Author Interviews, Exercise - Fitness, Frailty, JAMA / 06.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30249" align="alignleft" width="200"]Maayan Agmon, PhD The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Studies University of Haifa Haifa, Israel Dr. Maayan Agmon[/caption] Maayan Agmon, PhD The Cheryl Spencer Department of Nursing Faculty of Social Welfare and Health Studies University of Haifa Haifa, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Response: To address the issue of functional decline during and post hospitalization . Up to 40% of older adults decline in their function at the time of hospitalization and acute illness. Most part of this functional decline is not explained by illness itself. So far, we know that in-hospital mobility is a protective factor but how much walking is required to prevent this decline has yet to be determined.
AHA Journals, Author Interviews, Heart Disease, Outcomes & Safety, UT Southwestern / 04.12.2016

MedicalResearch.com Interview with: Rohan Khera, MD Cardiology Fellow, T32 Clinical-Investigator Pathway UT Southwestern Medical Center Dallas, TX MedicalResearch.com: What is the background for this study? What are the main findings? Response: Nearly 200 thousand people have an in-hospital cardiac arrest in the US each year. Of these, the vast majority have a non-shockable initial rhythm – either pulseless electric activity (PEA) or asystole. The survival of this type of arrest remains poor at around 12-14%. Moreover, even after accounting for differences in case mix, there is a wide variation in survival across hospitals – and this serves as a potential avenue for targeting quality improvement strategies at poor performing hospitals. Recent data suggest that a shorter time from the onset of cardiac arrest to the first dose of epinephrine is independently associated with higher survival. Against this background of wide hospital variation in cardiac arrest survival, and patient-level data suggesting an association between time to epinephrine and patient survival, we wanted to assess (A) if there were differences in time to epinephrine administration across hospitals, and (B) if a hospital’s rate of timely epinephrine use was associated with its cardiac arrest survival rate. Within Get With The Guidelines-Resuscitation, we identified nearly 104-thousand adult patients at 548 hospitals with an in-hospital cardiac arrest attributable to a non-shockable rhythms. delays to epinephrine, We found that (a) proportion of cardiac arrests with delayed epinephrine markedly across hospitals, ranging from no arrests with delay (or 0%) to more than half of arrests at a hospital (54%). There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge and survival with functional recovery - compared to a low-performing hospitals, survival and recovery was 20% higher at hospitals that performed best on timely epinephrine use.
Author Interviews, Colon Cancer, JAMA / 03.12.2016

MedicalResearch.com Interview with: [caption id="attachment_29864" align="alignleft" width="96"]David Lieberman MD Professor of Medicine Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University L461 Portland, OR 97239 Dr. David Lieberman[/caption] David Lieberman MD Professor of Medicine Chief, Division of Gastroenterology and Hepatology Oregon Health and Science University Portland, OR 97239 MedicalResearch.com: What is the background for this study? What are the main findings? Response: New guidelines for colorectal cancer (CRC) screening from the USPSTF were published in June 2016. They recommended any of 8 different screening programs. The purpose of this review was to highlight elements not included in the USPSTF report: 1. Elements of informed decision making associated with each program 2. Quality metrics for each program 3. Recommendations for higher than average risk individuals
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Depression, JAMA / 03.12.2016

MedicalResearch.com Interview with: Zahinoor Ismail MD FRCPC Clinical Associate Professor, Hotchkiss Brain Institute University of Calgary MedicalResearch.com: What is the background for this study? What are the main findings? Response: Depression and depressive symptoms are common in mild cognitive impairment (MCI). Evidence suggests that depression in MCI increases the likelihood of progression from MCI to dementia, compared to non-depressed people with MCI. In the newer construct of mild behavioural impairment (MBI), which describes the relationship between later life onset of sustained and impactful neuropsychiatric symptoms and the risk of cognitive decline and dementia, depression is an important subdomain (in addition to apathy, impulse control, social cognition and psychotic symptoms). Thus, depression and depressive symptoms are a significant risk factor for cognitive, behavioural and functional outcomes in older adults who have at most mild cognitive impairment. As the importance of neuropsychiatric symptoms in older adults emerges, good prevalence estimates are required to inform clinicians and researchers as well as public health policy and decision makers. We performed a systematic review and meta-analysis to determine the best estimate of prevalence of depression in  mild cognitive impairment. We included 57 studies, representing 20,892 participants in the analysis. While we determined that the omnibus prevalence estimate was 32%, there was significant heterogeneity in this sample based on setting. In community samples, the rate was 25%, but in clinical samples this was higher at 40%. Additionally, different case ascertainment methods for depression (self report, clinician administered or caregiver report) and different MCI criteria didn't change the prevalence estimates.
Author Interviews, BMJ, Clots - Coagulation, Testosterone, Thromboembolism / 03.12.2016

