MedicalResearch.com Interview with: Raúl J. Bellinga, MD, FEBOMS FACIALTEAM Surgical Group, Marbella High Care International Hospital, Marbella, Málaga, Spain MedicalResearch.com: What is the background for...
Dr. Bin He[/caption]
Bin He, Ph.D.
Director, Institute for Engineering in Medicine
Director, Center for Neuroengineering
Distinguished McKnight University Professor of Biomedical Engineering
Medtronic-Bakken Endowed Chair for Engineering in Medicine
University of Minnesota, Minneapolis, MN 55455
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This work is aimed at developing a noninvasive brains-computer interface to allow disabled patients to control their environment by just thinking about it.
We found 8 human subjects were able to accomplish 3D reach and grasp tasks without using any muscle activities but just thinking about it.
Dr. Mohammed Al-Omran[/caption]
Mohammed Al-Omran, MD, MSc, FRCSC
Head, Division of Vascular Surgery
St. Michael’s Hospital
Professor, Department of Surgery
University of Toronto
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: General surgery residency is among the most demanding clinical training programs in medicine. Several studies have suggested surgical residents have a relatively high attrition rate; however, no study has systematically reviewed the overall prevalence and causes of attrition among general surgery residents.
We included over 20 studies representing 19,821 general surgery residents in our review. Most studies were from the US. We found the pooled estimate of attrition prevalence among general surgery residents was 18%. Female residents were more likely to leave than male (25% versus 15%), and residents were most likely to leave after their first training year (48%). Departing residents most commonly switched to another medical specialty (such as anaesthesia, plastic surgery, radiology or family medicine) or relocated to another general surgery program. The most common causes of attrition were uncontrollable lifestyle (range of 18% to 88%) and transferring to another specialty (range of 18% to 39%).
Dr. June Robinson[/caption]
June K. Robinson, MD
Research Professor of Dermatology
Northwestern University Feinberg School of Medicine
Department of Dermatology
Chicago, IL 60611
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This is a secondary finding from a randomized controlled trial of a structured skills training program for melanoma patients and their skin check partners.
The pairs learned and performed skin self-examination for the early detection of melanoma. They continued to perform skin checks for 2 years and trained pairs identified more early melanoma (melanoma in situ and Stage 1A melanoma) than controls.
MedicalResearch.com Interview with: [caption id="attachment_30354" align="alignleft" width="133"] Dr. Christos Hatzis,[/caption] Christos Hatzis, PhD Assistant Professor of Medicine Director of Bioinformatics, Breast Medical Oncology Yale Comprehensive...
Dr. Alec Zhang[/caption]
Chengcheng (Alec) Zhang, Ph.D.
Associate Professor
Hortense L. and Morton H. Sanger Professorship in Oncology
Michael L. Rosenberg Scholar for Medical Research
Department of Physiology
UT Southwestern Medical Center
MedicalResearch.com: What is the background for this study?
Response: New therapeutic targets and approaches are needed to effectively treat leukemia. Acute myeloid leukemia (AML) is the most common form of adult acute leukemia whereas acute lymphoblastic leukemia (ALL) is the most common form of cancer in children; ALL also occurs in adults. Although treatment of pediatric ALL is highly effective, a sizeable number of patients are non-responders who succumb to this disease. The outcome of ALL in adults is significantly worse than for pediatric ALL. Additionally, some types of ALL have a much poorer prognosis than others.
Dietary restriction, including fasting, delays aging and has prolonged effects in a wide range of organisms and has been considered for cancer prevention. In certain types of solid tumor,_ENREF_1 dietary restriction regimens are able to promote T cell-mediated tumor cytotoxicity and enhance anticancer immunosurveillance, and coordinate with chemotherapy to promote the anti-cancer effects. However, the responsiveness of hematopoietic malignancies to dietary restriction, including fasting, remains unknown. Furthermore, whether dietary restriction alone can inhibit cancer development is not clear.
Dr. Joshua Thorpe[/caption]
Joshua M. Thorpe, PhD, MPH
From the Center for Health Equity Research and Promotion
Veterans Affairs Pittsburgh Healthcare System
Pittsburgh Pennsylvania, and
Center for Health Services Research in Primary Care
Department of Pharmacy and Therapeutics
University of Pittsburgh School of Pharmacy
MedicalResearch.com: What is the background for this study?
