MedicalResearch.com: Medical Research Exclusive Interviews April 1 2015

MedicalResearch.comExclusive Interviews with Medical Research and

Health Care Researchers from Major and Specialty Medical Research Journals and Meetings

Editor: Marie Benz, MD [email protected]

April 1 2015

For Informational Purposes Only: Not for Specific Medical Advice.

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Read more interviews on MedicalResearch.com

Electric Lights Disrupts Human Circadian RhythmMedicalResearch.com Interview with:

Richard G. Stevens, Ph.D.,Professor, Cancer Epidemiologist

UConn Health

• Medical Research: What is the background for this study? What are the main findings?

Dr. Stevens: Since first introducing the concept of a possible connection between exposure to light at night and breast cancer in the mid-80s, we’ve seen growing evidence of how artificial light can suppress the circadian hormone melatonin and bring about physiological changes.

• The extent of this “circadian disruption” varies by the type of light and the time of day. Humans evolved with a body clock that followed the solar clock. Nature intended us to be awake in daylight and at rest in the dark of night. Therefore, the intense, short-wavelength light of the sun in the morning triggers us to become awake and alert, just as the absence of sunlight in the evening allows our body to produce melatonin. Even with the use of fire to provide light in the evening, the circadian impact was relatively minimal because of firelight’s place on the red end of the visible spectrum.

• Humans survived under this simple formula for many thousands of years. Then electric light started to take an increasingly strong foothold in everyday life. Today we are typically surrounded at all hours of the day and night by artificial light – in many cases it’s not bright enough during the day to match the sun, and it’s too bright at night to be conducive to the natural sleep/wake cycle. Think computer screens, tablets, smart phones, e-readers, etc. These devices emit enough short-wavelength, or blue, light to disrupt our body clocks in the evening. So do fluorescent and LED lights.

Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.

http://medicalresearch.com/sleep-disorders/electric-lights-disrupts-human-circadian-rhythm/12970/

http://medicalresearch.com/menopause/should-the-ovaries-be-removed-at-time-of-hysterectomy-for-benign-disease/1236/




UConn Health

• Our paper – I worked with Dr. Yong Zhu from Yale on this – represents a new analysis and synthesis of what we know up to now on the effect of lighting on our health. We don’t know for certain, but there’s growing evidence that the long-term implications of this may have ties to breast cancer, obesity, diabetes, and depression, and possibly other cancers.

• Exposure to electric light started about 130 years ago, which is a tiny period of time in evolutionary terms. In other words, not long enough to undo human evolution.







UConn Health

• Medical Research: What should clinicians and patients take away from your report?

• Dr. Stevens: An understanding of the importance of maintaining the sleep/wake cycles, and the effect even typical lighting in the modern world can have on it, could go a long way in staving off the potentially harmful long-term impact. Our smart phones and LED bulbs can’t disrupt our body clocks if we don’t let them. We can opt for reading a book under an incandescent light before bed, rather than on an e-reader with a blue backlight. And because we’re gaining more of an understanding about this, we’re starting to see our technology come equipped with the option of adjusting the type and intensity of light it emits.







UConn Health

• Medical Research: What recommendations do you have for future research as a result of this study?

• Dr. Stevens: Although studying people assigned to “dark” and “light” groups may tell us a great deal, we can’t ethically do that. What we can do is continue to study people who already have lifestyles that would be of interest to the science. We can survey third-shift workers and compare their health experience to day workers, for example. Or we can follow children who grow up in a rural area who don’t use smart phones and compare them to city dwellers who do. We certainly can do studies with animal models. But perhaps most important would be an understanding of the possibility of long-term health effects associated with artificial light. If we’re aware of it, perhaps we can take steps today to reduce our chances of illness tomorrow.

• Citation:

• G. Stevens, Y. Zhu. Electric light, particularly at night, disrupts human circadian rhythmicity: is that a problem? Philosophical Transactions of the Royal Society B: Biological Sciences, 2015; 370 (1667): 20140120 DOI: 10.1098/rstb.2014.0120



http://dx.doi.org/10.1098/rstb.2014.0120



Prostate Cancer: Does Timing of Radiation Therapy Affect Outcome?MedicalResearch.com Interview with:

Timothy N. Showalter, MD, MPHAssociate Professor & Residency Program Director Department of Radiation Oncology

University of Virginia School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Showalter: Early radiation therapy has been shown to be an effective curative treatment for prostate cancer patietns with a rising PSA blood test after radical prostatectomy and for men with locally advanced prostate cancer who are at high risk of recurrence after prostatectomy. Despite evidence that radiation therapy is more effective when delivered early (or when the PSA is low), radiation therapy delivery is often delayed to allow more time for patients to recover urinary and sexual function. In order to provide evidence regarding whether delaying radiation therapy does reduce the risks of side effects of treatment, my colleagues and I evaluated outcomes of for a large cohort of patients who received treatment in the Emilia Romagna Region of Italy. We identified a total 0f 9,786 prostate cancer patients who received prostatectomy, including 22% of whom received post-prostatectomy radiation therapy. We found that earlier delivery of radiation therapy was not associated with increased risk of any adverse events, including gastrointestinal, urinary or sexual complications.


http://medicalresearch.com/cancer-_-oncology/prostate-cancer/prostate-cancer-does-timing-of-radiation-therapy-affect-outcome/12926/

http://medicalresearch.com/endocrinology/hormone-therapy/long-term-androgen-deprivation-plus-radiation-for-high-risk-prostate-cancer/11935/







• Dr. Showalter: This study provides new evidence that radiation therapy timing after prostatectomy is not a primary determinant of the risk of complications. Therefore, for patients with an indication for postoperative radiation therapy, treatment need not be delayed as long as possible in order to maximize urinary and sexual function. This is potentially reassuring information for patients with high-risk, locally advanced prostate cancer, for whom earlier radiation therapy has been shown to be more effective at achieving a prostate cancer cure than delayed radiation therapy.



http://medicalresearch.com/author-interviews/treatment-choics-cloudy-if-psa-remains-elevated-after-prostatectomy/11652/







• Dr. Showalter: Although this study provides direct evidence regarding the lack of effect of radiation timing on treatment-related complications, there are a number of other factors to consider in the decision-making process for prostate cancer patients faced with post-prostatectomy treatment decisions. Future research should focus on how to use new genomic tests, which provide a molecular fingerprint of a patient’s tumor, to help guide treatment decisions based upon the chance of an individual patient’s tumor progressing. This would be another important piece of evidence for patients contemplating post-prostatectomy radiation therapy.

• Citation:

• Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, ItalyShowalter TN1, Hegarty SE2, Rabinowitz C3, Maio V4, Hyslop T5, Dicker AP6, Louis DZ3.Int J Radiat Oncol Biol Phys. 2015 Mar 15;91(4):752-9. doi: 10.1016/j.ijrobp.2014.11.038.



http://medicalresearch.com/cancer-_-oncology/prostate-cancer/early-prostate-cancer-watchful-waiting-radical-prostatectomy/4082/

http://www.ncbi.nlm.nih.gov/pubmed/25752388




Tau Protein A Key Driver Of Cognitive Decline in Alzheimer’s diseaseMedicalResearch.com Interview with:

Melissa Murray, Ph.DAssistant Professor of Neuroscience

Mayo Clinic


Dr. Murray: Our study investigates two of the hallmark brain pathologies that underlie Alzheimer’s disease, abnormally accumulated tau and amyloid proteins. While both are integral to diagnosing Alzheimer’s disease postmortem, their exclusive relationship with cognitive decline has been debated. Using a large series from our brain bank we found that while an increase in abnormal accumulation of both proteins shares a close relationship with a decline in cognition, tau is the key driver of decline. This was important for us to understand as the second part of our study investigated amyloid brain scanning. We found that amyloid brain scanning closely represents amyloid deposits and not tau in postmortem brain tissue. One particular aspect we focused on is the cutoff for what would be a amyloid-positive brain scan that indicates Alzheimer’s disease. Our study supports that currently available cutoffs correspond to a level of amyloid accumulation that occurs before Alzheimer’s disease has too far advanced.


• Dr. Murray: Given the relationship exists between cognitive decline and amyloid if tau is not considered, amyloid brain scanning can still be used to monitor Alzheimer’s disease in lieu of a marker for tau accumulation. This will be important as lifestyle risk factors are explored as Alzheimer’s disease modifiers and as tau therapeutics or combination therapeutics become more available. More importantly perhaps, evaluation of amyloid brain scanning cutoffs should be considered for clinical trials evaluating inclusion and exclusion of research participants. This study would not be possible without the patient’s and families who so selflessly donated their brain tissue.


http://medicalresearch.com/mental-health-research/alzheimers-dementia/tau-protein-a-key-driver-of-cognitive-decline-in-alzheimers-disease/12916/

http://medicalresearch.com/mental-health-research/alzheimers-dementia/alzheimers-antisense-molecule-reduced-amyloid-improved-memory-in-mice-study/5440/

http://medicalresearch.com/mental-health-research/alzheimers-dementia/alzheimers-amyloid-deposits-healthy-people-signals-increased-brain-atrophy/5038/

http://medicalresearch.com/mental-health-research/alzheimers-dementia/brain-amyloid-deposition-strongly-related-arterial-stiffness/4487/



Tau Protein A Key Driver Of Cognitive Decline in Alzheimer’s diseaseMedicalResearch.com Interview with:

Melissa Murray, Ph.DAssistant Professor of Neuroscience

Mayo Clinic


• Dr. Murray: The next exciting chapter in the field of Alzheimer’s disease is the possibility of tau brain scanning. More work needs to be done make this possibility a reality. The combination of tau and amyloid brain scanning would enable clinicians to improve diagnostic accuracy and enhance efforts toward early detection. The shift toward Tau therapeutics will be a necessary step toward managing and hopefully one day preventing the effects of Alzheimer’s disease on cognitive decline.

