Medical Research Journals

13 Dec New Genetic Loci for Gigantism and Acromegaly Identified

Posted at 20:15h in Author Interviews, Genetic Research, NEJM, NIH

MedicalResearch.com Interview with: Dr. Constantine A. Stratakis, M.D., D.Sc National Institutes of Health, Clinical Research Center Bethesda, MD 20892-1862 Medical Research: What is the background for this study? What are the main findings? Dr. Stratakis: We have been working for years on the genetics of pituitary tumors in association with other conditions. A few years ago (attached), we studied for the first time a series of pediatric giants that we sequenced for then known genes. We found a few MEN1 and AIP mutations but all mutations were present in older kids with gigantism. This left out the youngest among the giants without any genetic defect. This was the first time I realized that I was dealing with a different disease. We started looking for additional genetic defects and when we found the Xq26 microduplications in 3 kindreds. We contacted the custodians of the largest series in the world - Dr. Beckers in Liege. He screened his cases, once we gave him the coordinates, and boom - it was there... The most significant thing here is that this is a new disease really: the early pediatric gigantism is almost exclusively due to Xq26 microduplications unless it is part of a family with another syndrome (AIP, MEN1, Carney complex). If there is no family history and you are dealing with a toddler with gigantism, based in these data, there is a more than 80% chance of having an Xq26 defect. This is pretty amazing! In addition, assuming that GPR101 is the responsible gene (which needs to be confirmed with additional studies) this identifies a new molecular pathway of increasing growth hormone secretion, most likely due to upregulation of GHRH - all of this needs to be confirmed in further human and animal studies. The Xq26 genomic micro-arrangements (which contain the GPR101, but also 3 other genes) is the big news here...

13 Dec Complaints of Memory Loss May Signal Increased Stroke Risk

Posted at 14:07h in Author Interviews, Erasmus, JACC, Memory, Stroke

MedicalResearch.com Interview with: M. Arfan Ikram, MD, PhD,and Ayesha Sajjad, MD Department of Epidemiology Erasmus University Medical Center, Rotterdam Rotterdam, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The occurrence of cognitive impairment and dementia after a stroke event are already known. Since these neuro-degenerative processes and stroke share vascular pathways in their pathogenesis such as small vessel disease, we aimed to study whether early cognitive impairment can be predictive of stroke onset in the elderly. We also hypothesized that a higher cognitive reserve (due to higher education attainment) may mask early symptoms of memory loss and thus put these older individuals at a higher risk of stroke. We found that self-reported subjective memory complaints as answered by a single question: “ Do you have memory complaints?” was highly predictive of stroke especially in older persons who were highly educated. In comparison, objective measures of cognitive impairment such as MMSE did not show any association with the risk of stroke.

13 Dec Supplement May Reduce Cardiovascular Risks Linked to NSAIDS

Posted at 13:54h in Author Interviews, Heart Disease, Imperial College, JACC

MedicalResearch.com Interview with: Dr. Jane A. Mitchell National Heart and Lung Institute Imperial College, London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Mitchell: Anti-inflammatory drugs (NSAIDs) work by inhibiting the enzyme COX-2. COX-2 selective anti-inflammatory drugs, like Vioxx, were introduced to reduce gastrointestinal side effects associated with these drugs. However, COX-2 inhibitors as well as most older NSAIDs are associated with increased risk of heart attacks although the precise mechanisms underlying these side effects are not completely understood. The main findings of this study are: 1) COX-2 is highly expressed in the kidney where its genetic deletion leads to changes in more than 1000 genes. 2) Analysis of these genes revealed changes in 2-3 specific genes that regulate levels of ADMA, an endogenous inhibitor of the nitric oxide released by vessels, that can be reversed by giving more of the substrate for NO, L-arginine. 3) Further studies showed that ADMA was indeed increased in the plasma of mice where COX-2 gene was knocked out or in normal mice given a COX-2 inhibitor. 4) In mice where COX-2 was knocked out the release of nitric oxide from vessels was reduced and this could be reversed by supply L-arginine. 5) ADMA was also increased in human volunteers taking a COX-2 inhibitor

13 Dec ABIM MOC and Recertification May Have No Impact On Patient Quality Care

Posted at 13:31h in Author Interviews, Education, JAMA

MedicalResearch.com Interview with: John Hayes, MD Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin Medical Research: What is the background for this study? What are the main findings? Response: Prominent in the discussions about ABIM MOC and recertification has been an ongoing debate about the evidence that supports a relationship between recertification, MOC and patient care. Since many healthcare organizations use board certification as a criteria for employment consideration, the new status of “certified” but not meeting MOC throws considerable disarray into credentialing and hiring committees. We can now have ABIM labeling a physician who boarded eleven years ago as “not certified” but a physician who boarded 25 years ago as “certified” with an asterisk. And of course discussions like this bring employers and healthcare organizations back to the question: What is the additive value of MOC and recertification on patient care? The integrated Veterans Health Administration electronic health record generates performance reports for primary care physicians at regular intervals. In our study, we were able to observe for any difference based on certification groups. We reviewed ten industry-standard quality care measures in approximately 68,000 patients across 4 VA medical centers and found that internists holding time-unlimited certificates performed just as well as those holding time-limited certificates.