MedicalResearch.com Interview with: Dr. Carlos Martinez Institute for Epidemiology, Statistics and Informatics GmbH Frankfurt, Germany, MedicalResearch.com: What is the background for this study? Response: A 10-fold increase in testosterone prescriptions per capita in the United States and a 40-fold increase in Canada in men has occurred over the first decade of this century, mainly for sexual dysfunction and/or decreased energy. Recognised pathological disorders of the male reproductive system remain the sole unequivocal indication for testosterone treatment but there has been increasing use in men without pathological hypogonadism. A variety of studies and meta-analyses have provided conflicting evidence as to the magnitude of the risk of cardiovascular events including venous thromboembolism in men on testosterone treatment. In June 2014, the US Food and Drug Administration and Health Canada required a warning about the risk of venous thromboembolism to be displayed on all approved testosterone products. Studies have reported contradictory results on an association between testosterone use and the risk of venous thromboembolism. The effect of timing and duration of testosterone use on the risk of venous thromboembolism was not studied and may explain some of these contradictory findings.
Author Interviews, HIV, NEJM / 03.12.2016

MedicalResearch.com Interview with: Ms. Neliëtte Van Niekerk M.Com and Dr. Annalene Nel M.B., Ch.B., Ph.D. From International Partnership for Microbicides Silver Spring, MD MedicalResearch.com: What is the background for this study? What are the main findings? Response: Existing prevention methods have not done enough to stop the alarming rates of infection among women and girls, especially in sub-Saharan Africa, where young women are at least twice as likely to have HIV as young men. Rates of new infections among women aged 15-24 were more than four times greater than that of men the same age, and this age group accounted for 25 percent of new infections in South Africa. To provide women with more prevention options, the nonprofit International Partnership for Microbicides (IPM) developed a vaginal ring that contains an antiretroviral drug called dapivirine. Women insert the ring themselves and replace it every month. The Ring Study was a Phase III clinical trial that assessed the safety and long-term efficacy of the monthly dapivirine ring among nearly 2,000 women in South Africa and Uganda. We found that the ring reduced the risk of HIV-1 infection in about one-third of the women in the trial, and it was safe, with no difference in adverse effects between the active and placebo ring groups.
Author Interviews, Microbiome, Nature, Weight Research / 03.12.2016

MedicalResearch.com Interview with: Dr. Eran Elinav. Principal investigator Immunology Department Weizmann Institute of Science Rehovot, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recurrent obesity is a very common yet poorly studied and under researched phenomenon. It is well known that many people diet, but then regain the weight they lost and even add more weight. We found that the gut microbiome is a major driver of this enhanced weight regain phenomenon. We found that in the obese state, the microbiome is altered, and these alterations are not reversed upon weight loss. And these alterations are sufficient to drive weight regain, since transferring them to germ-free mice also transferred the enhanced weight regain phenotype. Moreover, we provide three different treatments for this condition: (1) Antibiotics; (2) transfer of bacteria from lean mice; and (3) addition of specific molecules that we found to be lacking in the altered microbiome. All of these treatments cured the mice we tested from enhanced weight regain.
Author Interviews, Infections, MRSA, Nature / 03.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30155" align="alignleft" width="136"]Ferric C. Fang, M.D. Professor of Laboratory Medicine and Microbiology Adjunct Professor of Medicine (Infectious Diseases) Director, Harborview Medical Center Clinical Microbiology Laboratory University of Washington School of Medicine Seattle, WA Dr. Ferric C. Fang[/caption] Ferric C. Fang, M.D. Professor of Laboratory Medicine and Microbiology Adjunct Professor of Medicine (Infectious Diseases) Director, Harborview Medical Center Clinical Microbiology Laboratory University of Washington School of Medicine Seattle, WA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Fang lab has a longstanding interest in the interaction between nitric oxide (NO·) and pathogenic bacteria. NO· is an important mediator of the host innate immune response that restricts the growth of invading bacterial pathogens. One of the known actions of NO· is the reversible inhibition of aerobic respiration that results from NO· binding to the heme centers of terminal oxidases. Like mammalian hosts, many bacteria also possess the ability to enzymatically synthesize NO·. Our latest research investigated the physiological role of the Staphylococcus aureus nitric oxide synthase (saNOS). We discovered that endogenously produced NO· is able to target bacterial terminal oxidases under microaerobic conditions, allowing the bacteria to transition to nitrate respiration when oxygen concentrations are limited and helping to maintain the membrane potential. This process was found to be essential for S. aureus nasal colonization in a mouse model. Thus, a conserved mechanism is involved in both the antimicrobial actions of NO· and the physiological role of NO· in regulating bacterial electron transfer reactions. Interestingly, NO·-heme interactions have been shown to control mitochondrial respiration during hypoxia in mammalian cells.
Author Interviews, Mental Health Research, PLoS, Psychological Science / 02.12.2016