• Citation:

• Clinicopathologic and 11C-Pittsburgh compound B implications of Thal amyloid phase across the Alzheimer’s disease spectrum

• Co-authors of the study are, from Mayo Clinic in Jacksonville: Neill Graff-Radford, M.D., Amanda Liesinger, Ashley Cannon, Ph.D., Bhupendra Rawal, M.S., Owen Ross, Ph.D., and Dennis Dickson, M.D.; from Mayo Clinic in Rochester: Val Lowe, M.D., Scott Przybelski, Joseph Parisi, M.D., Ronald Petersen, M.D., Ph.D., Kejal Kantarci, M.D., David Knopman, M.D., and Clifford Jack, Jr., M.D.; and Ranjan Duara, M.D., from Mount Sinai Medical Center.

• Clinicopathologic and 11C-Pittsburgh compound B implications of Thal amyloid phase across the Alzheimer’s disease spectrum



http://medicalresearch.com/mental-health-research/alzheimers-dementia/alzheimers-albumin-amyloid-beta-complexes/2085/

http://brain.oxfordjournals.org/content/early/2015/03/20/brain.awv050





Physician-Pharmacist Collaboration in Primary Care Offices Improved Blood Pressure ControlMedicalResearch.com Interview with:

Barry L. Carter, PharmDProfessor of Pharmacy Professor of Family Medicine

U Iowa Carver College of Medicine


Response: Numerous studies and meta-analyses have found physician-pharmacist collaborative models can improve blood pressure (BP) control. In these models, pharmacists are located within primary care offices to assist with patient management. The physician delegates responsibility to pharmacists to perform a medication history, identify problems and barriers to achieving disease control, perform counseling on lifestyle modification and adjust medications following hypertension guidelines. However, it was not known if this model would be implemented in a large number of diverse primary care offices, if the effect could be sustained after discontinuation and if the intervention was as effective in under-represented minorities as in Whites. In this study, 32 clinics from throughout the U.S. were randomized to a 9 month intervention that was discontinued, a 24-month pharmacist intervention our usual care. All subjects received structured research measured blood pressure at baseline, 6, 9, 12, 18 and 24 months. We enrolled 625 subjects and 53% were from minority groups, 53% had < 12 years of education, 50% had diabetes or chronic kidney disease and 25% had Medicaid or self-pay for their care payments. All of these variables typically make it much more difficult to achieve BP control. BP control was 43% in the intervention groups and 34% in the control group at 9-months (adjusted OR 1.57 [95% CI 0.99-2.50], p = 0.059). However, when using the higher BP goals in the 2014 guidelines, blood pressure control was achieved in 61% of intervention subjects and 45% of control subjects at 9 months [(adjusted OR, 2.03 [95% CI 1.29-3.22], p=0.003). Of importance was the finding that the degree of systolic BP reduction (6 mm Hg) with the intervention compared to usual care was not only statistically significant but also the same in minority subjects (2/3 Black and 1/3 Hispanic) compared to all subjects. Interestingly, BP control seemed to be maintained in the subjects from minority groups at 18 and 24 months in both the group with the short (9-month) or sustained (24 month) intervention. In contrast, blood pressure control deteriorated slightly in non-minority subjects in all three groups.


http://medicalresearch.com/author-interviews/physician-pharmacist-collaboration-improved-blood-pressure-control-in-primary-care-offices/12974/

http://medicalresearch.com/author-interviews/hispanic-and-uninsured-adults-may-experience-barriers-to-blood-pressure-control/12670/

http://medicalresearch.com/blood-pressure-hypertension/sweet-spot-systolic-blood-pressure-control/6757/







• Response: Many primary care offices now employ clinical pharmacists to assist with patient management. This study demonstrates that the physician-pharmacist collaborative model can be implemented in very diverse primary care offices, even when they did not provide these types of services in the past. The study also demonstrates very good BP improvements in Blacks and Hispanics. Clinicians and health systems continue to implement patient-centered strategies and strive for high rates for risk factor control, immunizations and other preventative services. This study provides one model that can be used to improve outcomes and increase the numbers of patients who can achieve these important benchmarks.



http://medicalresearch.com/author-interviews/canadian-universal-health-insurance-reduces-racial-disparities-primary-care-access/8356/







• Response: While many studies have utilized this model, we still need research to determine the optimal use of various team members to maximize performance and efficiency. We are currently conducting cost-effectiveness analyses for this study to assist health systems and providers with implementation of this model. We also need additional research to continue to evaluate patient-specific interventions especially for under-represented minorities.

• Citation:Cluster-Randomized Trial of a Physician/Pharmacist Collaborative Model to Improve Blood Pressure Control

• Barry L. Carter, Christopher S. Coffey, Gail Ardery, Liz Uribe, Dixie Ecklund, Paul James, Brent Egan, Mark Vander Weg, Elizabeth Chrischilles,and Thomas Vaughn

• Circ Cardiovasc Qual Outcomes. 2015;CIRCOUTCOMES.114.001283published online before print March 24 2015, doi:10.1161/CIRCOUTCOMES.114.001283



http://circoutcomes.ahajournals.org/citmgr?gca=circcvoq;CIRCOUTCOMES.114.001283v1





Mental Health Issues Increase Hospital ReadmissionsMedicalResearch.com Interview with:

Brian K. Ahmedani, PhD, LMSWResearch Scientist Henry Ford Health System

Center for Health Policy & Health Services Research Detroit, MI 48202


Dr. Ahmedani: The Centers for Medicare and Medicaid Services (CMS) have begun penalizing hospitals for excessive all-cause hospital readmissions within 30 days after discharge for pneumonia, heart failure, and myocardial infarction. We wanted to determine the influence of comorbid mental health and substance use conditions on the rate of 30-day hospital readmissions for individuals with these conditions. Overall, individuals with a comorbid mental health condition were readmitted to the hospital within 30-days approximately 5% more often than those without one (21.7% versus 16.5%). Comorbid depression and anxiety were associated with a 30-day readmission rate of more than 23% each, overall.


• Dr. Ahmedani: The main message is that health systems and clinicians should assess and treat mental health as part of their initiatives to reduce hospital readmissions. Patients should be screened for these conditions and offered during-hospitalization and post-discharge mental health care, if needed.


http://medicalresearch.com/mental-health-research/mental-health-issues-increase-hospital-readmissions/12996/

http://medicalresearch.com/author-interviews/multifaceted-approach-required-improve-self-care-reduce-hospital-readmissions/5258/

http://medicalresearch.com/diabetes/elderly-with-co-morbidities-account-for-most-readmissions-for-diabetics/11645/



Mental Health Issues Increase Hospital ReadmissionsMedicalResearch.com Interview with:

Brian K. Ahmedani, PhD, LMSWResearch Scientist Henry Ford Health System

Center for Health Policy & Health Services Research Detroit, MI 48202


• Dr. Ahmedani: Current initiatives within health systems have been able to reduce hospital readmissions overall, but have not typically included mental health components. Future research needs to test comprehensive readmissions reduction models, which include mental health screening, assessment, and treatment.

• Citation:

• Psychiatric Comorbidity and 30-Day Readmissions After Hospitalization for Heart Failure, AMI, and Pneumonia

• Brian K. Ahmedani, Ph.D., L.M.S.W.; Leif I. Solberg, M.D.; Laurel A. Copeland, Ph.D.; Ying Fang-Hollingsworth, M.P.H., M.S.; Christine Stewart, Ph.D.; Jianhui Hu, Ph.D.; David R. Nerenz, Ph.D.; L. Keoki Williams, M.D., M.P.H.; Andrea E. Cassidy-Bushrow, Ph.D.; Jeanette Waxmonsky, Ph.D.; Christine Y. Lu, Ph.D.; Beth E. Waitzfelder, Ph.D.; Ashli A. Owen-Smith, Ph.D.; Karen J. Coleman, Ph.D.; Frances L. Lynch, Ph.D.; Ameena T. Ahmed, M.D., M.P.H.; Arne Beck, Ph.D.; Rebecca C. Rossom, M.D., M.S.C.R.; Gregory E. Simon, M.D., M.P.H.

• http://dx.doi.org/10.1176/appi.ps.201300518



http://medicalresearch.com/infections/personalized-risk-calculations-may-reduce-readmissions-of-sepsis-survivors/12531/

http://ps.psychiatryonline.org/doi/10.1176/appi.ps.201300518

http://ps.psychiatryonline.org/doi/10.1176/appi.ps.201300518

http://dx.doi.org/10.1176/appi.ps.201300518



Air Pollution Linked To Increased Risk Of StrokeMedicalResearch.com Interview with:

Dr Anoop ShahCardiology Research fellow Centre of Cardiovascular sciences

University Of Edinburgh Edinburgh


Response: Stroke accounts for five million deaths each year and is a major cause of disability. The incidence of stroke is increasing, particularly in low and middle income countries, where two thirds of all strokes occur. The global burden of stroke related disability is therefore high and continues to rise. This has been primarily attributed to an aging population in high income countries and the accumulation of risk factors for stroke, such as smoking, hypertension, and obesity, in low and middle income countries. The impact of environmental factors on morbidity and mortality from stroke, however, might be important and is less certain.

• From 103 studies and across 6.2 million fatal and non-fatal strokes, our findings suggest a strong association between short term exposure to both gaseous (except ozone) and particulate air pollution, and admissions to hospital for stroke or mortality from stroke. These associations were strongest in low and middle income countries, suggesting the need for policy changes to reduce personal exposure to air pollutants especially in highly polluted regions.