12 Dec Intestinal Bacterial Implicated In Onset of Obesity and Diabetes

Posted at 14:54h in Author Interviews, Diabetes, Nature, Weight Research

MedicalResearch.com Interview with: Prof. Dr. Patrice D. Cani PhD, Research Associate FRS-FNRS Louvain Drug Research Instiute, Metabolism and Nutrition WELBIO, Walloon Excellence in Life sciences and BIOtechnology NeuroMicrobiota lab, European Associated Laboratory (INSERM/UCL) and Dr Amandine Everard Université Catholique de Louvain, Louvain Drug Research Institute, WELBIO (Walloon Excellence in Life sciences and BIOtechnology), Metabolism and Nutrition Research Group, Brussels, Belgium Medical Research: What is the background for this study? What are the main findings? Response: Our intestine harbors more than 100 trillions of bacteria. This huge number of bacteria permanently interacts with our own human cells. Among the systems involved in this crosstalk, the immune system plays a key role in these interactions. We previously showed that specific gut bacteria are able to control energy metabolism, harmful inflammation associated with obesity, body weight gain and type-2 diabetes. However mechanisms involved these effects of gut bacteria on the host during obesity and type-2 diabetes were poorly understood. We identify the essential role of the intestinal immune system in the onset of obesity and type-2 diabetes both induced by a high dose of fat in the diet. This discovery highlights an unexpected mechanism for the control of energy metabolism during obesity and type-2 diabetes. We demonstrate for the first time that the inactivation of a part of the intestine immune system (more specifically the protein MyD88), which is overstimulated by a diet rich in fat, allows to induce weight-loss and to reduce type-2 diabetes associated with obesity. When we tune the immune system by disabling the protein MyD88 specifically in cells covering the intestine, we are able to limit the adipose tissue development induced by the diet rich in fat, to slow down diabetes, to reduce harmful inflammation associated with obesity, to reinforce gut barrier function assumed by our intestine to avoid the inappropriate translocations of bacteria compounds from our intestine in our body. We reveal various mechanisms explaining the partial protection against obesity induced by the inactivation of this protein of the immune system. Among them, we point out that mice that do not have this protein of the immune system (i.e. MyD88) in their intestine are partially protected against obesity because they spend more energy than other obese mice. Moreover, our study shows that this protein of the immune system is able to shape the composition of the gut microbiota residing in our intestine under a high-fat diet. These changes observed in mice deleted for this protein also explain their protection against obesity because when we transfer intestinal bacteria of these mice into other mice that are axenic (without flora), these latest mice are also partially protected against obesity. In conclusions, our studies published in the scientific journal Nature Communications, demonstrated that during consumption of fat food, the intestinal immune system plays an important role in fat storage regulation in the body and is capable to modify the composition of intestinal bacteria (including some which are still unidentified), confirm the implication of intestinal bacteria in the onset of obesity.

12 Dec Breast Cancer: Older Patients Still Receiving Radiation Therapy Despite Limited Benefit

Posted at 14:05h in Author Interviews, Breast Cancer, Cancer, Duke

MedicalResearch.com Interview with: Rachel Blitzblau, M.D., Ph.D. Butler Harris Assistant Professor Department of Radiation Oncology Duke University Medical Center Durham, NC 27710

Medical Research: What is the background for this study? What are the main findings? Dr. Blitzblau: Radiation reduces the risk of loco-regional recurrence. Data from the CALGB 9343 study suggests that the local benefit from adjuvant radiation is less in older women with small, . The potential acute and late toxicities of radiotherapy, patient inconvenience and healthcare costs must be considered given the small clinical benefit associated with adjuvant radiotherapy in this patient group. We looked at rates of radiotherapy in women fitting the entry criteria of this trial before and after publication of 5 year results of the CALGB trial. We found an approximately 5% decrease in use of radiotherapy overall, and noted that there seemed to be a small but significant shift in the type of radiotherapy used for these patients. Less patients received standard whole breast radiotherapy, and more received a short course of treatment to just the tumor bed plus margin called accelerated partial breast irradiation. We concluded that the publication of the trial therefore had only a very small impact on practice patterns.