MedicalResearch.com Interview with: Dr-Gunther-Meinlschmidt.jpg Prof. Dr. Gunther Meinlschmidt, Psych University of Basel, Department of Psychology, Division of Clinical Psychology and Epidemiology Faculty of Medicine Switzerland MedicalResearch.com: What is the background for this study? Response: Physical diseases and mental disorders affect a person’s quality of life. Further, they present a huge challenge for the healthcare system. It has been reported that physical and mental disorders systematically co-occur already early in life. What we wanted to know is whether there are certain temporal patterns between mental disorders and physical diseases during childhood and adolescence. A better understanding of such patterns may help to reveal processes that could be relevant both to the origins of physical diseases and mental disorders and to their treatment.
Author Interviews, FDA, JAMA, Ophthalmology / 02.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30144" align="alignleft" width="200"]Malvina Eydelman, M.D. Division Director; Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health FDA. Dr. Malvina Eydelman[/caption] Malvina Eydelman, M.D. Division Director; Division of Ophthalmic and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health FDA. MedicalResearch.com: What is the background for this study? Response: In October 2009, the FDA, the National Eye Institute (NEI), and the Department of Defense (DoD) launched the LASIK Quality of Life Collaboration Project (LQOLCP) to help better understand the potential risk of severe problems that can result from LASIK. The project aimed to develop a tool to determine the percent of patients who develop difficulties performing their usual activities following LASIK, and to identify predictors for those patients. At the time we developed our project, there was a limited amount of valid scientific data on certain patient-reported outcomes (PROs) related to LASIK. A PRO is a report of a condition experienced and reported by the patient, not the health care provider. Most LASIK studies used tools, such as questionnaires, to assess visual symptoms, but only after the surgery. The Patient-Reported Outcomes with LASIK (PROWL) studies in the LQOLCP assessed visual symptoms both before and after their LASIK surgery to identify changes over time. The studies also measured the impact symptoms directly had on performing usual activities, which had not previously been done.
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Johns Hopkins / 02.12.2016

MedicalResearch.com Interview with: [caption id="attachment_29945" align="alignleft" width="80"]Dr. Amol K. Narang, MD Instructor of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins Sidney Kimmel Comprehensive Cancer Center Dr. Amol  Narang[/caption] Dr. Amol K. Narang, MD Instructor of Radiation Oncology and Molecular Radiation Sciences Johns Hopkins Sidney Kimmel Comprehensive Cancer Center MedicalResearch.com: What is the background for this study? Response: We know that cancer care is becoming increasingly expensive in the U.S., but the financial impact on patients in the form of out-of-pocket expenses is not well understood, in part because of the lack of data sources that track this information. As such, we used the Health and Retirement study, a national panel study that closely tracks the out-of-pocket medical expenditures of older Americans, to understand the level of financial strain that Medicare patients experience after a new diagnosis of cancer. We further investigated what factors were associated with high financial strain and what type of health services were driving high costs in this population.
Author Interviews, Gastrointestinal Disease, Mental Health Research, Nature, Probiotics / 02.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30115" align="alignleft" width="200"]Elizabeth Bryda, PhD Professor, Director, Rat Resource and Research Center Veterinary Pathobiology University of Missouri Columbia, Missouri Dr. Elizabeth Bryda[/caption] Elizabeth Bryda, PhD Professor, Director, Rat Resource and Research Center Veterinary Pathobiology University of Missouri Columbia, Missouri MedicalResearch.com: What is the background for this study? What are the main findings? Response: A number of groups have demonstrated the ability of probiotics to benefit digestive health and there is a growing body of evidence to suggest an association between mental health and “gut health”. We were interested to see if probiotic bacteria could decrease anxiety- or stress-related behavior in a controlled setting using zebrafish as our model organism of choice for these studies. We were able to show that Lactobacillus plantarum decreased overall anxiety-related behavior and protected against stress-induced dysbiosis (microbial imbalance). The fact that administration of probiotic bacteria also protected other resident gut bacteria from the dramatic changes seen in “stressed” fish not receiving the probiotic was unexpected and suggested that these bacteria may be working at the level of the GI tract and the central nervous system.
Author Interviews, CDC, JAMA, Lipids, Nutrition / 02.12.2016

