • 1) survival results overall, regardless of treatment arm, have improved,
  • 2) for children, an adequately dosed single umbilical cord blood unit is sufficient, giving a survival result of 72% at one year,
  • 3) double umbilical cord blood transplant is associated with more GVHD and poorer platelet recovery but survival is comparable to an adequately dosed single unit, and
  • 4) HLA mismatch is well tolerated with potentially better disease free survival in patients transplanted with HLA mismatched umbilical cord blood , a provocative finding that requires further investigation.
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Author Interviews, Biomarkers, BMJ, Ovarian Cancer / 03.11.2014

Ben Van Calster PhD Department of Development and Regeneration KU Leuven, Herestraat Leuven, BelgiumMedicalResearch.com Interview with: Ben Van Calster PhD Department of Development and Regeneration KU Leuven, Herestraat Leuven, Belgium   MedicalResearch: What is the background for this study? What are the main findings? Dr. Van Calster: Ovarian cancer is a very common type of cancer among women, with over 200,000 new cases per year worldwide. It is the most lethal of gynecological malignancies. Research has shown that the referral of patients with ovarian cancer to specialized gynecological oncologists in high volume centers improves survival. However, audits in Europe and the United States also show that only a minority of women with ovarian cancer are appropriately triaged to receive specialist care. In addition, different types of malignancies are not treated in the same way. Hence optimal personalized management of an ovarian tumor hinges on the detailed preoperative diagnosis of its nature. Unfortunately, current prediction models focused on the discrimination between benign and malignant tumors without further specification of the likely type of malignancy. Various prediction models and rules have been developed to help predict whether an ovarian mass is benign or malignant. A recent systematic review meta-analysis has shown that the IOTA model LR2 and simple rules perform better than any other previous test. However none of these tests give anything other than a dichotomous outcome – i.e. cancer or non-cancer. In practice the position is more nuanced. The ADNEX model estimates the likelihood that a tumor is benign, borderline malignant, stage I cancer, stage II-IV cancer, or secondary metastatic cancer. This model is the first that is able to differentiate between benign and these four subtypes of malignancy. To do so, ADNEX uses three clinical predictors (age, serum CA-125 level, and type of center), and six ultrasound characteristics of the tumor (maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites). The model is based on data from almost 6,000 women recruited at 24 centers in 10 countries. (more…)
Author Interviews, Biomarkers, Nature, Pancreatic / 03.11.2014

Dr. Murray Korc MD, Professor Department of Medicine, Division of Endocrinology, Biochemistry and Molecular Biology, and the Pancreatic Cancer Signature Center IU Simon Cancer Center, Indiana University School of Medicine Indianapolis, IndianaMedicalResearch.com Interview with Dr. Murray Korc MD, Professor Department of Medicine, Division of Endocrinology, Biochemistry and Molecular Biology, and the Pancreatic Cancer Signature Center IU Simon Cancer Center, Indiana University School of Medicine Indianapolis, Indiana Medical Research: What is the background for this study? What are the main findings? Dr. Korc: Pancreatic ductal adenocarcinoma (PDAC) is a deadly cancer with an overall 5-year survival rate of 6%. Currently, there are no highly specific and sensitive biomarkers in the blood that can be used for definitively diagnosing the presence of this cancer. In addition, in spite of the usefulness of CA19-9 in differentiating between patients with pancreatic cancer and chronic pancreatitis, this test may yield a significant number of false positive and false negative results, and it may be influenced by the presence of jaundice. These difficulties are compounded by the fact that patients with pancreatitis are at-risk for developing Pancreatic ductal adenocarcinoma. We decided to carry out a study of microRNAs using plasma from treatment-naïve PDAC patients, chronic pancreatitis patients, and controls without pancreatic disease. We focused on microRNAs because they are known to be present in the blood and to be very stable. We chose to conduct these assays in plasma because we reasoned that there would be fewer confounding factors by comparison with either whole blood or serum. We determined that five microRNAs were elevated in plasma from PDAC patients by comparison with either chronic pancreatitis or controls. Importantly, among these five microRNAs, high levels of miR-10b, miR-155, and miR-106b in the plasma were highly accurate in diagnosing Pancreatic ductal adenocarcinoma with ~95% sensitivity and ~100% specificity. (more…)
Author Interviews, Heart Disease, JACC, Lipids / 31.10.2014