11 Dec Coenzyme Q Deficiency May Contribute To Aging and Heart Disease

Posted at 20:52h in Aging, Author Interviews, FASEB

MedicalResearch.com Interview with: Jane Tarry-Adkins BSc Biochemistry Research Assistant University of Cambridge · Institute of Metabolic Science

Medical Research: What is the background for this study? What are the main findings? Response: From epidemiological and animal studies, it has been known for several years that a suboptimal in utero environment that causes low birth weight combined with accelerated postnatal growth is strongly linked to increased risk of cardiovascular disease (CVD). However underlying molecular mechanisms for this phenomenon, known as ‘developmental programming’ are still unknown. In this study, we used a rat model where animals are born small because their mother ate a low protein diet during pregnancy but grow quickly during lactation when they are suckled by a control diet fed mum. These ‘recuperated’ rats displayed indices of accelerated aortic cellular aging and damage which was associated with a deficit in coenzyme Q (CoQ); (the most abundant endogenous antioxidant in the body), compared to offspring of a normal birth-weight. When these ‘recuperated’ offspring were supplemented with a clinically relevant dose of coenzyme Q, this corrected these markers of aortic cellular aging and aortic damage. Importantly, measurement of CoQ in white blood cells (WBCs) a clinically accessible tissue demonstrated a coenzyme Q deficit in these ‘recuperated’ offspring. Importantly, this strongly correlated with aortic CoQ levels. Furthermore, we also showed a highly significant relationship between CoQ levels and aortic telomere length in WBCs, suggesting that low WBC CoQ levels can predict short aortic telomeres, and therefore susceptibility to aortic disease.

11 Dec Modest Weight Loss Can Diminish Metabolic Side Effects of Obesity

Posted at 20:24h in Author Interviews, PLoS, Weight Research

MedicalResearch.com Interview with: Peter Würtz, PhD, Docent Head of Molecular Epidemiology, Computational Medicine, Institute of Health Sciences, University of Oulu, Finland

Medical Research: What is the background for this study? What are the main findings? Dr. Würtz: Obesity is linked with unfavorable cholesterol and blood sugar levels, but the fine-grained metabolic consequences of excess body weight remain unclear. We used a novel profiling technology developed in our research group to examine the metabolic consequences of excess body weight. We profiled over 12,000 healthy young volunteers from the general population to determine the detailed metabolic effects of having higher BMI (body mass index). We found that higher BMI is causing adverse metabolic changes in the blood levels of many amino acids and lipids, as well as an altered balance of omega-fatty acids and sex hormones. These measures have been linked with higher risk for developing heart disease and type 2 diabetes. Importantly, the metabolic deviations were not limited to obese individuals, but were observed in a continuous manner including for those who are lean or overweight. In other words, the metabolic profile becomes more adverse for any increase in BMI, with no threshold below which an increase in BMI would not affect the cardiometabolic risk profile. Genetic information was used to demonstrate that the metabolic effects are actually caused by having higher BMI. On the positive side, even a modest weight loss helped to diminish the adverse metabolic influences of excess body fat.

11 Dec Hepatitis C: Progression to Liver Fibrosis Starts Early

Posted at 20:12h in Author Interviews, Hepatitis - Liver Disease, JAMA, University of Pittsburgh

MedicalResearch.com Interview with: Adeel A. Butt, MD, MS, FACP, FIDSA Vice Chair for Faculty Affairs Department of Medicine Hamad Medical Corporation, Doha, Qatar Adjunct Associate Professor of Medicine and Clinical and Translational Science University of Pittsburgh School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Butt: Precise rate of progression of liver disease in Hepatitis C (HCV) infection is unknown because the precise time of infection with HCV is seldom known. Knowledge of liver disease progression is critical to determine the optimal time for treatment. We found that progression of liver disease starts early after acquiring HCV infection. This is more rapid than was previously thought. About 18% of HCV infected persons develop cirrhosis within 10 years of acquiring HCV infection, which is 3-fold higher than demographically similar HCV uninfected persons.

11 Dec Lipid Metabolites in Blood Predictive of Future Coronary Artery Disease

Posted at 19:47h in Author Interviews, Heart Disease, Lipids, PLoS

MedicalResearch.com Interview with: Prof. Erik Ingelsson, MD, PhD, FAHA Professor of Molecular Epidemiology and Andrea Ganna PhD student Uppsala University Medical Research: What is the background for this study? What are the main findings? Response: Coronary heart disease (CHD) comprises a major cause of morbidity and mortality throughout the world. Measurement of metabolites, small molecules, in the blood could allow earlier diagnosis and inform about mechanisms leading to CHD. We examined the metabolic profiles (including thousands of metabolites) of blood samples from more than 3,600 individuals from Sweden that had been followed-up for up to 10 years, and found two lipid-related metabolites, lysophosphatidylcholine and sphingomyelin that reduced the risk of developing coronary heart disease and another lipid metabolite, monoglycerides, that was instead associated with increased risk.