MedicalResearch.com Interview with: Asher Rosinger, PHD, MPH Epidemic Intelligence Service Officer, Centers for Disease Control and Prevention Division of Health and Examination Nutrition Examination Surveys, Analysis Branch National Center for Health Statistic MedicalResearch.com: What is the background for this study? Response: Total cholesterol, triglycerides, and low-density lipoprotein (LDL) levels are linked to coronary heart disease and cardiovascular events. Between 1999 and 2010, total cholesterol, triglycerides, and LDL levels declined among U.S. adults. We used new data from the 2011-2014 nationally representative National Health and Nutrition Examination Survey (NHANES) to determine if earlier trends continued.
Author Interviews, Insomnia, JAMA / 02.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30102" align="alignleft" width="133"]Lee M. Ritterband, Ph.D. Professor, Department of Psychiatry and Neurobehavioral Sciences Director, Center for Behavioral Health and Technology University of Virginia School of Medicine Ivy Foundational Translational Research Building Charlottesville, VA 22903 Dr. Lee M. Ritterband[/caption] Lee M. Ritterband, Ph.D. Professor, Department of Psychiatry and Neurobehavioral Sciences Director, Center for Behavioral Health and Technology University of Virginia School of Medicine Ivy Foundational Translational Research Building Charlottesville, VA 22903  MedicalResearch.com: What is the background for this study? Response: Cognitive behavioral therapy for insomnia, a non-pharmacological intervention, is the first line recommendation for adults with chronic insomnia (see recommendations made earlier this year from the American College of Physicians). Access to CBT-I, however, is limited by numerous barriers, including a limited supply of behavioral medicine providers. One way to help improve access to this effective treatment is to develop and evaluate additional delivery methods of CBT-I, including Internet-delivered CBT-I. This study was designed to evaluate the efficacy of an Internet-delivered CBT-I program (SHUTi: Sleep Healthy Using The Internet) over the short-term (9-weeks) and long-term (1-year).
Author Interviews, Cancer Research, Nature / 01.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30081" align="alignleft" width="150"]Sudarshan Anand, PhD Department of Cell, Developmental and Cancer Biology Department of Radiation Medicine Oregon Health and Science University Portland, Oregon Dr. Sudarshan Anand[/caption] Sudarshan Anand, PhD Department of Cell, Developmental and Cancer Biology Department of Radiation Medicine Oregon Health and Science University Portland, Oregon MedicalResearch.com: What is the background for this study? What are the main findings? Response: Almost half of all cancer patients receive radiation therapy during the course of their disease. While the impact of radiation on the cancer cells has been well studied in experimental models, its effects on the accessory cells that are present in the tumor are not well known. One of the major interests of our lab is studying these accessory cells of the tumor aka “the tumor microenvironment”. These group of cells consists of blood vessel cells, fibroblasts and immune cells that are normal cells that have been recruited by the tumor and generally support tumor growth. The goal of this study was to understand the impact of radiation (and broadly DNA damaging agents) on the blood vessel cells in the tumor. We focused on a specific type of molecule called microRNAs (miRs) in these cells. miRs are small RNA molecules that bind to dozens of messenger RNAs and the production of proteins. We discovered a group of microRNAs that was induced in blood vessel cells by radiation, a chemotherapy agent cisplatin and peroxide an agent that mimics oxidative stress that is often present in cancers. We found that the top candidate on this list was a microRNA that mimicked radiation by inducing DNA damage and eventually killing the blood vessel cells. Administering this microRNA, either within a tumor or using a specific nanoparticle that delivers cargo to the tumor blood vessels, decreased tumor growth in mouse models of breast cancer, brain cancer and colorectal cancer. We found that the efficacy of this agent was a result of its ability to suppress a protein TREX1, that is often mutated in human lupus. In other words, this microRNA was able to create some of the immune and inflammatory features of lupus within a tumor and induce proteins that triggered cell death on tumor cells. Overall, our work illustrates how the tumor accessory cells respond to radiation and highlights the cross-talk between different accessory cells and the tumor cells.
Author Interviews, Infections, MRSA, NIH, Science / 01.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30077" align="alignleft" width="106"]Warren Leonard, M.D. NIH Distinguished Investigator Laboratory of Molecular Immunology NHLBI, NIH Dr. Warren Leonard[/caption] Warren Leonard, M.D. NIH Distinguished Investigator Laboratory of Molecular Immunology NHLBI, NIH MedicalResearch.com: What is the background for this study? Response: TSLP is a cytokine that has been well studied in the context of T cell helper type 2 (TH2) responses and the promotion of atopic diseases. TSLP is naturally expressed at barrier surfaces, such as the skin; however, its role in skin infections was not previously explored. In our study, we investigated whether TSLP plays a role in host defense to Staphylococcus aureus skin infections, using the most common strain of methicillin-resistant S. aureus (MRSA) present in the United States.
Author Interviews, Genetic Research, Lipids, NEJM / 01.12.2016