Response: Care coordination for persons with dementia is challenging for health care systems under the best of circumstances. These coordination challenges are exacerbated in Medicare-eligible veterans who receive care through both Medicare and the Department of Veterans Affairs (VA). Recent Medicare and VA policy changes (e.g., Medicare Part D, Veteran’s Choice Act) expand veterans’ access to providers outside the VA. While access to care may be improved, seeking care across multiple health systems may disrupt care coordination and increase the risk of unsafe prescribing - particularly in veterans with dementia. To see how expanded access to care outside the VA might influence medication safety for veterans with dementia, we studied prescribing safety in Veterans who qualified for prescriptions through the VA as well as through the Medicare Part D drug benefit.
Dr. Charlie Wray[/caption]
Charlie M. Wray, DO, MS
Assistant Clinical Professor of Medicine
University of California, San Francisco Department of Medicine
San Francisco VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Since the establishment of residency duty hour regulations in 2010, which subsequently lead to increased discontinuity of inpatient care and more resident shift work, educators and researchers have attempted to establish which shift handoff technique(s) or strategies work best.
National organizations, such as the ACGME, AHRQ, and the Joint Commission have made specific recommendations that are considered "best practice". In our study, using an annual national survey given to Internal Medicine Program Directors, we examined the degree of implementation of these recommended handoff strategies and the proportion of Program Director satisfaction with each of the respective strategies.
Dr. Bernard M Duvivier[/caption]
Bernard M Duvivier
Department of Human Biology and Movement Science
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre
Maastricht, the Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The health benefits of exercise have been well established but sitting is a risk factor for health, independent of exercise.
As many people with type 2 diabetes don’t like to exercise we investigated whether replacing sitting time with light-intensity activities (standing and light walking) is equally effective to exercise when energy expenditure is comparable. Our results suggest that for people with type 2 diabetes, light-intensity activities (light walking and standing) can be an alternative to exercise to improve glucose regulation.
In addition we showed that too much sitting has negative effects on insulin sensitivity which could not be fully compensated by 1 hour of exercise per day.
Dr. Osterberg[/caption]
E. Charles Osterberg, M.D.
Assistant Professor of Surgery
Genitourinary Reconstruction and Trauma
University of Texas- Dell Medical School
Dell-Seton Medical Center / University Hospital
MedicalResearch.com: What is the background for this study?
Response: Pubic hair grooming has become an increasingly common practice among men and women. Perceptions of genital normalcy have changed as modern society’s definition of attractiveness and feelings of femininity and masculinity have changed. Pubic hair grooming has been shown to increase morbidity such as genital injuries, however little is known about the relationship between grooming practices and sexually transmitted infections.
Dr. Adrian Lee[/caption]
Dr. Adrian Lee PhD
Professor, Department of Pharmacology and Chemical Biology
Director, Women's Cancer Research Center
University of Pittsburgh Cancer Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The goal of this study was to understand molecular changes which occur when breast cancers metastasize to the brain, with the eventual of identifying new therapeutic strategies. Brain metastases occur in 10-15% of patients with metastatic breast cancer and are a major clinical challenge. Limited therapeutic options exist for patients with brain metastases. We analyzed molecular changes in pairs of patient-matched primary breast cancers and brain metastases. We found that brain metastases tended to have the same intrinsic subtype as the primary breast cancer, however, there were many genes which changes in gene expression and may represent therapeutic targets.
The most common change was an increase in ErbB2/HER2 which can be targeted clinically.
Dr. Dagfinn Aune[/caption]
Dr. Dagfinn Aune
Department of Epidemiology and Biostatistics
School of Public Health
Imperial College London
St. Mary's Campus London UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is a growing body of evidence suggesting that intake of nuts may reduce the risk of coronary heart disease, but the relation between nut intake and other diseases like cancer and stroke, and the relation with mortality and less common causes of death is not clear. Also it is not clear how much nuts are needed to reduce the risk.