10 Dec Reduction of Surgical Resident Duty Hours Resulted In No Change In Outcomes

Posted at 06:20h in Author Interviews, Case Western, Education, JAMA, Surgical Research

MedicalResearch.com Interview with: Ravi Rajaram MD Division of Research and Optimal Patient Care, American College of Surgeons Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies in the Institute for Public Health and Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Rajaram: The Accreditation Council for Graduate Medication Education (ACGME) first implemented restrictions to resident duty hours in 2003. In surgical populations, these reforms have not been associated with a change in patient outcomes. However, in 2011, the ACGME further restricted resident duty hours to include: a maximum of 16 hours of continuous duty for first-year residents (interns), direct supervision of interns at all times, a maximum of 4 hours for transitions in care activities for residents in-house for 24 hours, and that these residents be given 14 hours off prior to returning to work. The association between the 2011 ACGME resident duty hour reform with surgical patient outcomes and resident education has not previously been reported. The 2011 resident duty hour reform was not associated with a change in death or serious morbidity in the two years after the reform was implemented. Additionally, the 2011 duty hour reform was not associated with a change in any of the secondary outcomes examined, including any morbidity, failure to rescue, surgical site infection, and sepsis. Furthermore, common measures of surgical resident education, such as in-training examination scores and board certification pass rates, were unchanged after the implementation of the 2011 duty hour reform when compared to scores prior to the reform.

10 Dec Few Physicians Are Bilingual Despite Growing Need

Posted at 06:14h in Author Interviews, Education, JAMA

MedicalResearch.com Interview with: Lisa Diamond, MD, MPH, FACP | Assistant Attending Memorial Sloan-Kettering Cancer Center Immigrant Health and Cancer Disparities Service Department of Psychiatry & Behavioral Sciences | Department of Medicine Evelyn Lauder Breast Center New York, NY 10065 Medical Research: What is the background for this study? What are the main findings? Dr. Diamond: More than 25 million U.S. residents have limited English proficiency, an 80 percent increase from 1990 to 2010. Limited English proficiency (LEP) may impede participation in the English language-dominant health care system. Little is known about the non-English-language skills of physicians in training. In our analysis of the non-English-language skills of applicants to residency programs in the U.S., we found that although applicants are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with Limited English proficiency.

10 Dec Preeclampsia Raises Risk of Autism Spectrum Disorder

Posted at 05:54h in Author Interviews, Autism, JAMA, OBGYNE, UC Davis

MedicalResearch.com Interview with: Cheryl K. Walker, MD Associate Professor Department of Obstetrics & Gynecology Faculty, The MIND Institute School of Medicine, University of California, Davis Medical Research: What is the background for this study? What are the main findings? Dr. Walker: Autism spectrum disorder (ASD) is a neurobehavioral condition identified in 1 in 68 U.S. children and is part of a broader group of developmental disabilities that affects 1 in 6 children. Growing evidence suggests that Autism spectrum disorder and developmental delay originate during fetal life. Preeclampsia is a complicated and frequently dangerous pregnancy condition that appears to arise from a shallow placental connection and may increase the risk of abnormal neurodevelopment through several pathways. Medical Research: What are the main findings? Dr. Walker: Children with Autism spectrum disorder were more than twice as likely to have been exposed to preeclampsia compared with children with typical development. Risk for ASD was increased further in children born to mothers with more severe presentations of preeclampsia. Mothers of children with developmental delay were more than 5 times more likely to have had severe forms preeclampsia – often with evidence of reduced placental function – compared with mothers of children with typical development.

09 Dec Ultrasonography For All Dense Breasts Not Cost Effective

Posted at 14:34h in Annals Internal Medicine, Author Interviews, Breast Cancer, Radiology

MedicalResearch.com Interview with: Brian L. Sprague, PhD Office of Health Promotion Research, University of Vermont, Burlington, VT MedicalResearch: What is the background for this study? Dr. Sprague: Mammographic breast density refers to the appearance of breast tissue on a mammogram. High breast density means that there is a greater amount of glandular tissue and connective tissue, which appears white on a mammogram. It is more difficult to detect breast cancer on a mammogram when there is greater breast density. It has also been shown that women with dense breasts are at a higher risk of developing breast cancer. Because of these two factors, women with dense breasts have a greater chance of developing breast cancer after a normal screening mammogram than women whose breasts are not dense. Many states have now passed laws that require mammography facilities to inform women with dense breasts so that they are aware of this. Similar legislation is now under consideration at the national level. More than 40% of women undergoing mammography screening have dense breasts. Researchers are trying to determine whether supplemental breast cancer screening with other tools would improve outcomes for women with dense breasts. One possible approach is to use ultrasound imaging to screen for breast cancer in women with dense breasts after they have had a normal mammogram. We wanted to estimate the benefits, harms, and cost-effectiveness of this approach compared to mammography screening only. No randomized trials or observational studies have assessed long term outcomes after ultrasound screening for women with dense breasts, but we have short term data on how often cancer is diagnosed by ultrasound screening and how often false positive exams occur. We used computer simulation modeling to estimate long term outcomes by combining the currently available data on mammography and ultrasound screening with the best available data on breast cancer risk and survival.