MedicalResearch.com Interview with: Brian A. Ference, M.D Division of Cardiovascular Medicine Wayne State University School of Medicine Detroit, MI MedicalResearch.com: What are the main findings? Response: Lifelong exposure to modestly lower plasma LDL-C levels caused by rare loss-of-function mutations in the PCSK9 gene is associated with a substantially lower lifetime risk of developing cardiovascular disease. This discovery motivated the development of monoclonal antibodies directed against PCSK9 which have now been shown to reduce plasma LDL-C levels by 50-60%. The cardiovascular medicine community is early anticipating the results of two large cardiovascular outcome trials that will determine if lowering LDL-C levels by inhibiting PCSK9 will reduce the risk of cardiovascular events. Because monoclonal antibodies and other therapies directed against PCSK9 are designed to recapitulate the phenotype of PCSK9 loss-of-function mutations, we reasoned that it may be possible to anticipate the efficacy and safety results of the ongoing cardiovascular outcome studies by more precisely characterizing the effect of genetic variants in the PCSK9 gene on the risk of both cardiovascular events and new onset diabetes. To do this, we a constructed genetic score consisting of multiple independently inherited variants in the PCK9 gene to create an instrument that mimics the effect of PCSK9 inhibitors. We then compared the effect of genetic variants that mimic the effect of PCSK9 inhibitors with the effect of genetic variants in the HMGCR gene that mimic the effect of statins to make inferences about the likely effect of PCSK9 inhibitors on the risk of cardiovascular events and new onset diabetes as compared to treatment with a statin.
Author Interviews, Frailty, JAMA, Surgical Research, University of Pittsburgh / 01.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30060" align="alignleft" width="200"]Daniel E. Hall, MD, MDiv, MHSc, FACS Associate Professor of Surgery University of Pittsburgh Staff Surgeon VA Pittsburgh Healthcare System Core Investigator VA Center for Health Equity Research and Promotion. PIttsburgh, PA Dr. Daniel E. Hall[/caption] Daniel E. Hall, MD, MDiv, MHSc, FACS Associate Professor of Surgery University of Pittsburgh Staff Surgeon VA Pittsburgh Healthcare System Core Investigator VA Center for Health Equity Research and Promotion. PIttsburgh, PA MedicalResearch.com: What is the background for this study? What are the main findings? Response: A growing body of research demonstrates that frailty is a more powerful predictor of postoperative outcomes than risk-prediction models based on age or comorbidity alone. However, it has not been clear if surgeons could intervene on frailty to improve outcomes. This study reports what we believe to be the first ever demonstration that it is not only feasible to screen an entire health system for frailty, but that it is possible to act on that information to improve outcomes. Every patient evaluated for elective surgery was screened for frailty with a brief tool that takes 1-2 minutes to complete. Those identified as potentially frail and thus at greater risk for poor surgical outcomes received an ad-hoc administrative review aimed at optimizing perioperative care. After implementing the frailty screening initiative, we observed a 3-fold increase in long-term survival at 6 and 12 months—even after controlling for age, frailty, and predicted mortality.
Author Interviews, JAMA, Outcomes & Safety / 30.11.2016