So our current meta-analysis reviewed the data from 20 studies (29 publications) on nut intake and different health outcomes. We found that a nut intake of approximately one serving per day (28 g/d or a handful) was associated with a reduced risk of coronary heart disease (by 30%), total cancer (15%), all-cause mortality (22%) and mortality from respiratory disease (50%), diabetes (40%), and infections (75%), although there were few studies in the latter three analyses. We found that most of the benefit was observed up to an intake of around 20 grams per day. Similar results were found for total nuts, tree nuts and peanuts (which are botanically defined as legumes), but peanuts were also associated with reduced risk of stroke, while only tree nuts were associated with reduced cancer risk. We also calculated the number of deaths that potentially could be avoided, under the assumption that the observed associations are causal, and arrived at 4.4 million deaths in North and South America, Europe, Southeast Asia and the Western Pacific (unfortunately we did not have data on nut intake from West Asia and Africa so we were not able to include those areas).
Dr. Joshua Denson[/caption]
Joshua L Denson MD
Pulmonary and Critical Care Medicine
University of Colorado School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Miscommunication during physician transition in care has been associated with adverse patient events and medical errors; however, an understudied topic is the transition in care that occurs each month when resident physicians switch clinical rotations, also called an end-of-rotation transition. During this handoff, hospitalized patients (up to 10-20) are handed over to an oncoming physician who has never met the patients. We sought to investigate if this type of transition was associated with worse patient outcomes, specifically mortality.
On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations limited first-year resident physicians (interns) to 16 continuous hours of work. Although these rules do not appear to have affected overall patient safety outcomes, they have been associated with an increase in shift-to-shift handoffs among training physicians. Given this, we wanted to study how they might impact patient outcomes surrounding end-of-rotation transitions in care.
Dr. Audrey Chu[/caption]
Audrey Chu, Ph.D.
Division of Intramural Research
National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Body shape reflects the underlying adipose tissue distributed throughout different compartments of the body (ectopic fat). Variation in ectopic fat is associated with diabetes, hypertension and heart disease. This is mostly independent of overall adiposity. Ectopic fat can be measured using special x-rays procedures such as CT (“CAT scans”) or MRI and can give more information about fat distribution. Fat distribution characteristics can run in families, suggesting that a person’s genes can help determine the amount of fat that can accumulate in different parts of the body. Identifying genes that are associated with ectopic fat can provide insight into the biological mechanisms leading to differences in cardiometabolic disease risk.
In order to understand which genes might be involved, we examined genetic variants across the genome and their association with ectopic fat in the largest study of its kind including over 18,000 individuals of four different ancestral backgrounds.
Several new genetic regions were identified in association with ectopic fat in addition to confirming previously known regions. The association of the new regions was specific to ectopic fat, since the majority of the regions were not associated with overall or central adiposity. Furthermore, most of these regions were not associated with type 2 diabetes, lipids, heart disease or blood pressure. The major exception was the region surrounding the UBE2E2 gene, which was associated with diabetes.
Dr. Carlos Simón[/caption]
Carlos Simón, M.D., Ph. D.
Professor of Obstetrics & Gynecology. Valencia University, Spain
Scientific Director, Igenomix SL.
Adjunct Clinical Professor, Department of Ob/Gyn, Stanford University, CA
Adjunct Professor, Department of Ob/Gyn, Baylor College of Medicine, TX
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The main findings of this study reside in the concept that the uterine cavity, which has been classically considered as a sterile organ, possess its own microbiome and that the composition of this uterine microbiome have a functional impact on the reproductive outcome of IVF patients.
Prof. Jan Karlseder[/caption]
Professor Jan Karlseder
Molecular and Cell Biology Laboratory
Donald and Darlene Shiley Chair
Salk Institute for Biological Studies
MedicalResearch.com: What is the background for this study?
Response: Telomeres are repetitive stretches of DNA at the ends of each chromosome whose length can be increased by an enzyme called telomerase. Our cellular machinery results in a little bit of the telomere becoming lopped off each time cells replicate their DNA and divide. As telomeres shorten over time, the chromosomes themselves become vulnerable to damage. Eventually the cells die. The exception is stem cells, which use telomerase to rebuild their telomeres, allowing them to retain their ability to divide, and to develop (“differentiate”) into virtually any cell type for the specific tissue or organ, be it skin, heart, liver or muscle—a quality known as pluripotency. These qualities make stem cells promising tools for regenerative therapies to combat age-related cellular damage and disease.