Medical Research: What should clinicians and patients take away from your report?

• Response: Clinicians should realize that in addition to more traditional risk factors for stroke such as high blood pressure, environmental risk factors also play a significant role. However unlike traditional risk factors such diabetes or hypertension where only a fraction of the pollution are exposed, air pollution affects the whole population.


http://medicalresearch.com/stroke/air-pollution-linked-to-increased-risk-of-stroke/12937/

http://medicalresearch.com/heart-disease/heart-failure-air-pollution/1985/

http://medicalresearch.com/stroke/golden_hour_thrombolysis_improved_discharge_to_home/9249/



Air Pollution Linked To Increased Risk Of StrokeMedicalResearch.com Interview with:

Dr Anoop ShahCardiology Research fellow Centre of Cardiovascular sciences

University Of Edinburgh Edinburgh


• Response: There are two areas of research that now need to take place. One to study effective measures that may reduce exposure to air pollution and how this may improve health in the future and two to understand the underlying mechanisms by which air pollution triggers stroke.

• Citation:

• Short term exposure to air pollution and stroke: a systematic review and meta analysis

• Anoop S V Shah, clinical lecturer in cardiology,

• Kuan Ken Lee, core medical trainee,

• David A McAllister, senior lecturer in epidemiology,

• Amanda Hunter, specialist trainee in cardiology,

• Harish Nair, senior research fellow in epidemiology,

• William Whiteley, MRC clinician scientist and consultant neurologist,

• Jeremy P Langrish, clinical lecturer in cardiology,

• David E Newby, professor of cardiology,

• Nicholas L Mills, reader in cardiology and consultant cardiologist.

• BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1295 (Published 24 March 2015



http://medicalresearch.com/tobacco-research/tobacco/smokers_homes_have_high_air_pollution_levels/8325/

http://www.bmj.com/content/350/bmj.h1295













Prenatal Exposure To Air Pollutants May Produce Structural Brain AbnormalitiesMedicalResearch.com Interview with:

Dr. Bradley S. Peterson, M.DDirector of the Institute for the Developing Mind

The Saban Research Institute of Children’s Hospital Los Angeles Children’s Hospital Los Angeles

Medical Research: What is the background for this study?

Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7.


http://medicalresearch.com/author-interviews/prenatal-exposure-to-air-pollutants-may-produce-structural-brain-abnormalities/12920/

http://medicalresearch.com/pediatrics/association-surgery-low-birth-weight-infants-subsequent-neurodevelopmental-impairment/5910/






Medical Research: What are the main findings?

Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy. We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression. Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability.









• Dr. Peterson: Exposure to PAH from smoke and exhaust during pregnancy and infancy seems to produce a distinct pattern of abnormalities in brain structure that subsequently lead to ADHD-like symptoms and poorer cognitive functioning. Clinicians should educate prospective parents, especially early in pregnancy, about these risks and urge them to avoid, to the extent possible and for the health of their baby, exposure to smoke, exhaust, and other sources of PAH.



http://medicalresearch.com/author-interviews/pesticide-exposure-may-impact-development-of-adhd/11268/







• Response: Additional research should focus on identifying the nature of this PAH-related abnormality in white matter. This will include new brain imaging studies in humans and more basic science research using animal models. Those research efforts will help us to identify ways of countering the adverse effects of PAH exposure on the developing brain. In addition, other research should assess how changing policies affect the level of environmental PAH exposure and the prevalence of these PAH-related brain abnormalities, focusing on their associated societal impact, including the economic consequences of reducing these adverse long-term outcomes.

• Citation:

• Peterson BS, Rauh VA, Bansal R, et al. Effects of Prenatal Exposure to Air Pollutants (Polycyclic Aromatic Hydrocarbons) on the Development of Brain White Matter, Cognition, and Behavior in Later Childhood. JAMA Psychiatry. Published online March 25, 2015. doi:10.1001/jamapsychiatry.2015.57.



http://medicalresearch.com/author-interviews/bilingualism-can-preserve-white-matter-in-brain/10627/

http://archpsyc.jamanetwork.com/article.aspx?articleid=2205842



Imiquimod Cream May Be Effective In Primary And Adjuvant Treatment Of Lentigo MalignaMedicalResearch.com Interview with:

Susan Swetter, MDProfessor of Dermatology and Director, Pigmented Lesion and Melanoma Program

Stanford University Medical Center and Cancer Institute.


Dr. Swetter: This retrospective cohort study sought to explore the role of the topical immunomodular – imiquimod 5% cream – as both primary and adjuvant therapy (following optimal surgery) for patients with the lentigo maligna subtype of melanoma in situ. Assessment of alternative treatments to surgery for this melanoma in situ subtype are warranted given the increasing incidence of lentigo maligna in older, fair-complexioned individuals in the United States. Surgical management of lentigo maligna is complicated by its location on cosmetically sensitive areas such as the face, histologic differentiation between lentigo maligna and actinic melanocytic hyperplasia in chronically sun-damaged skin, and potential surgical complications in the elderly who may have medical co-morbid conditions.


http://medicalresearch.com/author-interviews/imiquimod-cream-may-be-effective-in-primary-and-adjuvant-treatment-of-lentigo-maligna/13005/







Dr. Swetter: We conducted a retrospective review of 63 cases of lentigo maligna in 61 patients (mean age 71.1 years) who used topical 5% imiquimod cream instead of surgery (22 of 63 cases, 34.9%) or as an adjuvant therapy following attempted complete excision (63 cases, 65.1%), in which no clinical residual tumor was present but the histologic margins were transected or deemed narrowly excised. Our study showed overall clinical clearance of 86.2% in the 58 patients analyzed for local recurrence at a mean of 42.1 months of follow-up (standard deviation 27.4 months), with primarily treated cases demonstrating 72.7% clearance at a mean of 39.7 months (standard deviation 23.9 months), and adjuvant cases showing 94.4% clearance at a mean of 39.7 months (standard deviation 23.9 months). We found a statistically significant association between imiquimod-induced inflammation and clinical or histologic clearance in primary but not adjuvant cases, although this latter finding may be explained by a lack of residual atypical melanocytes or true LM in the adjuvant setting, in which wide local excision had already been performed.



http://www.dermnetnz.org/lesions/lentigo-maligna.html







• Dr. Swetter: While our study is not a prospective clinical trial assessing the use of imiquimodcream in the treatment of lentigo maligna, it adds to the body of published data demonstrating efficacy of this topical agent in both the primary and adjuvant settings. Current National Comprehensive Cancer Network and American Academy of Dermatology Guidelines recommend surgical excision of lentigo maligna when possible, but also recognize the role of alternative therapies in cases where surgery has been optimized or is not possible. The use of topical imiquimod for melanoma in situ, lentigo maligna type, remains “off-label” (non-FDA-approved), and a thorough discussion with the patient/family must occur regarding potential risks, benefits, and limitations of topical therapy in place of, or as an adjunct to surgery. Imiquimod field therapy requires close clinical surveillance and patient compliance with treatment and follow-up.









• Dr. Swetter: A multi-center, randomized controlled prospective trial should be conducted to determine the long term efficacy of topical imiquimod compared with or as an adjunct to surgical resection of lentigo maligna. Given the high and increasing rates of the lentigosubtype in older individuals, further study of this topical field treatment is warranted.

• Citation:

• Imiquimod 5% cream as primary or adjuvant therapy for melanoma in situ, lentigo malignatype

• Susan M. Swetter, MD, Frank W. Chen, MD David D. Kim, BA, Barbara M. Egbert, MD

• DOI: http://dx.doi.org/10.1016/j.jaad.2015.02.008



http://dx.doi.org/10.1016/j.jaad.2015.02.008



Anxiety Symptoms Raised by Air PollutionMedicalResearch.com Interview with:

Melinda C Power, ScDPost-Doctoral Research Fellow

Epidemiology Department, Johns Hopkins Bloomberg School of Public HealthNeurology Department, Johns Hopkins School of Medicine


Dr. Power: Air pollution may be related to mental health, particularly anxiety, through effects on oxidative stress and systemic inflammation or through promotion or aggravation of chronic diseases. However, there has been very little research on the relation between air pollution exposures and anxiety in people. Our study found that those with higher exposures to fine particulate matter, a type of air pollution, were more likely to experience elevated anxiety symptom levels. Our study also suggests that recent exposures to find particulate matter air pollution are potentially more relevant to anxiety symptom levels than long-term past exposures.


• Dr. Power: Everyday exposures to toxicants and pollutants may play a role in mental health. Further research is needed to confirm our findings and to further explore this possibility.


Anxiety Symptoms Raised by Air Pollution Posted on March 26, 2015 Melinda C Power, ScD Post-Doctoral Research Fellow Epidemiology Department, Johns Hopkins Bloomberg School of Public Health Neurology Department, Johns Hopkins School of MedicineMedicalResearch.com Interview with: Melinda C Power, ScD Post-Doctoral Research Fellow Epidemiology Department, Johns Hopkins Bloomberg School of Public Health Neurology Department, Johns Hopkins School of Medicine

http://medicalresearch.com/heart-disease/air-pollution-may-raise-risk-of-carotid-artery-stenosis/12710/



Anxiety Symptoms Raised by Air PollutionMedicalResearch.com Interview with:

Melinda C Power, ScDPost-Doctoral Research Fellow

Epidemiology Department, Johns Hopkins Bloomberg School of Public HealthNeurology Department, Johns Hopkins School of Medicine


• Dr. Power: We hope that our findings will be replicated in other settings. If our results are confirmed, we would recommend additional research on whether reductions in exposure to ambient fine particulate matter air pollution would have a meaningful impact on the population-level burden of anxiety.