09 Dec Distance To Hospital Prevents Timely PCI and Lytic Therapy For Many Patients

Posted at 14:10h in Author Interviews, Heart Disease, JAMA, Johns Hopkins, Outcomes & Safety

MedicalResearch.com Interview with: Dr. Amit Navin Vora MD, MPH Third Year Cardiovascular Fellow John Hopkins University Medical Research: What is the background for this study? What are the main findings? Response: Current guidelines recommend timely reperfusion in patients presenting with ST-elevation myocardial infarction, with primary PCI being the preferred method if delivered in an expedient fashion. Otherwise, guidelines recommend that eligible patients should be treated with fibrinolysis prior to transfer to a PCI capable hospital. In our study, we used Google Maps to estimate drive times between the initial presenting hospital and the PCI-capable hospital looked at the association between estimated drive time and reperfusion strategy (primary PCI or fibrinolysis) selection. We found that less than half of eligible patients with an estimated drive time of more than 30 minutes received primary PCI in time, and only half of patients with more than an hour’s drive received lytics before transfer. This suggests that neither primary PCI nor pre-transfer fibrinolytic therapy is being used optimally. Among eligible patients with a drive time of 30-120 minutes, we found no significant mortality difference but higher bleeding risk among patients receiving lytics prior to transfer; this increased bleeding risk was focused in patients that required rescue PCI.

08 Dec CT Scan May Predict Risk of Second Stroke

Posted at 02:52h in AHA Journals, Author Interviews, Stroke

MedicalResearch.com Interview with Jeff Perry, MD, MSc, CCFP-EM Associate Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician, Epidemiology Program, The Ottawa Hospital, Ottawa, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Perry: Currently many patients with a TIA or non-disabling stroke have a subsequent stroke which may be very disabling or result in death prior to having all investigations completed and maximal stroke prevention implemented. Prior to this study, the utility of CT findings for predicting subsequent stroke was incompletely understood in this patient population. Dr. Perry: Main findings: Compared to patients without ischemia, the probability of another stroke occurring within 90 days of the initial episode was:

2.6 times greater if the CT image revealed newly damaged tissue due to poor circulation (acute ischemia);
5.35 times greater if tissue was previously damaged (chronic ischemia) in addition to acute ischemia;
4.9 times greater if any type of small vessel damage occurred in the brain, such as narrowing of the small vessels in addition to acute ischemia;
8.04 times greater if acute and chronic ischemia occurred in addition to microangiopathy.

06 Dec Staggering Number of Hospital Monitors Leads to Alarm Fatigue

Posted at 11:26h in Author Interviews, Outcomes & Safety, PLoS, UCSF

MedicalResearch.com Interview with: Barbara J. Drew, RN, PhD, FAAN, FAHA David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology University of California, San Francisco (UCSF) Department of Physiological Nursing San Francisco

MedicalResearch: What is the background for this study? What are the main findings? Dr. Drew: Hospital cardiac monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening arrhythmia may be missed in this milieu of sensory overload. Our study is the largest prospective study to date on the alarm fatigue problem. We found a staggering total number of alarms (>2,500,000 in one month) in 461 consecutive patients treated in our 77 adult intensive care unit beds. Although many of these alarms were configured to be visual text messages, we still found a high audible alarm burden of 187 audible alarms per bed per day. A noisy alarm environment interrupts patients’ sleep and invokes fear in patients and their families. We analyzed nearly 13,000 arrhythmia alarms and found that 88% of them were false alarms.

05 Dec Genes Influence Body Weight in Smokers and Never-Smokers

Posted at 04:16h in Author Interviews, PLoS, Smoking, Weight Research

MedicalResearch.com Interview with: Marcus Munafò PhD Professor of Biological Psychology MRC Integrative Epidemiology Unit UK Centre for Tobacco and Alcohol Studies School of Experimental Psychology University of Bristol United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Munafo: We were conducting an analysis of data on smoking behaviour and body mass index (BMI), in order to better understand the potential causal effects of smoking on different measures of adiposity. Mendelian randomisation uses genetic variants associated with the exposure of interest (in this case smoking) as proxies for the exposure, in order to reduce the risk of spurious associations arising from confounding or reverse causality. As expected, we found that, among current smokers, a genetic variant associated with heavier smoking was associated with lower BMI, providing good evidence that smoking reduces BMI. However, we also unexpectedly found that the same variant was associated with higher BMI in never smokers. This suggests that this variant might be influencing BMI via pathways other than smoking.