MedicalResearch.com Interview with: Dr Vincent Laprévote Praticien Hospitalier (MD, PhD, HDR) Pôle Hospitalo-Universitaire de Psychiatrie du Grand Nancy Centre Psychothérapique de Nancy MedicalResearch.com: What...
Dr. Wayne Levy[/caption]
Wayne C. Levy, MD
Division of Cardiology
University of Washington
Seattle, Washington
MedicalResearch.com: What is the background for this study?
Response: There is uncertainty how effective ICDs are outside of clinical trials in real world patients who are often older with more comorbidities. The recent DANISH ICD only reiterates provider and patient concerns regarding the effectiveness of an ICD, that may be life saving, but does not improve heart failure symptoms or reduce hospitalizations. Many patients die without ever having an ICD shock, so the ICD was not necessary for the patient.
We postulated that the effectiveness of an ICD is not driven by the absolute risk of sudden death (event rate/year) but rather the proportion of all deaths that are due to sudden death vs non sudden death. If a patient has a 3% annual risk of sudden death and this is decreased to 1% with an ICD (a 67% reduction in sudden death), the patient benefit will be much greater if the non sudden death rate is 1%/year than if it is 12%/year. In the first scenario the absolute mortality is decreased from 4% to 2% (a 50% reduction) whereas in the second patient, the mortality would be decreased from 15% to 13% (a 13% benefit).
We developed the Seattle Proportional Risk Model (SPRM) using 10 clinical variables that had a differential impact on the mode of death, sudden vs. non sudden, in ~10,000 patients with ~2,500 deaths. Sudden death was more common in younger patients, male, without diabetes mellitus, NYHA 1 or 2 vs. 3 or 4, lower EF, SBP closer to 140, normal sodium and creatinine, higher BMI, and digoxin use.
Dr. Patrik Brundin[/caption]
Patrik Brundin, M.D., Ph.D.
Director, Center for Neurodegenerative Science
Van Andel Research Institute
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The investigational drug at the heart of our study, MSDC-0160, has been in development to treat type 2 diabetes by improving cellular metabolism.
In Parkinson’s, reductions in cellular metabolism slow down vital housekeeping processes that clear out toxic proteins that otherwise accumulate with age. If these proteins aren’t removed, they clump together, leading to the damage and cell death that causes Parkinson’s hallmark symptoms, such as rigidity and tremor. MSDC-0160 helps keep these housekeeping processes working, ultimately protecting the brain.
We demonstrated that MSDC-0160 has strong, reproducible, positive effects across multiple models of Parkinson’s disease—it rescued dopamine-producing cells, improved behavioral deficits in mouse models and reversed inflammation. Overall, we believe it is a strong candidate for repurposing as a potential treatment that actually may slow the disease’s progression, rather than only mitigating symptoms.
Anneke I. den Hollander, PhD
Department of Ophthalmology and Department of Human Genetics
Donders Institute for Brain, Cognition, and Behaviour
Radboud University Medical Center
Nijmegen, the Netherland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Age-related macular degeneration is caused by a combination of genetic and environmental factors. Rare genetic variants in the complement system have been described in AMD, but their effect remains largely unexplored. In this study we aimed to determine the effect of rare genetic variants in the complement system on complement levels and activity in serum.
MedicalResearch.com: What are the main findings?
Response: Carriers of CFI variants showed decreased FI levels, carriers of C9 Pro167Ser had increased C9 levels, while C3 and FH levels were not altered. Carriers of CFH and CFI variants had a reduced ability to degrade C3b, which for CFI was linked to reduced serum FI levels.
Dr. Lisa Meeks[/caption]
Dr. Steve Xu[/caption]
Steve Xu MD, MSc
Resident Physician
Department of Dermatology
Northwestern Feinberg School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Given the limited data on the effectiveness or safety of the different moisturizers examined in the study, how much do you think parents should decide what to use on their babies based on the "cost-effectiveness" determined in this study? Would you just say cheapest is best since we don't know how well these things work? Or what's the message?