• Citation:

• The relation between past exposure to fine particulate air pollution and prevalent anxiety: observational cohort study

• BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h1111 (Published 24 March 2015)



http://medicalresearch.com/mental-health-research/autism/air-pollution-linked-to-greater-risk-autism-spectrum-disorders/10076/





Women, Young Drivers More Likely to Talk or Text While DrivingMedicalResearch.com Interview with:

Michelle Wilkinson, MPHDoctoral Candidate Epidemiology

UT Houston School of Public HealthHouston, TX 77030


Response: Cell phone use (CPU) while driving impairs visual awareness and reaction time, increasing frequency of near-collisions, collisions, and accidents with injuries. National prevalence estimates of driver cell phone use range from 5-10%. Medical and academic centers have large concentrations of young, ill, or elderly pedestrians and drivers, who are often unfamiliar with the congested environment. Drivers distracted by Cell phone use are a safety threat to pedestrians and drivers in these demanding environments. This study aimed to describe the prevalence and correlates of cell phone use among Texas drivers in major medical and academic centers, 2011-2013. This study found the overall prevalence of cell phone use while driving was 18%. The prevalence of Cell phone useand talking declined, while texting increased during the study period. Cell phone users were more likely to be female, <25 years old, and driving without a passenger.


• Response: Cell phone use remains prevalent among drivers in Texas academic and medical campuses. This study found a higher prevalence of CPU than previous studies. Females and younger drivers appear to be more likely to engage in Cell phone use , thus public safety campaigns should target these groups.


http://medicalresearch.com/author-interviews/women-young-drivers-more-likely-to-talk-or-text-while-driving/13029/

http://medicalresearch.com/author-interviews/text_while_driving_bans_and_reduction_in_roadway_deaths/5941/



Women, Young Drivers More Likely to Talk or Text While DrivingMedicalResearch.com Interview with:

Michelle Wilkinson, MPHDoctoral Candidate Epidemiology

UT Houston School of Public HealthHouston, TX 77030


• Response: Future legislation should incorporate public health campaigns targeting high risk groups to stop CPU while driving and reduce traffic related injuries.

• Citation:

• Prevalence and correlates of cell phone use among Texas drivers

• Michelle L. Wilkinson, Austin L. Brown, Iman Moussa R. Sue DayPreventive Medicine Reports Volume 2, 2015, Pages 149–151



http://www.sciencedirect.com/science/article/pii/S2211335515000200





Vascular Calcification Can Predict Mortality in Predialysis Chronic Kidney DiseaseMedicalResearch.com Interview with:

Dr. José L. GórrizDepartment of Medicine and Nephrology

Valencia Hospital Universitario Valencia. Spain

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Górriz: The background of the study is that several studies have reported on the high prevalence

of vascular calcification in chronic kidney disease (CKD) patients not on dialysis. Vascular calcification (VC) has been associated with high cardiovascular mortality in patients on dialysis, but there are no studies in patients in stages before dialysis which analyse the prognostic significance of the presence of Vascular calcification assessed by simple X-ray.

• Vascular calcification can occur in both the intima and media of the vessel wall. Intimal calcification is an indicator of atherosclerosis and is associated with ischemic heart disease and medial calcification is associated with arterial stiffness, systolic hypertension, and left ventricular hypertrophy.

• Although Vascular calcification can be assessed by various methods, such as ultrasonography, tomography, and arteriography, simple radiology has the advantages of being simple, inexpensive, and commonly applicable in daily clinical practice.

• OSERCE 2 is an observational, multicentre and 3-year prospective study performed in 39 Nephrology centres in Spain, which analyzes the presence of Vascular calcification in CKD patients stages 3 and 4 (eGFR between 15-59 ml/min/1,73 m2) and its effect on morbimortality (death, hospitalization and renal progression).

• The main findings of the study were that Vascular calcification is highly prevalent in patients with chronic kidney disease, and Vascular calcification assessment using AS independently predicts death and time to hospitalization.

• Therefore, it could be a useful index to identify patients with chronic kidney disease at high risk of death and morbidity as previously reported in patients on dialysis.


http://medicalresearch.com/author-interviews/vascular-calcification-and-chronic-kidney-disease/12833/

http://medicalresearch.com/author-interviews/most-kidney-failure-patients-around-world-die-without-access-to-dialysis/12828/






• MedicalResearch: What should clinicians and patients take away from your report?

• Dr. Górriz: Using X-ray assessment, they are two indexes which analyse Vascular calcification, Kauppila score (aortic calcification of lumbar aorta) and Adragao score (detects VC in iliac, femoral, radial, and digital arteries). Our study demonstrates the Kauppila is mainly related to atherosclerotic traditional risk factors and age and don’t predict mortality after adjusting by age. But Adragao score predicts mortality and risk of hospitalization in chronic kidney disease patients. When we analysed only Vascular calcification in hands (Adragado score-hands) we can predict mortality, since Vascular calcification in hand only affects to muscular arteries and it is related to alterations in mineral metabolism due to CKD. A simple X-ray of the hands can predict mortality in chronic kidney disease patients.

• The main message of the study is that Vascular calcification is common in predialysis CKD, can predict mortality and hospitalization. The study supports the importance of differentiating intimal and medial calcification because participants with medial calcification had a higher risk of all-cause and cardiovascular mortality, but patients with intimal calcification did not (based on plain radiography).

• This information may be used to update the guidelines and management of CKD-MBD and improve its diagnosis, treatment, and prognosis through a multidisciplinary approach.

• The nephrology community needs to focus on studies of Vascular calcification as a way of improving outcomes for our patients.



http://medicalresearch.com/heart-disease/interarm-blood-pressure-variability-linked-to-greater-cardiovascular-risk-in-ckd/12580/






• MedicalResearch: What recommendations do you have for future research as a result of this study?

• Dr. Górriz: Concerning the assessment of Vascular calcification, it would be of interest to validate our results with other more complex imaging techniques such as vascular ultrasonography, carotid ultrasonography or computed tomography in other territories (i.e. coronary arteries)

• On the other hand, once we have assessed the importance of Vascular calcification and chronic kidney disease we need clinical trials to assess if interventions to slow the progression of Vascular calcification in this population may be feasible, especially interventions in chronic kidney disease-mineral bone disorders markers (calcium, phosphorus, parathyroid hormone, vitamin D and other) that were not fully evaluated in the study.

• Citation:

• Vascular Calcification in Patients with Nondialysis CKD over 3 Years.

• José L. Górriz, Pablo Molina, M. Jesús Cerverón, Rocío Vila, Jordi Bover, Javier Nieto, Guillermina Barril, Alberto Martínez-Castelao, Elvira Fernández, Verónica Escudero, CelestinoPiñera, Teresa Adragao, Juan F. Navarro-Gonzalez, Luis M. Molinero, Cristina Castro-Alonso, Luis M. Pallardó, and Sophie A. Jama

• CJASN CJN.07450714; published ahead of print March 13, 2015, doi:10.2215/CJN.07450714



http://medicalresearch.com/vitamin-d/vitamind/9107/

http://cjasn.asnjournals.org/citmgr?gca=clinjasn;CJN.07450714v1

http://cjasn.asnjournals.org/citmgr?gca=clinjasn;CJN.07450714v1



Low Dose Vitamin C May Improve Iron Deficiency in Dialysis PatientsMedicalResearch.com Interview with:

Dr. Tanjim Sultana MDDepartment of Nephrology

Lenox Hill Hospital New York


Response: Almost all dialysis patients are anemic. One quarter of patients requiring High dose Epogen have functional iron deficiency, which means they have adequate iron store but unable to utilize it. Vitamin C has been shown to mobilize iron from their storage and making it available to use in red blood cell production. Prior studies showed intravenous high dose vitamin C could increase hemoglobin levels and decrease epogen requirement. In our study we used daily low dose oral vitamin C in functional iron deficient patients to achieve the same goals. Patients taking daily low dose vitamin C for 3 months had significant decrease in their epogen dose compared to the control group.

• Medical Research: What should clinicians and patients take away from your report?• Response: Low Dose vitamin C was shown to be effective in our small group of functional iron

deficient dialysis patients.• Medical Research: What recommendations do you have for future research as a result of this

study?• Response: Further research should include more patients and have longer duration of vitamin C

supplementation. Since vitamin C can convert to oxalate which is poorly dialyzed in ESRD patients, oxalate levels needs to be measured before wide spread long term use of vitamin C can be implemented

• Citation:• Abstract presented at the 2015 National Kidney Foundation meeting• ORAL VITAMIN C SUPPLEMENTATION FOR FUNCTIONAL IRON

DEFICIENCY IN DIALYSIS PATIENTS


http://medicalresearch.com/author-interviews/low-dose-vitamin-c-may-improve-iron-deficiency-in-dialysis-patients/12968/

http://www.epogen.com/

http://medicalresearch.com/author-interviews/coronary-angiography-vitamin-c-and-protection-against-contrast-induced-kidney-disease/1642/

https://www.kidney.org/spring-clinical/abstracts



http://medicalresearch.com/author-interviews/low-dose-vitamin-c-may-improve-iron-deficiency-in-dialysis-patients/12968/

High Fluid Intake Reduces Risk Of New Kidney StonesMedicalResearch.com Interview with:

Wisit Cheungpasitporn, MD, Nephrology FellowProgram director: Suzanne Norby, MD Project mentors: Stephen B. Erickson, MD and John C. Lieske, MD

Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN

• MedicalResearch: What is the background for this study?