05 Dec Gene Network Linked To Lifetime Alcohol Consumption

Posted at 02:12h in Alcohol, Author Interviews, Nature, University Texas

MedicalResearch.com Interview with: R. Dayne Mayfield PhD and Sean Farris Post Doc Fellow Harris Lab Waggoner Center for Alcohol and Addiction Research University of Texas at Austin MedicalResearch: What is the background for this study? Response: Alcoholism is psychiatric disorder adversely affecting the health of millions of individuals worldwide. Despite considerable research efforts, alcoholism cannot be attributed to any individual gene. We sought out to identify coordinately regulated gene networks, rather than a single candidate gene, that may be collectively driving the consumption of alcohol.

05 Dec Increased Breastfeeding Would Reduce Morbidities and Costs

Posted at 02:00h in Author Interviews, BMJ, Cost of Health Care, Pediatrics

MedicalResearch.com Interview with Rosemary Dodds Senior Policy Adviser NCT (formerly National Childbirth Trust), London, UK Medical Research: What is the background for this study? What are the main findings? Response: The study, which was commissioned by UNICEF UK, was designed to take an in-depth look at how raising breastfeeding rates might save money for the health service through reducing illness. It found that low breastfeeding rates in the UK are costing the health service millions of pounds. We calculated that from reducing rates of illnesses, where the evidence is strongest, moderate increases in breastfeeding could see potential annual savings to the health service of around £40m per year. It should be noted however, that this figure is likely to be only the tip of the iceberg when the full range of conditions affected by breastfeeding are taken into account. Economic models around five illnesses (breast cancer in the mother, and gastroenteritis, respiratory infections, middle ear infections and necrotising enterocolitis (NEC) in the baby), show that moderate increases in breastfeeding would translate into the following cost savings for the NHS:

If half those mothers who currently do not breastfeed were to do so for up to 18 months over their life, there would be:

- 865 fewer cases of breast cancer - With cost savings to the NHS of over £21million - Improved quality of life equating to more than £10million[1] Over the lifetime of each annual cohort of first-time mothers.

If 45% of babies were exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfeeding at discharge, each year there would be:

- 3,285 fewer babies hospitalised with gastroenteritis and 10,637 fewer GP consultations, saving more than £3.6million - 5,916 fewer babies hospitalised with respiratory illness, and 22,248 fewer GP consultations, saving around £6.7million - 21,045 fewer GP visits for ear infection, saving £750,000 - 361 fewer cases of the potentially fatal disease necrotising enterocolitis, saving more than £6million

05 Dec Mediterranean Diet May Delay Telomere Shortening, Increase Longevity

Posted at 00:38h in Aging, Author Interviews, BMJ, Brigham & Women's - Harvard, Mediterranean Diet

MedicalResearch.com Interview with: Immaculata De Vivo PhD Associate Professor Harvard Medical School Director, Dana Farber/Harvard Cancer Center High Throughput Genotyping Core Facility. Channing Division of Network Medicine Boston, MA 02115 MedicalResearch: What is the background for this study? What are the main findings? Dr. De Vivo: Our study found that greater adherence to the Mediterranean diet is associated with longer telomeres. Following a diet closer to the Mediterranean diet, can prevent accelerated telomere shortening. Our unique contribution to the literature is that we provide a potential molecular mechanism, preventing telomere shortening. Telomeres are bits of DNA that protect your chromosomes. MedicalResearch: Is telomere shortening reversible? Dr. De Vivo: Telomere shortening is a biological process, the shorten with age. However, lifestyle choices can help to prevent accelerated shortening. Fruits, vegetables, olive oil and nuts – key components of the Mediterranean diet have well known antioxidant and anti-inflammatory effects that could balance out the “bad effects” of smoking and obesity.