Price. Petrolatum is an extremely effective moisturizer. It also happens to be one of the most affordable. Unlike adults, I don't suspect newborns will complain too much about the greasiness of petrolatum. They're less concerned that their work clothes will get ruined. They are less likely to care about cosmetic elegance.
I also will say that petrolatum is less likely to include any artificial fragrances, preservatives that could serve as irritants or allergens in the future. That's an added bonus.
Dr. Suzanne Cannegieter,[/caption]
Suzanne C. Cannegieter, M.D., Ph.D.
Einthoven Laboratory
Leiden University Medical Center
The Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Patients who undergo arthroscopic knee surgery and patients who are treated with casting of the lower leg are at increased risk for venous thromboembolism (VTE). It is uncertain whether thromboprophylaxis is effective in these situations to prevent VTE. For both indications, several trials have been performed to evaluate the effectiveness of anticoagulant prophylaxis. However, an overall risk–benefit balance could not be established because of methodologic shortcomings; hence, there has been reluctance to establish international guidelines regarding the use of anticoagulant therapy for either of these indications.
Platypus[/caption]
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Platypus and Echidnas are the only representative of the unique group of egg-laying mammals. These peculiar animals are human’s most distant relatives amongst living mammals and they have allow unprecedented insights into the evolution of mammals. Many aspect of the biology of these extraordinary mammals are unusual. One of the most remarkable changes is that monotremes lack a functional stomach and lost many genes involved in digestion. This sparked our interest to investigate the Insulin release pathway as a key aspect of blood glucose regulation which is affected in Diabetes.
When we identified and characterised the hormone that is central to the release of insulin after a meal (called GLP-1)we were surprised to see it active in gut where is should be but also in the venom gland of platypus and echidna.
When we investigated the monotreme GLP-1 further we discovered that this hormone is not degraded in human serum. This is exciting as the human GLP-1 is degraded very rapidly (within minutes) and a major treatment approach in type 2 diabetes is to develop long-lasting GLP-1 variants like the one we discovered in platypus and echidna.
Dr. Karen Hauer[/caption]
Karen E. Hauer, MD, PhD
Associate Dean, Competency Assessment and Professional Standards
Professor of Medicine, UCSF
San Francisco, CA 94143
MedicalResearch.com: What is the background for this study?
Response: As part of the Accreditation Council for Graduate Medical Education (ACGME)’s Next Accreditation System, residency programs are now required to rate residents using the Milestones. Evidence of validity of Milestone ratings is needed to show whether this rating system measures meaningful aspects of residents’ practice.
In the field of internal medicine, we compared ratings of residents using the old evaluation form, the pre-2015 Resident Annual Evaluation Summary (RAES), which has a non-developmental rating scale that rates residents from unsatisfactory to superior on a 9-point scale, with developmental Milestone ratings. This was a cross-sectional study of all United States internal medicine residency programs in 2013-14, including 21,284 internal medicine residents. Milestone ratings are submitted by residency program directors working with Clinical Competency Committees. We correlated RAES and Milestone ratings by training year; correlated ratings of Medical Knowledge milestones using the two systems with American Board of Internal Medicine (ABIM) certification examination scores; and examined ratings of unprofessional behavior using the two systems.
Dr. Christina Fitzmaurice[/caption]
Christina Fitzmaurice, MD, MPH
Assistant Professor
Department of Medicine, Division of Hematology
Institute for Health Metrics and Evaluation
University of Washington
Seattle, WA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Cancer is the second leading cause of death worldwide behind cardiovascular diseases. We found that cancer cases increased by 33% from 13.1 million cases in 2005 to 17.5 million in 2015. The largest driver behind this increase was an aging population, followed by a growing population worldwide. The smallest factor contributing to this increase was a rise in cancer incidence rates. Because of increasing life expectancy and better control of communicable diseases cancer will remain a major burden in the foreseeable future. Adjusting and building health systems that can appropriately deal with this challenge is only possible with good data on the burden of cancer. In our study we estimate the number of cancer cases, and cancer deaths over time for 32 cancers in 195 countries and territories from 1990 to 2015. We also estimate how many years of life were lost due to cancer as well as disability adjusted life years and a summary measure that combines these two into disability adjusted life years.