• Dr.Cheungpasitporn: Kidney stones are very common urologic problems. In addition, once someone has a kidney stone, the likelihood of having another episode increases to 50% within 5 years. Increased fluid intake has been suggested as a simple strategy for kidney stone prevention. However the data on conclusions regarding the benefit, adherence and safety of high fluid intake for the primary or secondary prevention of stones were limited. Thus, we conducted this meta-analysis to evaluate the treatment effect of high fluid intake on the incidence of kidney stones, and to assess the compliance and safety of high fluid intake to prevent kidney stones. Our data presented at the National Kidney Foundation’s 2015 Spring Clinical Meetings may help improve clinicians’ ability to manage kidney stones.

• MedicalResearch: What are the main findings?

• Dr.Cheungpasitporn: Our meta-analysis included 9 studies with 273,954 patients. According to the findings of our study, individuals with daily high fluid intake (to achieve a urine volume of at least 2.0‒2.5 L per day) had lower risk of new kidney stones by approximately 50%. High fluid intake provided the same benefit in men and women. In addition, high fluid intake reduced the risk of recurrent kidney stones by 40%. Overall, high fluid intake is safe with low adverse events.


http://medicalresearch.com/author-interviews/high-fluid-intake-reduces-risk-of-new-kidney-stones/12884/

http://medicalresearch.com/author-interviews/kidney_stones_non_invasive_treatment_not_always_better/5331/



High Fluid Intake Reduces Risk Of New Kidney StonesMedicalResearch.com Interview with:

Wisit Cheungpasitporn, MD, Nephrology FellowProgram director: Suzanne Norby, MD Project mentors: Stephen B. Erickson, MD and John C. Lieske, MD

Departments of Nephrology and Hypertension Mayo Clinic, Rochester, MN


• Dr.Cheungpasitporn: Our study confirmed the effectiveness of water therapy. Protective effect of high fluid intake against stone formation by increasing the urine flow rate and urine volume is likely the key. Our study clearly demonstrates a reduction in the risk of new and recurrent kidney stones among individuals with high fluid intake. The magnitude of risk reduction is high.


• Dr.Cheungpasitporn: Kidney stones have recently been linked to many comorbid conditions including hypertension, diabetes, kidney disease and heart diseases. It would be nice if we can further identify the effects of high fluid intake on the reduction of those kidney stone related comorbidities.

• Citation:

• Abstract presented at the National Kidney Foundation Spring 2015 Abstract

• TREATMENT EFFECT AND SAFETY OF HIGH FLUID INTAKE FOR THE PREVENTION OF INCIDENT AND RECURRENT KIDNEY STONES



http://medicalresearch.com/heart-disease/kidney-stones-marker-of-increased-heart-disease-risk-in-women/1244/

http://medicalresearch.com/heart-disease/kidney-stones-marker-of-increased-heart-disease-risk-in-women/1244/





Senna May Relieve Itching In Some Dialysis PatientsMedicalResearch.com Interview with:

Mohammad Kazem Fallahzadeh Abarghouei, M.D.Baylor University Medical Center, Dallas, TX

• Medical Research: What is the background for this study?

Response: Uremic pruritus (itch) is a common problem in hemodialysis patients. No effective treatment exists for uremic pruritus due to its complex pathogenesis. Systemic inflammation and elevated serum levels of interleukin-2 (IL-2) are implicated in the pathogenesis of uremic pruritus. Senna is an herbal drug commonly used for treatment of constipation. Senna also has anti-inflammatory properties. We performed this randomized double-blind placebo-controlled trial to evaluate the effect of senna on reduction of uremic pruritus and serum levels of IL-2 in hemodialysis patients.

• Medical Research: What are the main findings?

Response: Sixty hemodialysis patients with moderate to severe pruritus (visual analogue scale ≥4) of at least 6 week duration were enrolled in this study. Enrolled patients were randomized into 2 equal groups to receive either senna or placebo tablets for 8 weeks. Severity of pruritus and serum levels of IL-2 were measured before and at the end of treatment phase. At the end of treatment phase, pruritus decreased in both groups; however, the mean reduction in the severity of pruritus was significantly higher in senna than placebo group (p<0.05). Mean serum levels of IL-2 decreased in the senna group but increased in the placebo group; the mean reduction in IL-2 serum levels in the senna group was significantly different from the mean increase in the placebo group (p<0.05).


http://medicalresearch.com/author-interviews/senna-may-relieve-itching-in-some-dialysis-patients/12942/

http://medicalresearch.com/heart-disease/dialysis_patients_with_atrial_fibrillation/4457/

http://medicalresearch.com/author-interviews/serum_il31_linked_to_itching_in_hemodialysis_patients/7941/



Senna May Relieve Itching In Some Dialysis PatientsMedicalResearch.com Interview with:

Mohammad Kazem Fallahzadeh Abarghouei, M.D.Baylor University Medical Center, Dallas, TX


• Response: Senna can potentially be an effective medication for treatment of itch (uremic pruritus) in hemodialysis patients.


• Response: Further studies with larger sample sizes and longer duration of follow-up are needed to better evaluate the effect of senna on reduction of uremic pruritus in hemodialysis patients.

• Citation: Abstract Presented at the 2015 National Kidney Foundation Meeting

• EFFECT OF SENNA ON REDUCTION OF UREMIC PRURITUS IN HEMODIALYSIS PATIENTS: A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TIRAL

• Authors:

• Mohammad Kazem Fallahzadeh1, Pouya Faridi2, Arian Kamali Sarvestani2, Mohammad Mahdi Sagheb2, Joan Blondin3, Abdolali Mohagheghzadeh2, Jamshid Roozbeh2

• Baylor University Medical Center, Dallas, TX

• Shiraz University of Medical Sciences, Shiraz, Iran.

• LSUHSC-S, Shreveport, LA











Study Finds Medicaid Improves Depression But Not Physical HealthMedicalResearch.com Interview with:

Peter Muennig, MD, MPHColumbia University

Mailman School of Public Health NYC 10032


• Dr. Muennig: The Oregon Health Insurance Experiment (OHIE) is one of just two experimental investigations of the health benefits of medical insurance. The first was the Rand Health Insurance Experiment, which was conducted over 3 decades ago. The OHIE randomly assigned participants to receive Medicaid or their usual care. It found that Medicaid protected families from financial ruin caused by medical illness, that it reduced depression, and that it increased preventive screening tests. However, it produced no medical benefits with respect to high blood pressure, diabetes, or high cholesterol. Medicaid opponents suggested that this meant that we should get rid of Medicaid because Medicaid does not improve physical health. But Medicaid proponents suggested that too few participants enrolled to detect a benefit, and, regardless of the study’s flaws, reduced depression, financial protections, and improved screening were reason enough to continue.

• We found that the Medicaid opponents were right. Medicaid actually didn’t produce any meaningful benefits with respect to blood pressure, diabetes, or cholesterol. But we also found that the Medicaid proponents were right. It’s impacts on depression alone rendered it cost-effective even if one does not account for the benefits of financial protections or medical screening.


• Dr. Muennig: All of the benefits of screening for blood pressure, diabetes, and high cholesterol have been very thoroughly documented in carefully managed experiments. But in the real world, many people might not actually take their medicines or listen to the advice of their doctor.


http://medicalresearch.com/author-interviews/study-finds-medicaid-improves-depression-but-not-physical-health/13041/

http://medicalresearch.com/author-interviews/study-shows-families-save-1000-average-states-expanded-medicaid/11449/



Study Finds Medicaid Improves Depression But Not Physical HealthMedicalResearch.com Interview with:

Peter Muennig, MD, MPHColumbia University

Mailman School of Public Health NYC 10032


• Dr. Muennig: We need to understand how to make preventive screening work better for low-income populations. We also need to know whether other kinds of screening (such as breast cancer screening) actually save lives. In this study, that question might have been answered if we had enough participants.

• The most important take home message, though, is that we need more research on social policies. We are spending over a trillion dollars on social programs that have not been adequately studied. It is astounding that this study—which cost less than a tenth of a percent of the annual Medicaid budget—took so long to actually be conducted. Education, housing, and other social policies have potential, but we really don’t know whether they work. Only a very limited number of programs (such as welfare reform) have been tested rigorously in this way.

• Citation:

• Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health StudyPeter A. Muennig, Ryan Quan, Codruta Chiuzan, and Sherry Glied. (2015). Considering Whether Medicaid Is Worth the Cost: Revisiting the Oregon Health Study. American Journal of Public Health. e-View Ahead of Print.doi: 10.2105/AJPH.2014.302485



http://medicalresearch.com/cancer-_-oncology/breast-cancer/telephone_reminders_may_increase_breast_cancer_screening/9244/

http://www.healthcanal.com/blood-heart-circulation/blood-pressure/61754-medicaid-is-a-very-good-investment-even-if-it-does-not-lower-cholesterol-blood-pressure-or-blood-sugar.html

http://www.healthcanal.com/blood-heart-circulation/blood-pressure/61754-medicaid-is-a-very-good-investment-even-if-it-does-not-lower-cholesterol-blood-pressure-or-blood-sugar.html



Pediatric Meningococcal Vaccine Immunity May Wane By AdolescenceMedicalResearch.com Interview with:

Dr Fiona McQuaidClinical Research Fellow

University of Oxford, United Kingdom


• Response: Meningococcal B disease is a common cause of sepsis and meningitiswith significant mortality and morbidity. A multicomponent vaccineagainst serogroup B meningococcus has been licensed for use in theEurope, Australia, Canada and recently the USA (though only in the10-25 years age group) but questions remain about how long thebactericidal antibodies induced by infant vaccination persist and thelikely breath of strain coverage. This was a follow on study lookingat a group of children aged 5 years who had been vaccinated as infantsand a different group who were vaccinated for the first time at 5years of age.