MedicalResearch.com Interview with: Jianhui Hu, PhD Center for Health Policy & Health Services Research Henry Ford Health System Detroit, Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: In July of 2016, the Center for Medicare and Medicaid services (CMS) released its first-ever hospital Star Rating for consumers to use to compare hospital quality. Since earlier studies have shown that hospitals serving lower-socioeconomic-status (SES) communities have lower scores on measures like readmission rate that are a part of the Star Rating system, we wanted to find out whether a similar relationship might be found between community-level SES and the Star Ratings. Our study used a recently released “stress” ranking of 150 most populated U.S cities and explored possible associations with the hospital Star Ratings. This “stress” ranking was a composite score of 27 individual metrics measuring a number of characteristics of the cities, such as job security, unemployment rate, housing affordability, poverty, mental health, physical activity, health condition, crime rate, etc. Our study found that less-stressed cities had average higher hospital Star Ratings (and more-stressed cities had lower average hospital Star Ratings). Cities such as Detroit and Newark are good examples of those with high “stress” and relatively low hospital Star Ratings, and cities like Madison and Sioux Falls of those with relatively low stress and relatively high hospital Star Ratings. Our correlational analysis indicated that around 20% of the difference in the Star Ratings can be explained by characteristics of the cities in which hospitals were located.
Author Interviews, End of Life Care, JAMA, University of Pittsburgh / 30.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29804" align="alignleft" width="120"]Dr. Dio Kavalieratos, PhD Assistant Professor of Medicine Section of Palliative Care and Medical Ethics Division of General Medicine Institute of Clinical Research University of Pittsburgh Dr. Dio Kavalieratos[/caption] Dr. Dio Kavalieratos, PhD Assistant Professor of Medicine Section of Palliative Care and Medical Ethics Division of General Medicine Institute of Clinical Research University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: The field of palliative care has seen a dramatic surge in research and clinical implementation over the past decade. The last systematic review of palliative care trials was published in 2008. In that review, the authors reported very weak evidence for palliative care, as well as major methodological limitations in the trials that had been done to date. Since then, several landmark trials have been published, some with very compelling findings such increased survival. Therefore, an up-to-date review was in order. There also had not previously been enough trials to perform a meta-analysis. A meta-analysis is the statistical process of combining the results of multiple trials, which gives you an overall effect for an intervention, in this case, palliative care. We were able to conduct the first meta-analysis of the effect of palliative care with three important outcomes: patient quality of life, patient symptom burden, and patient survival.
Author Interviews, Infections, PLoS / 30.11.2016

MedicalResearch.com Interview with: Romolo Nonno, DVM, PhD Istituto Superiore di Sanità Dipartimento di Sanità Pubblica Veterinaria e Sicurezza Alimentare Roma Italy MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies have suggested that prion populations are composed of a variety of conformational variants subjected to Darwinian evolution driven by selective regimes. However, the exact molecular mechanisms that make prions able to self-replicate and mutate are still poorly understood. A major technical advance in this field has been the discovery of techniques that allow to replicate prions in vitro, outside live organisms. One of these techniques, Protein Misfolding Cyclic Amplification (PMCA), allows to grow prion populations for a very high number of replications in a relatively short time period. Furthermore it is conceivable that the in vitro environment offers less constraint to prion replication than live animals or cells, due to the absence of active clearance and cell division, which are key players of conformers selection in ex vivo models. These features make PMCA an attractive tool to investigate prion replication, mutation and evolution. By using PMCA, we investigated the in vitro evolution of prion populations derived from natural scrapie. Unexpectedly, we found that the cloud of conformational variants which compose a natural scrapie isolate also includes “defective” variants which, once isolated, are unable to self-sustain in vivo. Importantly, we found that the defective prion mutant that we have isolated possesses unique biochemical properties in that its prion domain lacks the central region of prion protein, which is invariably present in known infectious mammalian prions.
Author Interviews, BMJ, Exercise - Fitness, Heart Disease / 30.11.2016

MedicalResearch.com Interview with: [caption id="attachment_30012" align="alignleft" width="133"]Dr. Emmaneul Stamatakis PhD, MSc, BSc Associate Professor | NHMRC Senior Research Fellow Charles Perkins Centre, Prevention Research Collaboration School of Public Health, Sydney Medical School The University of Sydney Dr. Emmaneul Stamatakis[/caption] Dr. Emmaneul Stamatakis PhD, MSc, BSc Associate Professor | NHMRC Senior Research Fellow Charles Perkins Centre, Prevention Research Collaboration School of Public Health, Sydney Medical School The University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: We examined the association between participation in different sports and risk of death during subsequent decade in a large sample of >80k adults aged 30 and over who lived in Scotland and England between 2994 and 2008 . We found the following significant reduction in risk of dying from all causes among participants compared with non-participants: cycling 15%, aerobics 27%, swimming 28%, racquet balls 47%; there was no significant reduction in mortality for running/jogging and football/rugby. We also found the following significant reduction in risk of dying from cardiovascular diseases: aerobics 36%, swimming 41%, racquet balls 56%; there were no significant reduction in mortality for running, cycling and football/rugby. Results in both cases were adjusted for the potential confounders: age, sex, chronic conditions, alcohol drinking and smoking habits, mental health, obesity, education level, doctor-diagnosed CVD, cancer, weekly volume of other physical activity besides the sport (including walking and domestic activity.
Author Interviews, Flu - Influenza, Pediatrics, Science, UCLA / 28.11.2016