Prof. Frank B Hu Department of Nutrition Department of Epidemiology Harvard School of Public HealthMedicalResearch.com Interview with Frank B. Hu, MD, PhD Professor of Nutrition and Epidemiology Harvard School of Public Health Professor of Medicine Harvard Medical School Boston, MA 02115 Medical Research: What is the background for this study? What are the main findings? Dr. Hu: There has been much confusion and sensational headlines about the role of different types of fat in coronary heart disease.  A recent meta-analysis suggested that higher saturated fat intake was not associated with coronary heart disease (CHD), but people don't consume saturated fat in isolation from other components of diet. Typically people swap for one type of fat for another. Therefore it is important to look at replacement nutrient when we talk about health effects of saturated fat. Randomized clinical trials have shown that replacing saturated fat with polyunsaturated fat reduces total and LDL cholesterol. Thus it is important to examine whether such replacement confers long-term beneficial effects on heart disease prevention. We performed a systematic review and meta-analysis of prospective cohort studies to summarize the evidence regarding the link between dietary intake of linoleic acid (the predominant type of polyunsaturated fat) and heart disease risk in generally healthy people. We identified 13 published and unpublished cohort studies with a total of 310,602 individuals and 12,479 total  coronary heart disease events including 5,882 CHD deaths. We found that dietary linoleic acid intake is inversely associated with  coronary heart disease risk in a dose-response manner—meaning, higher intake of linoleic acid resulted in a lower risk of CHD. Comparing the highest to the lowest level of consumption, dietary linoleic acid was associated with a 15% lower risk of  coronary heart disease events and a 21% lower risk of CHD deaths. These results were independent of common coronary heart disease risk factors such as smoking and other dietary factors such as fiber consumption. (more…)
Annals Internal Medicine, Author Interviews, Ebola, Yale / 30.10.2014

Dr. Dan YasminMedicalResearch.com Interview with: Dan Yamin PhD Postdoctoral Associate Yale School of Public Health New Haven, CT 06520   Medical Research: What is the background for this study? Dr. Yamin: With limited resources, West Africa is currently overwhelmed by the most devastating Ebola epidemic known to date. In our research, we seek to address two questions:
  • 1) who is mostly responsible for transmission? and 2) what intervention programs should be applied to contain the current Ebola outbreak?
(more…)
Author Interviews, BMJ, General Medicine, Heart Disease / 30.10.2014

MedicalResearch.com Interview with: Anne Bellemain-Appaix Service de Cardiologie-La Fontonne Hospital, Antibes, France and Gilles Montalescot Professor of  Cardiology Institut de CardiologiePitié-Salpêtrière Hospital Université Paris 6, France ACTION Study Group, Paris, France Medical Research: What is the background for this study? Response: Pretreatment with P2Y12 inhibitors for Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS) patients, although advised in current guidelines, has been recently questioned in term of benefit/risk ratio (no ischemic benefit and increase in major bleeding). We wanted to answer this question by giving enough power to results in a complete meta-analysis of studies comparing P2Y12 inhibitors pretreatment (defined as its administration before the coronary angiogram) to no pretreatment in NSTE-ACS. (more…)
Author Interviews, BMJ, Orthopedics / 29.10.2014

MedicalResearch.com Interview with: Professor Karl Michaëlsson Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery Uppsala Clinical Research Institute MedicalResearch.com Interview with: Professor Karl Michaëlsson Professor in Medical Epidemiology, Senior Consultant in Orthopaedic Surgery Uppsala Clinical Research Institute Medical Research: What are the main findings of the study? Prof. Michaëlsson: A high milk intake is recommended for the prevention of osteoporotic fractures but milk is also the major dietary source of galactose intake. The addition of galactose by injection or in the diet is an established animal model of aging by induction of oxidative stress and inflammation. Previous research results regarding the importance of milk intake for the prevention of fractures and the influence on mortality rates are conflicting. High milk intake was in our study associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker). (more…)
Author Interviews, BMJ, Case Western / 29.10.2014