03 Dec Lung Cancer: More Efficient CT Screening Model Proposed

Posted at 12:34h in Author Interviews, Lung Cancer, PLoS

MedicalResearch.com Interview with: Dr. Martin C. Tammemägi Professor (Epidemiology), Brock University Department of Health Sciences St. Catharines, Ontario, Canada L2S 3A1 Medical Research: What is the background for this study? What are the main findings? Dr. Tammemägi: Lung cancer is the leading cause of cancer death in North America and the world. Lung cancer survival following diagnosis is generally poor, in the range of 10% to 15%, and has improved little over the last four decades. The biggest recent breakthrough for reducing lung cancer mortality came with the findings of the National Lung Screening Trial (NLST), a large, well-conducted randomized screening trial, which demonstrated that low dose computed tomography (LDCT) screening versus chest X-ray (CXR) screening can reduce lung cancer mortality by 20%. Currently, most guidelines for selecting screenees for lung screening use the NLST enrolment criteria of 30 or more pack-years smoked, former smokers must have quit smoking within 15 years and ages between 55 and 74, or use a variant of the NLST criteria. The US Preventive Services Task Force (USPSTF) essentially recommends using the NLST criteria but extended the inclusion age to 80 years. The current study applied the PLCOm2012 lung cancer risk prediction model1 to NLST data and identified that the risk above which lung cancer mortality is consistently lower in the LDCT arm compared to the CXR arm, is ≥1.51% 6-year risk (65th percentile). The USPSTF and the PLCOm2012 risk ≥0.0151 criteria were then applied to the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) intervention arm smokers (the PLCOm2012 was developed in PLCO controls) to determine who would be selected for lung cancer screening. Compared to USPSTF criteria, the PLCOm2012 risk ≥0.0151 threshold selected 8.8% fewer individuals, but identified 12.4% more lung cancers (sensitivity 80.1% vs. 71.2%), and had fewer false positives (specificity 66.2% vs. 62.7%). 26% of smokers who were USPSTF criteria positive had risks below the PLCOm2012 risk ≥0.0151 threshold. Of PLCO former smokers who quit more than 15 years ago, 8.5% had PLCOm2012 risk ≥0.0151, suggesting that they might benefit from screening (2.9% of them developed lung cancer in 6 year). None of 65,711 never-smokers in the PLCO had PLCOm2012 risk ≥0.0151, indicating that never-smokers should not be screened. Individuals age ≥65–80 years had significantly higher risks and more lung cancers than those 55-64 years.

03 Dec Maternal Obesity Linked To Increase Infant Mortality

Posted at 12:26h in Author Interviews, BMJ, OBGYNE, Weight Research

MedicalResearch.com Interview with: Stefan Johansson, MD PhD consultant neonatologist Stockholm, Sweden Medical Research: What is the background for this study? Dr. Johansson: Maternal obesity (BMI ≥ 30) has previously been linked to increased infant mortality. However, research has not produced consistent results. For example, there are disagreements whether infants to overweight mothers (BMI 25-29) are at increased risk, and research on BMI-related specific causes of death is scarce.

03 Dec Adaptive Behaviors To Stress Can Be Transmitted Across Generations

Posted at 12:20h in Author Interviews, General Medicine, Genetic Research, Nature

MedicalResearch Interview with: Prof Dr Isabelle Mansuy Lab of Neuroepigenetics University/ETH Zürich Brain Research Institute Zürich, Switzerland MedicalResearch: What is the background for this study? What are the main findings? Prof. Mansuy: It is recognised that being exposed to traumatic stress in early life increases the susceptibility to psychiatric and metabolic diseases later in life. This is true for people directly exposed but also for their progeny across generations. It is also known that sometimes, stress exposure in early life can help an individual develop response strategies and be better prepared for later stressful experiences. The mechanisms of such beneficial effects and the question of whether they can be transmitted or not are not known. This study in mice was designed to answer these questions. The main findings are that exposure to traumatic stress of mouse newborns makes the animals and their progeny more efficient in challenging tasks when adult. For instance, they are more able to adapt to rules that change in a complex task to get a water ration when they are thirsty. This suggests more adaptive behaviours in challenging situations that are transmitted across generation. The study identifies the mineralocorticoid receptor, a stress hormone receptor in the brain, as an important molecular mediator of this effect and demonstrates that its expression is altered in the brain by epigenetic mechanisms.

03 Dec Are Bisphosphonates Underutilized In Men on Androgen Deprivation Therapy?

Posted at 01:19h in Author Interviews, JAMA, Osteoporosis, Pharmacology, Testosterone