• Response: The percentage of children with protective antibody levels who hadbeen immunized as infants fell in the 20 months since their lastimmunization but this varied by the strain of meingococcus B testedand by the different infant/toddler vaccination schedules.

• The children who were vaccinated for the first time at 5 years of ageshowed a good antibody response, but most reported pain and rednessaround the site of vaccination and 4-10% had a fever.


http://medicalresearch.com/infections/pediatric-meningococcal-vaccine-immunity-may-wane-by-adolescence/13048/



Pediatric Meningococcal Vaccine Immunity May Wane By AdolescenceMedicalResearch.com Interview with:

Dr Fiona McQuaidClinical Research Fellow

University of Oxford, United Kingdom

• Medical Research: What should clinicians and patients take away from your report?• Response: These data will be useful for those planning the introduction of this

vaccine into routine vaccine schedules. It seems unlikely thatimmunity to meningococcal B disease will persist into adolescence,when the second peak of disease occurs, therefore an a teenagerbooster dose may be required. Five year old children immunised for thefirst time with the vaccine showed a good response one month aftertheir second vaccine which is important if it were to be used in anoutbreak setting and the reactogenicity data will be helpful forproviders when explaining to parents what to expect after vaccination.

• Of note, the vaccine is currently not licensed for use under the ageof 10 in the USA and these data may not necessarily apply to older agegroups. Clinicians should continue to follow their locally recommendedvaccination schedules.

• Medical Research: What recommendations do you have for future research as a result of this study?• Response: A larger study has been completed and the results of this will give

further details about persistence after infant vaccination. Furtherfollow up would be required to assess the persistence of vaccineinured antibodies into adolescence and the potential role for ateenage booster. It will be important to continue monitor for anyevidence of waning vaccine effectiveness. If vaccine is introducedroutinely into the UK, as recommended by the UK Joint Committee onVaccination and Immunization, this will provide a great deal ofimportant information on how the vaccine works in a real-world setting

• Citation:• McQuaid, M. D. Snape, T. M. John, S. Kelly, H. Robinson, L.-M. Yu, D. Toneatto, D. D’Agostino, P. M. Dull, A. J. Pollard.

Persistence of specific bactericidal antibodies at 5 years of age after vaccination against serogroup B meningococcus in infancy and at 40 months. Canadian Medical Association Journal, 2015; DOI: 10.1503/cmaj.141200



http://dx.doi.org/10.1503/cmaj.141200



Mobile Health Technologies Will Change Chronic Disease ManagementMedicalResearch.com Interview with:

Ryan Jeffrey Shaw, PhD, MS, RNAssistant Professor School of Nursing Center for Health Informatics

Center for Precision Medicine Duke University


Dr. Shaw: Primary care delivery revolves around a series of episodes, rather than functioning as a continuum. When patients come to a clinic data on their health is collected as a single data point. This model neglects potentially meaningful data from patients’ daily lives and results in less informed treatment and scheduling of follow-up visits. Lack of meaningful data further blinds clinicians to patients’ health outside of the clinic and can contribute to unnecessary emergency department visits and hospitalizations.

• Personalized care through mobile health technologies inspires the transition from isolated snapshots based on serial visits to real time and trended data. By using technologies from cell phones to wearable sensors, providers have the ability to monitor patients and families outside of the traditional office visit.


http://medicalresearch.com/author-interviews/mobile-health-technologies-will-change-chronic-disease-management/13050/

http://medicalresearch.com/author-interviews/free-pesonalized-text-messages-remind-patients-to-take-medications/12266/







• Dr. Shaw: As mobile technologies and access to the Internet become universal, healthcare systems and private practices will leverage capabilities that allow the transfer of data on a daily and hourly basis. This has the potential to catapult the personalized or precision medicine movement forward. By gathering real-time data from patients in their homes and work sites, additional insight can be gained into what day-to-day health actually looks like. Although “snapshot” clinic visits will still be important, the ability to see a real-time trend of patients’ blood glucose or blood pressure level will change chronic disease management.

• There are still challenges regarding data validity, collection, privacy, presentation, and overflow that will need to be addressed though. However, technology, innovation, and the need to rethink chronic disease management and decrease healthcare costs will drive solutions to these problems



http://medicalresearch.com/diabetes/text-messaging-may-help-diabetics-improve-glycemic-control/5983/







• Dr. Shaw: With the recent announcement of Meaningful Use Stage 3, CMS reimbursement will in part soon be tied to leveraging these new mobile technologies and their data. Thus, future research will need to focus on how to integrate models of care delivery capable of deciphering meaningful information from patients’ mobile health devices, to enable physician to deliver true personalized medicine- the right treatment for the right patient at the right time.

• Citation:

• Mobile Health Technology for Personalized Primary Care Medicine

• Ryan J. Shaw, PhD, RN, Jonathan Bonnet, MD, Farhad Modari, DO, Aaron George, DO,Mohammad Shaheshebi, MD, MBA

• Received: December 19, 2014; Received in revised form: January 8, 2015; Accepted: January 8, 2015; Published Online: January 19, 2015



http://medicalresearch.com/addiction/alcohol/personalized-advice-may-help-risky-drinkers-reduce-alcohol/11764/

http://www.amjmed.com/article/S0002-9343(15)00014-5/abstract






Chronic Rhinosinusitis Varies By Bacterial MicrobiomeMedicalResearch.com Interview with:

Vijay R. Ramakrishnan, MDAssistant Professor University of Colorado

Department of Otolaryngology Aurora, CO 80045


Dr. Ramakrishnan: Chronic rhinosinusitis (CRS) is an extremely common problem, associated with major quality of life alterations and financial burden. Bacteria are thought to play a role in the initiation or sustenance of the disease, at least in a subset of CRS patients. Chronic rhinosinusitis is probably a group of heterogeneous diseases with different pathways that result in the same endpoint. Here, we study the bacterial microbiome of a large group of CRS and healthy sinuses, and discover that a few clinical subtypes display unique bacterial microbiome profiles and that the microbiome may predict outcomes from severe Chronic rhinosinusitis patients electing to undergo surgery.


• Dr. Ramakrishnan: We should really start thinking about subtypes of Chronic rhinosinusitis in the clinical setting, rather than lumping everyone into the same treatment algorithm. It is likely that Chronic rhinosinusitis patients with asthma, for instance, have a unique pathophysiology. As such, therapies can be selectively administered, and a better understanding of the disease course and prognosis can be offered to the patient.


http://medicalresearch.com/infections/chronic-rhinosinusitis-varies-by-bacterial-microbiome/13056/



Chronic Rhinosinusitis Varies By Bacterial MicrobiomeMedicalResearch.com Interview with:

Vijay R. Ramakrishnan, MDAssistant Professor University of Colorado

Department of Otolaryngology Aurora, CO 80045


• Dr. Ramakrishnan: We need to continue research efforts in this field to determine if these bacteria are actively promoting health or disease, and knowing what these bacteria are doing may allow us to intervene in a completely novel way.

• Citation:

• Sinus microbiota varies among chronic rhinosinusitis phenotypes and predicts surgical outcome

• Vijay R. Ramakrishnan, MD, Leah J. Hauser, MD, Leah M. Feazel, MS, Diana Ir, BS, Charles E. Robertson, PhD, Daniel N. Frank, PhD

• The Journal of Allergy and Clinical Immunology Published Online: March 26, 2015

• DOI: http://dx.doi.org/10.1016/j.jaci.2015.02.008



http://www.jacionline.org/article/S0091-6749(15)00228-6/abstract



http://dx.doi.org/10.1016/j.jaci.2015.02.008



Psoriasis: Effective Two Year Response to IL-17A Antagonist CosentyxMedicalResearch.com Interview with:

Andrew Blauvelt, M.D., M.B.A.President and Investigator

Research Excellence & Personalized Patient Care Portland, OR 97223


Dr. Blauvelt: A2303E1 is a multicenter, double-blind, randomized withdrawal extension to the FIXTURE and ERASURE pivotal phase III studies. The purpose of this extension study was to collect additional long term efficacy, safety, and tolerability data on secukinumab (i.e., Cosentyx) in patients who demonstrated a PASI 75 response to Cosentyx at Week 52 of these core studies in moderate-to-severe plaque psoriasis.

• In the extension phase, 995 patients who achieved Psoriasis Area Severity Index (PASI) 75 responses after 52 weeks of therapy received either Cosentyx 300 mg, Cosentyx 150 mg, or placebo for an additional year (Week 104). After two full years of therapy in patients treated with Cosentyx 300 mg, almost 9 out of 10 (88.2%) patients maintained their PASI 75 response, 7 out of 10 (70.6%) had clear or almost clear skin (PASI 90), and 4 out of 10 (43.9) had clear skin (PASI 100) at Week 104. For patients treated with Cosentyx 150 mg, 75.5% maintained their PASI 75 response, 44.6% had clear or almost clear skin (PASI 90), and 23.5% had clear skin (PASI 100) at Week 104. In addition, 94.8% of patients who initially received placebo (at the start of the extension), and were switched to receive Cosentyx 300 mg after relapse, were able to achieve PASI 75 and 70.3% achieved PASI 90 within 12 weeks of re-starting Cosentyx.


http://medicalresearch.com/author-interviews/psoriasis-effective-two-year-response-to-il-17a-antagonist-cosentyx/13060/







• Dr. Blauvelt: The two-year extension data shows that 7 out of 10 psoriasis patients who were PASI 75 responders at 52 weeks, achieved clear to almost clear skin (PASI 90) after two years of Cosentyx 300 mg treatment. After two full years of therapy with Cosentyx 300 mg, almost 9 out of 10 psoriasis patients sustained their PASI 75 response.