MedicalResearch.com Interview with: Dr. med. Rainer Erices Institut für Geschichte und Ethik der MedizinMedicalResearch.com Interview with: Dr. med. Rainer Erices Institut für Geschichte und Ethik der Medizin Medical Research: What are the main findings of the study? Dr. Erices: The study presents the results of a first systematic investigation of clinical drug trials carried out by Western pharmaceutical firms in Eastern Germany in the 1980s. The scientific investigation of the East German Health system has only just started. The study shows that in that period of time, around 220 clinical trials were carried out. We now know how many patients took part and what remuneration the GDR received. It continues to be difficult to evaluate these tests. Despite intensive research efforts in different archives, we have been unable to find documentation on how detailed (and systematically) patients were informed about the trial they were taking part in. The responsible institutions repeatedly advised testers to stick to the law during the clinical trials. The law required that these trials should only be carried out on patients which had given their informed consent and had decided to participate voluntarily. However, so far there is no convincing proof that these legal requests were met. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, Duke, Race/Ethnic Diversity / 29.10.2014

Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research InstituteMedicalResearch.com Interview with: Kevin L Thomas, MD Assistant Professor of Medicine Division of Clinical Cardiac Electrophysiology Duke Clinical Research Institute   Medical Research: What are the main findings of the study? Dr. Thomas: The number of participants with controlled blood pressure (readings of less than 140/90) increased by 12 percent in the six months between the first and last readings. Mean systolic blood pressure for the population decrease by 4.7mmHg. The number of participants who had high blood pressure in the range of 140-149/90-99 decreased systolic blood pressure by a mean of  8.8mmHg and those with readings in the higher range of 150/100 or above decreased systolic blood pressure by 23.7percent. The study concluded that a program that followed this type of approach was associated with improved blood pressures across a diverse  high-risk community.” (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC / 29.10.2014

Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195MedicalResearch.com Interview with: W. H. Wilson Tang, MD FACC FAHA Professor of Medicine, Cleveland Clinic Lerner College of Medicine at CWRU Director, Cardiomyopathy Program, Kaufman Center for Heart Failure Research Director, Section of Heart Failure and Cardiac Transplantation Medicine Heart and Vascular Institute, Cleveland Clinic Cleveland, OH 44195 Medical Research: What are the main findings of the study? Dr. Tang: A chemical byproduct of gut bacteria-dependent digestion, TMAO (trimethylamine N-oxide), was previously shown to contribute to heart disease development. In this study, blood levels of TMAO for the first time are linked to heart failure development and mortality risk. (more…)
Author Interviews, Heart Disease, JAMA, Lipids / 29.10.2014

George Thanassoulis, MD MSc FRCP(C) Director, Preventive and Genomic Cardiology FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien Assistant Professor of Medicine, McGill University McGill University Health Center Montreal, QCMedicalResearch.com Interview with: George Thanassoulis, MD MSc FRCP(C) Director, Preventive and Genomic Cardiology FRQ-S Clinician-Scientist/Chercheur-Boursier Clinicien Assistant Professor of Medicine, McGill University McGill University Health Center Montreal, QC Medical Research: What is the background for this study? What are the main findings? Dr. Thanassoulis: Although LDL-C (i.e. bad cholesterol) has been linked with aortic valve disease in several prior reports, randomized trials to lower cholesterol in aortic valve disease were not effective suggesting that cholesterol may not be important in valve disease. To address this, we performed a Mendelian randomization study, that showed that a genetic predisposition to LDL-C, was associated with both calcium deposits on the aortic valve and aortic stenosis (I.e. Valve narrowing).  These results can be viewed as the effect of a life-long increase in LDL-C on the incidence of aortic valve disease and suggest that increases in LDL-C cause aortic stenosis.   (more…)