MedicalResearch.com Interview with: Katelyn M. Gostic and Monique Ambrose Department of Ecology and Evolutionary Biology University of California Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Monique Ambrose: Influenza pandemics pose a serious, recurrent threat to human public health. One of the most probable sources of future pandemic influenza viruses is the pool of influenza A virus (IAV) subtypes that currently circulate in non-human animals. It has traditionally been thought that the human population is immunologically naïve and unprotected against these unfamiliar subtypes. However, our work suggests that an individual ‘imprints’ to the influenza A virus (IAV) encountered in early childhood in such a way that they retain protection against severe disease if they later encounter a novel IAV subtype that belongs to the same genetic group as their first exposure. Our research looked at human cases of H5N1 and H7N9, two avian IAV subtypes of global concern, to investigate what factors most strongly predicted risk of severe disease. The most striking explanatory factor was childhood IAV imprinting: our results suggest that individuals who had childhood imprinting on an IAV in the same genetic group as the avian IAV they encountered later in life experienced 75% protection against severe disease and 80% protection against death.
Author Interviews, Lancet, Outcomes & Safety, Thromboembolism, Transfusions / 28.11.2016

MedicalResearch.com Interview with: Mary A.M. Rogers, PhD, MS Research Associate Professor Research Director, Patient Safety Enhancement Program Department of Internal Medicine University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: Peripherally inserted central catheters (PICCs) are commonly used for vascular access in hospitalized patients. Previous studies have shown that PICCs of larger gauge (diameter) increase the risk of developing venous thromboembolism (blood clots in the deep veins that sometimes travel to the lung). Red blood cell transfusion is also known to increase the risk of venous thromboembolism. Because PICCs are often used to transfuse blood, we designed a study to investigate whether the method of transfusion delivery influences the risk of developing venous thromboembolism.
Author Interviews, Kidney Disease, Lancet, Transplantation / 28.11.2016

MedicalResearch.com Interview with: Prof. Dr. med. Christian Hugo Head, Division of Nephrology Medical Clinic III Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden Dresden MedicalResearch.com: What is the background for this study? Response: At the end of 2007, the harmony trial was designed predominantly based on the one year results of the ELITE-Symphony trial, demonstrating that low dose tacrolimus, mycophenolate mofetile, and steroids together with monoclonal interleukin-2-receptor (CD 25 antigen) antibody induction therapy has superior efficacy in renal transplant patients compared to all other regimens (low or normal dose cyclosporine or sirolimus) tested. While these advantages of the low dose tacrolimus protocol were so convincing to become the new gold standard of immunosuppressive therapy within the next few years (see KDIGO guide lines for renal transplantation in 2009), the low dose tacrolimus treatment arm also demonstrated increased incidence rates regarding post-transplantation diabetes mellitus (PTDM, at that time called new onset of diabetes after transplantation - NODAT) compared to the low cyclosporine treatment arm. Previous studies had also demonstrated a detrimental association between NODAT and cardiovascular events and mortality, the leading cause of death in renal transplant recipients. Corticosteroid-free or rapid withdrawal regimens were relatively encouraging regarding influencing NODAT rates but only at the price of an increased rate of T cell mediated acute rejections.
Author Interviews, JAMA, Neurological Disorders, Radiology, UCLA / 28.11.2016