• Psoriasis is a chronic condition causing itching, scaling, and pain; patients need therapies that provide relief and clear skin over a long period of time. The two-year data is significant because it represents results from the longest continuous phase III study to date evaluating an IL-17A antagonist in the treatment of psoriasis. The study not only strengthens our understanding of the efficacy and safety of Cosentyx, but it shows that Cosentyx responses are durable over time for individuals suffering from moderate-to-severe plaque psoriasis.



http://medicalresearch.com/infections/bacterial-dna-detected-in-blood-of-patients-with-active-psoriasis/12676/







• Dr. Blauvelt: The data on IL-17A inhibitors presented at the AAD annual meeting continue to demonstrate the benefits of blocking this new target in psoriasis. As with any new therapy, additional long-term safety studies are needed, as we still don’t know whether long-term use of Cosentyx, as well as other biologics, will have a positive benefit on cardiovascular function over time. I believe this will likely be the case, however, given that long-term biologic therapy for patients with rheumatoid arthritis has been associated with decreased risk of cardiovascular disease in these patients. The dermatology community looks forward to additional safety and efficacy findings with long-term therapy.

• Citation:

• 2015 American Academy of Dermatology Meeting abstract:Secukinumab treatment maintains efficacy in moderate to severe plaque psoriasis through second year of treatment: A randomized extension of the ERASURE



http://medicalresearch.com/author-interviews/rheumatoid_arthritis_evaluating_combination_therapies_with_non_biologics/8954/

https://www.aad.org/meetings/2015-annual-meeting/education/program

https://www.aad.org/meetings/2015-annual-meeting/education/program



Living Past 100 May Be In Your GenesMedicalResearch.com Interview with:

Thomas Perls, MD, MPH ProfessorBoston University School of Medicine


Dr. Perls: For years now, Gerontology scholars continue to state that 25% of what they interchangeably call aging, longevity, life expectancy and life span is genetic and 75% is due to the environment and health-related behaviors. This assertion is based on Scandinavian twins reared apart, but the oldest participants in those studies lived to their 70s and 80s. Part of the problem here is the lack of consistency in what people mean by the terms Aging, Life Span and Longevity.

• In fact, the Seventh Day Adventists, who generally have a high prevalence of healthy behaviors (vegetarian, daily exercise, eat in moderation, abstain from tobacco and alcohol, and activities that help manage stress well) have an average live expectancy of approximately 88 years. Yet, 7th Day Adventists are ethnically and racially heterogeneous and thus it appears that those healthy behaviors explain the vast majority of the variation in how old these people live to be. This finding is consistent with the optimistic view of the twin studies, that much of living to one’s 80’s is in our hands. Living to only our 50s-70’s is also in our hands (e.g. 75% behaviors) if we choose to smoke, eat red meat frequently, be obese, not exercise, be exposed to gun violence, have unsafe sex, do IV drugs, etc. So it is safe to say, in my opinion, that 75% of the variation in how old we live to be, is on average due to our behavior and exposure choices. The empowering and important point is that if we all lived like the Seventh Day Adventists, average life expectancy would increase almost 8 years and health costs would markedly decline because we would be getting to these older ages because we are healthier not because we are pouring more resources into more effectively treating diseases.

• The New England Centenarian Study, which I direct, and a number of other studies of nonagenarians (people in their 90s) have demonstrated via direct genetic studies as well as studies of family trees where at least some family members get to these very old ages, that with older and older ages of survival beyond age ~95 years, variations in genetic profiles explain a greater and greater proportion of the variation in how old people live to be at these ages. So much so that I believe the findings to date are consistent with the roles of genes and environment being reversed for survival to age 106+ years, that is, 75% genetics and 25% environment/behaviors. This supposition is based upon several observations:

• (1) as people reach the age of 105+ years, they become more and more alike in terms of what age-related diseases they get and when they get them. Consistent with Jim Fries; “Compression of Morbidity” hypothesis, people who survive to ages 110+ (called supercentenarians) and who therefore approximate the limit of human lifespan are on average disease and disability-free up until the last 5 or so years of their lives. This increasing homogeneity, especially compared to the increasing heterogeneity in the rates of aging and incidences of age-related diseases at younger percentiles or ages of survival, suggests underlying genetic similarities (similar genetic profiles) amongst groups of these supercentenarians;


http://medicalresearch.com/genetic-research/living-past-100-may-be-in-your-genes/13068/





• (2) the New England Centenarian Study previously discovered genetic signatures (made up of longevity-associated variations of about 130 genes) that were associated with surviving to age 106+ years with 80% accuracy, but with only 60% accuracy for accurately picking out people living to ~100 years. This increasing accuracy with older and older ages also suggests a stronger and stronger genetic influence upon survival to these rarest percentiles of survival.

• With the above background, we set out in this study and subsequent paper, to

• (1) assess sibling relative risk using the largest-ever collection of validated pedigrees of centenarians,

• (2) to assess the risk of a sibling achieving the same age as their very old sibling (e.g. ages 95, 100, or 105+ years) relative to average people born around the same time, and

• (3) to look at how when a person was born (eg before or after 1890) made a difference in these relative risks.








Dr. Perls: In this study, we analyzed survival data of the families of 1,500 participants in the New England Centenarian Study, the largest study of centenarians and their family members in the world, based at Boston Medical Center. Among those families, we looked at more than 1,900 sibling relationships that contained at least one person reaching the age of 90. We found that for people who live to 90 years old, the chance of their siblings also reaching age 90 is relatively small – about 1.7 times greater than for the average person born around the same time. But for people who survive to age 95, the chance of a sibling living to the same age is 3.5 times greater – and for those who live to 100, the chance of a sibling reaching the same age grows to about nine times greater. At 105 years old, the chance that a sibling will attain the same age is 35 times greater than for people born around the same time. However, this does not mean there are many 105 year old siblings running around. Because getting to such an age is so incredibly rare, just 10 sibships out of a 100 that contain a 105 year old will have another sibling living to that age. We also noted that the relative risks are higher for people born before 1890 versus those born after and this makes sense given that there were major changes in the public health around this time with cleaner water supplies, better socioeconomic conditions and so on and therefore the mortality rate, particularly among infants was dramatically declining.








• Dr. Perls: These much higher relative chances of survival likely reflect different and more potent genetic contributions to the rarity of survival being studied, and strongly suggest that survival to age 90 and survival to age 105 are dramatically different phenotypes or traits, with very different underlying and respectively stronger genetic influences.


• Dr. Perls: Because genes play a much stronger differentiating role in living to 105-plus years, studies of such individuals are much more powerful in discovering longevity-related genes than studies of people in their 90s. Therefore my co-authors and I call for investigators who are studying the determinants of living to the oldest ages to be precise in describing the rarity or percentile of survival that study participants achieve.

• Citation:

• Paola Sebastiani, Lisa Nussbaum, Stacy L. Andersen, Mara J. Black, and Thomas T. Perls. Increasing Sibling Relative Risk of Survival to Older and Older Ages and the Importance of Precise Definitions of “Aging,” “Life Span,” and “Longevity”. J Gerontol A Biol Sci Med Sci, 2015 DOI: 10.1093/gerona/glv020



http://medicalresearch.com/aging/living_to_extreme_old_age_influenced_by_genetics_hdl_cholesterol/8873/

http://dx.doi.org/10.1093/gerona/glv020



Genetic Fingerprint May Lead To Blood Test For Colon CancerMedicalResearch.com Interview with:

Professor Massimiliano Mazzone and Professor Hans PrenenLab of Molecular Oncology and Angiogenesis VIB Vesalius Research Center

University of Leuven Leuven Belgium


Response: Monocytes are circulating cells with patrolling behaviour. In case of harmful situations, they go to the site of injury rapidly to ensure immune and wound-healing functions. Once in the inflammation site, they differentiate into macrophages which are versatile cells adopting different phenotypes according to the stimuli they are subjected to. We hypothesized that cancer cells might release signals and soluble factors that educate and change monocytes already when in circulation. In this work, we proved our hypothesis and found that soluble molecules released by colorectal cancer cells imprint a specific signature in the circulating monocytes. Now, by collecting these monocytic cells from the blood, we are able to determine if colorectal cancer cells are present in the body, either at the primary site (in the colon) or in distant organs (where cancer cells give rise to metastases). (M. Mazzone).


http://medicalresearch.com/cancer-_-oncology/colon-cancer/genetic-fingerprint-may-lead-to-blood-test-for-colon-cancer/13072/

http://medicalresearch.com/cancer-_-oncology/intensive-colorectal-cancer-screening-recommended-often-harmful-medicare-beneficiaries/7009/







• Response: Since most patients can be cured from colorectal cancer when the disease is detected early, there is an urgent need for a specific and sensitive screenings tool. Moreover even in relapsing disease, the outcome depends on early detection of metastases. This is the first study that defined a genetic fingerprint, called the monomark, which is induced specifically in circulating monocytes of colorectal patients at early disease onset. We also showed that the genetic fingerprint found during disease rapidly reverted to normal (as found in healthy people) after resection of the primary tumor. This feature makes our signature also a potential good tool to study disease relapse. These findings will hopefully lead to an easy to use blood test that uses monocytes for early detection of colon cancer. Obviously, this test has the potential to reach a better compliance (since based on few millilitres of peripheral blood) thus allowing to screen more people at reasonable costs (the method is relatively cheap) and to select a more narrow population of at-risk population that will receive confirmation of the diagnosis by colonoscopy (thus reducing the needs for this costly and invasive, yet precise, detection method). (M. Mazzone, H. Prenen).



http://medicalresearch.com/cancer-_-oncology/colon-cancer/colon_cancer_new_noninvasive_stool_dna_test_for_patients_with_average_risk/4318/







• Response: A first research goal would be to use the monocyte profile to follow-up disease recurrence. Given the strong plasticity of these cells and their ability to promptly revert this signature, we hypothesize that the genetic profile will be reactivated upon disease relapse, meaning that the relapsing patients will be positive at the Monomark test, thus allowing an easier followup than routine CT scans.