MedicalResearch.com Interview with: Shabbir M. H. Alibhai, MD, MSc and Husayn Gulamhusein, BHSc Department of Medicine, University Health Network Toronto, Ontario, Canada Medical Research: What is the background for this study? What are the main findings? MedicalResearch: In 2009, we published a research letter in JAMA which examined the rate of bone mineral density (BMD) testing in men starting androgen deprivation therapy (ADT) in the province of Ontario, Canada, between 1995 and 2008. Despite being recommended as a tool to better characterize fracture risk and optimize bone health, use of bone mineral density testing was low throughout the study period. This current study focuses on another aspect of bone health, which is the use of bisphosphonates among men undergoing androgen deprivation therapy for prostate cancer. Bisphosphonates are generally safe and effective medications that can reduce fracture risk particularly in those at higher risk of future fracture. Throughout the 17-year study period, we found that rates of new prescriptions for bisphosphonates remained low. Even when focusing on those men who should be receiving bisphosphonates as per Canadian guidelines due to their high risk for future fracture, i.e. those with a prior fragility fracture or prior diagnosis of osteoporosis, prescription rates remained low. Moreover, in all three groups, new bisphosphonate prescriptions dipped between the 2007-09 and 2010-12 time periods. This may be partly due to recent negative media attention regarding the association of bisphosphonates with rare but serious side effects (i.e. osteonecrosis of the jaw and atypical femoral fracture).

02 Dec Childhood Falls May Be Decreased By Supervision and Safety Devices

Posted at 15:19h in Accidents & Violence, Author Interviews, JAMA, Pediatrics

MedicalResearch.com Interview with: Prof. Denise Kendrick Professor of Primary Care Research Division of Primary Care, University Park Nottingham UK Medical Research: What is the background for this study? What are the main findings? Prof. Kendrick: More than 1 million US children aged 0-4 years attend emergency departments because of a fall each year. Approximately half of all ED attendances in this age group are for falls, and most of these are falls from furniture, most commonly from beds, chairs , baby walkers, bouncers, changing tables and high chairs. In the US around 18,000 0-4 year olds are admitted to hospital following a fall each year and in 2012 there were 31 deaths in the US in 0-4 year olds from falls. Healthcare costs for falls in the US were estimated at $439 million for hospitalised children and $643 million for ED attendances in 2005. We found that children were more likely to attend hospital because of a fall from furniture in families that did not use safety gates across doorways or on stairs. For infants (aged 0-12 months) we found they were more likely to attend hospital because of a fall from furniture if they had been left on a raised surface (e.g. beds, sofas, work tops etc), had diapers changed on a raised surface or been put in a car seat or bouncing cradle on a raised surface. We also found that children aged over 3 years who had climbed or played on furniture were more likely to have a fall requiring a hospital visit than children who had not. Finally we found that children whose parents had not taught their children rules about climbing on objects in the kitchen were more likely to have a fall needing a hospital visit than children whose parents had taught these rules.

02 Dec Sculptra Injections: More Lumps If Patients Massage Skin

Posted at 15:13h in Author Interviews, Dermatology, JAMA

MedicalResearch.com Interview with: Dr. Tanveer Janjua MD Janjua Facial Surgery, Bedminster, New Jersey Medical Research: What is the background for this study? What are the main findings? Dr. Janjua: This study was conducted to determine if massage plays an important role in the prevention of lumps and nodules that can occur after injection of PLLA...

30 Nov Fenoldopam Does Not Prevent Acute Kidney Injury After Cardiac Surgery

Posted at 22:03h in Author Interviews, General Medicine, Heart Disease, JAMA, Kidney Disease

MedicalResearch.com Interview with: Giovanni Landoni, M.D. Head of Research,Department of Anesthesiology and Intensive Care Associate Professor at Università Vita-Salute San Raffaele, Milan Medical Research: What is the background for this study? Dr. Landoni: The prevention and treatment of acute kidney injury after cardiac surgery is a major therapeutic goal, but no effective agents have yet been identified. Meta-analyses suggested that fenoldopam might be effective. Medical Research: What are the main findings? Dr. Landoni: We found that in cardiac surgery patients with early acute kidney injury (defined as a ≥50% increase of serum creatinine from baseline or oliguria for ≥6 hours), fenoldopam had no impact on the need for renal replacement therapy or 30-day mortality, while increasing the rate of hypotension.

30 Nov Rhinoplasty: Complications Associated With Using Rib Cartilage

Posted at 14:23h in Author Interviews, JAMA, Surgical Research

MedicalResearch.com Interview with: Hong Ryul Jin, MD Professor and Chair Department of Otorhinolaryngology-HNS Seoul National University Boramae Medical Center, Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: Although autologous rib cartilage is a useful graft material for rhinoplasty, surgeons sometimes encounter unpleasant complication such as warping or donor-site morbidity. These complications are not infrequent, but there has been no systematic review with regarding this matter. For evidence-based practice, we aimed to assess the long-term safety of using rib cartilage by means of meta-analysis. By reviewing the 10 selected, eligible articles after extensive screening, we found that rates of warping, resorption, infection, and displacement were 3.1, 0.2, 0.6, and 0.4%, respectively. Hypertrophic scar at chest was found in 5.5%, with highest report of 23.8%. Warping and hypertrophic chest scarring showed relatively higher rates, warranting a surgeon’s attention