MedicalResearch.com Interview with: Joseph O’Neill, PhD Division of Child and Adolescent Psychiatry University of California–Los Angeles Semel Institute for Neuroscience Los Angeles MedicalResearch.com: What is the background for this study? What are the main findings? Response: Stuttering seriously diminishes quality of life. While many children who stutter eventually grow out of it, stuttering does persist into adulthood in many others, despite treatment. Like earlier investigators, we are using neuroimaging to explore possible brain bases of stuttering, aiming, eventually, to improve prognosis. What's novel is that our study deploy neuroimaging modalities-- arterial spin labelling and, in this paper, magnetic resonance spectroscopy (MRS)-- not previously employed in stuttering. MRS offers prospects of detecting possible neurochemical disturbances in stuttering. The MRS results showed differences in neurometabolite-- brain chemicals-- levels between people who stutter (adults and children) and those who don't in many brain regions where other neuroimaging has also observed effects of stuttering. In particular, MRS effects were apparent in brain circuits where our recent fMRI work detected signs of stuttering, circuits subserving self-regulation of speech production, attention and emotion. This reinforces the idea that stuttering has to do with how the brain manages its own activity along multiple dimensions: motivation, allocation of resources, and behavioral output.
Author Interviews, Cancer Research, JAMA, Lung Cancer / 27.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29726" align="alignleft" width="180"]Paul W. Sperduto, MD, MPP, FASTRO Dr. Paul W. Sperduto[/caption] Paul W. Sperduto, MD, MPP, FASTRO Minneapolis Radiation Oncology University of Minnesota Gamma Knife Center, Minneapolis, Minnesota MedicalResearch.com: What is the background for this study? What are the main findings? Response: Analysis of past randomized clinical trials involving patients with brain metastases, an extremely heterogeneous population, suggested that the stratification tools of the past were inadequate to ensure those trials were comparing similar patients which made the results of those trials difficult to interpret or misleading. So, in 2008, a new prognostic index, the Graded Prognostic Assessment (GPA) was designed and published to more accurately predict survival. In 2010, the GPA was refined when we learned survival and the factors that predict survival varied by diagnosis (i.e. lung, breast, melanoma, kidney cancer patients with brain metastases had different survival). Now we have learned survival also varies by gene mutations and the diagnosis-specific GPA for lung cancer is further refined in this article with this new information, specifically EGFR and ALK gene alterations. 27 co-authors from 12 academic medical centers contributed patients to this database which represents the largest study of lung cancer patients with brain metastases ever reported.
Author Interviews, CMAJ, Heart Disease, Stroke / 27.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29867" align="alignleft" width="200"]Dr-Tony-Antoniou.jpg Dr. Tony Antoniou[/caption] Dr. Tony Antoniou, PhD Research Scholar Department of Family and Community Medicine and a Scientist Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital Assistant Professor in the Department of Family and Community Medicine and Leslie Dan Faculty of Pharmacy University of Toronto, Toronto, Ontario MedicalResearch.com: What is the background for this study? What are the main findings? Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate.
AHA Journals, Author Interviews, Gender Differences, Heart Disease, Surgical Research / 27.11.2016

MedicalResearch.com Interview with: Dr. Stefano Savonitto  Director, Division of Cardiology Manzoni Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Over the last 15 years, there has been a shift from fibrinolytic therapy for STEMI to primary angioplasty, which required a re-organization of the whole STEMI treatment network. Besides the higher reperfusion efficiency of primary angioplasty, as compared to lytic therapy, it has been a global upgrade of the STEMI care system that has reduced the rate of no reperfusion. Elderly patients and women (who are, on average, also older than men) had theoretically the most to gain from this shift, but little data were available to assess this benefit. In the present paper, we have shown that “lack of reperfusion” was reduced dramatically across all age groups and in both sexes, with a progressive and uniform increase in primary angioplasty, and a significant reduction in mortality. Almost as expected, elderly women were the category with the most relevant mortality benefit. Nevertheless, after adjustment for age and other confounders, women continue to experience a higher mortality as compared to men. In the discussion of the paper, we propose some hypotheses for this persistently higher mortality in women.
Author Interviews, BMJ, Brigham & Women's - Harvard, Heart Disease, Nutrition / 25.11.2016

MedicalResearch.com Interview with: [caption id="attachment_29966" align="alignleft" width="190"]Dr. Qi Sun Sc.D, M.D., M.M.S. Assistant Professor in the Department of Nutrition Harvard T.H. Chan School of Public Heath Boston Dr. Qi Sun[/caption] Dr. Qi Sun Sc.D, M.D., M.M.S. Assistant Professor in the Department of Nutrition Harvard T.H. Chan School of Public Heath Boston MedicalResearch.com: What is the background for this study? What are the main findings? Response: Interpretation of existing human study data regarding saturated fat intake in relation to heart disease risk is quite confusing and distorted in certain publications. It is a fact that, depending on data analysis strategies, the effects of saturated fats may depend on which macronutrients they replace. For example, substituting saturated fats for refined carbohydrates will not lead to an elevated risk of heart disease because both nutrients are harmful whereas replacing saturated fats with good polyunsaturated fats results in risk reduction. In our current analysis, we clearly demonstrated that when total saturated fatty acids were replaced by polyunsaturated fatty acids, monounsaturated fatty acids, whole grain carbohydrates, and plant-based proteins, the diabetes risk would decrease. Furthermore, we showed that major individual saturated fatty acids were all associated with an elevated heart disease risk.