• Secondly, the monomark test should be compared with the available stool and blood based screening tools to compare sensitivity and specificity. Finally, the monomark should be evaluated in metastatic colorectal cancer patients, responding to a chemotherapeutic therapy. We hypothesize that tumor cells responding to chemotherapy, will not produce the factors that change the circulating monocytes, and therefore the Monomark (as we called this colorectal cancer specific monocyte-signature) could be used for response prediction. (M. Mazzone, H. Prenen)

• Citation:

• Tumour-Educated Circulating Monocytes are Powerfule Candidate Biomarkers for Diagnosis and Disease Follow-up of Colorectal Cancer

• Alexander Hamm, Hans Prenen, Wouter Van Delm, Mario Di Matteo, Mathias Wenes, Estelle Delamarre, Thomas Schmidt, Jürgen Weitz, Roberta Sarmiento, Angelo Dezi, Giampietro Gasparini, Françoise Rothé, Robin Schmitz, André D’Hoore, Hannes Iserentant, Alain Hendlisz, Massimiliano Mazzone

• Gut gutjnl-2014-308988Published Online First: 26 March 2015 doi:10.1136/gutjnl-2014-308988



http://medicalresearch.com/cancer-_-oncology/colon-cancer/half-colon-cancer-deaths-due-not-getting-screened/9780/

http://gut.bmj.com/citmgr?gca=gutjnl;gutjnl-2014-308988v1





Heart Attack Carries Worse Prognosis In Dialysis PatientsMedicalResearch.com Interview with:

Tanush Gupta, MDDepartment of Medicine, Division of Cardiology

New York Medical College, NY


Dr. Gupta: There are approximately 600,000 prevalent cases of end stage renal disease (ESRD) in the United States. Cardiovascular disease is the leading cause of death in ESRD patients. Moreover, approximately 20% of these deaths due to cardiovascular disease are attributable to acute myocardial infarction (AMI). Multiple studies have shown that ESRD patients have poor short- and long-term survival after AMI relative to the general population. We analyzed the publicly available Nationwide Inpatient Sample (NIS) databases from 2003 to 2011 to examine the temporal trends in ST-elevation myocardial infarction (STEMI), use of mechanical revascularization for STEMI, and in-hospital outcomes in adult ESRD patients in the United States.

• We found that from 2003 to 2011, whereas the number of acute myocardial infarction hospitalizations in ESRD patients increased from 13,322 to 20,552, there was a decline in the number of STEMI hospitalizations from 3,169 to 2,558. The use of percutaneous coronary intervention (PCI) for STEMI increased from 18.6% to 37.8%, whereas there was no significant change in the use of coronary artery bypass grafting. During the study period, in-hospital mortality in ESRD patients with STEMI increased from 22.3% to 25.3%. We also observed an increase in average hospital charges and a decrease in mean length of stay during the study period.


http://medicalresearch.com/heart-disease/heart-attack-carries-worse-prognosis-in-dialysis-patients/13095/

http://medicalresearch.com/diabetes/diabetics_with_acute_myocardial_infarction_have_higher_mortality/7929/



Heart Attack Carries Worse Prognosis In Dialysis PatientsMedicalResearch.com Interview with:

Tanush Gupta, MDDepartment of Medicine, Division of Cardiology

New York Medical College, NY


• Dr. Gupta:: ESRD patients comprise a very sick sub-group of the overall STEMI population and are often managed sub-optimally with lower use of revascularization and proven medical therapies. In this analysis, although we observed favorable trends in the use of PCI and length of stay, there was a temporal increase in in-hospital mortality. The increasing trend in in-hospital mortality in ESRD patients with STEMI is worrisome and is in stark contrast to the trends in outcomes of STEMI in the general population, where in-hospital mortality has decreased dramatically in the modern era of reperfusion therapy.


• Dr. Gupta: Reversal of the above mentioned adverse trends in in-hospital mortality in ESRDpatients with STEMI should be the focus of future investigations.

• Citation:

• Gupta T, Harikrishnan P, Kolte D, Khera S, Subramanian KS, Mujib M, Masud A, PalaniswamyC, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA, Aronow WS. Trends in Management and Outcomes of ST-Elevation Myocardial Infarction in Patients With End Stage Renal Disease in the United States. Am J Cardiol2015;115:1033-1041.



http://medicalresearch.com/heart-disease/biomarkers-improve-cardiovascular-risk-prediction-after-stemi/12548/

http://medicalresearch.com/author-interviews/equation-helps-predict-mortality-in-elderly-patients-with-chronic-kidney-disease/11952/



Diagnosing TB in Children: Evaluating Xpert AssayMedicalResearch.com Interview with:

Dr Anne K Detjen, MDChild Lung Health Consultant

International Union Against Tuberculosis and Lung Disease


• Dr. Detjen: The bacteriological diagnosis of tuberculosis (TB) in children is challenging due to the difficulty in obtaining specimens such as sputum and the lack of an accurate and accessible diagnostic test. In most cases, diagnosis is made on clinical grounds based on a contact history and a combination of signs and symptoms. We included 15 studies in a systematic review and meta-analysis of Xpert for the diagnosis of pulmonary TB in children.

• The accuracy of Xpert for diagnosing TB in children is suboptimal, and the majority of children will still have to be diagnosed clinically. However, in settings where it replaces smear microscopy Xpert will increase the likelihood of bacteriological confirmation of TB as well as MDR TB among children. Xpert does not increase the number of confirmed TB cases among culture-negative children. We also found that smear status highly impacted Xpert results, i.e. a higher yield among smear positive compared to smear negative children. Smear positivity increases with bacillary load and might be a proxy for disease severity. Unfortunately, we were not able to assess the performance among children with different stages of disease severity since this was not classified in any of the studies included.


http://medicalresearch.com/infections/diagnosing-tb-in-children-evaluating-xpert-assay/13088/

http://who.int/tb/laboratory/mtbrifrollout/en/

http://medicalresearch.com/infections/once-weekly-combination-regimen-effective-for-childhood-tuberculosis/10688/







• Dr. Detjen: Access to Xpert will increase the likelihood of confirming TB in children in settings where it replaces smear microscopy. At the same time, it will increase diagnosis of MDR TB among children. If available, Xpert should be used as part of the diagnostic workup among children with presumed TB. However, Xpert cannot be used as a rule-out test. The sensitivity of Xpert is suboptimal and a negative test does not exclude TB. In order to improve diagnostic yield it is important to collect quality specimens from children, either expectorated sputum (in older children), induced sputum or gastric fluids. Training of health care workers in specimen collection is crucial to optimize the use of Xpert. Results have to be interpreted in the context of other signs and symptoms including contact history and severity of disease.









• Dr. Detjen: Future research should address the performance of Xpert in children managed at different levels of the health care system (in- versus outpatients, higher-level versus secondary and primary level of care) as well as its performance in children with different stages of disease severity. These data are urgently needed to inform the scale-up of Xpertinto routine programmes. Routine data should be collected and analyzed, including the impact of Xpert on empiric treatment and treatment outcomes among children.

• Citation:

• Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis

• Detjen, Anne K et al.

• The Lancet Respiratory Medicine Published Online: 23 March 2015DOI: http://dx.doi.org/10.1016/S2213-2600(15)00095-8



http://medicalresearch.com/infections/diagnosing-tb-in-children-evaluating-xpert-assay/13088/Xpert MTB/RIF assay for the diagnosis of pulmonary tuberculosis in children: a systematic review and meta-analysis Detjen, Anne K et al. The Lancet Respiratory Medicine Published Online: 23 March 2015 DOI: http:/dx.doi.org/10.1016/S2213-2600(15)00095-8






Cardiorespiratory Fitness May Decrease Cancer Risk and Improve SurvivalMedicalResearch.com Interview with: Susan G. Lakoski, M.D.

Assistant Professor of Medicine, Hematology/Oncology DivisionDepartment of Medicine Director, Cardiovascular Prevention Program for Cancer PatientsVermont Cancer Center, Division of Hematology/OncologyUniversity of Vermont, BurlingtonCo-Investigators from Cooper

Center Longitudinal Study Cooper Institute in Dallas, Texas


•

Dr. Lakoski:

• High cardiorespiratory fitness (CRF) is associated with 55% reduction in lung cancer and 44% reduction in colorectal cancer in white men. These results were similar even among non-smokers.

• High cardiorespiratory fitness is associated with a one-third risk reduction in all cancer-related deaths among men who developed lung, colorectal, or prostate cancer at age 65 years or older compared with low cardiorespiratory fitness.

• High cardiorespiratory fitness is associated with a two-thirds reduction in cardiovascular death compared with low cardiorespiratory fitness among men who developed cancer at age 65 years or older.

• There is an strong inverse relationship association between fitness and subsequent diagnosis of incident lung and colorectal cancer, but not prostate cancer, in white men.


http://medicalresearch.com/cancer-_-oncology/cardiorespiratory-fitness-may-decrease-cancer-risk-and-improve-survival/13075/

http://medicalresearch.com/cancer-_-oncology/colon-cancer/colorectal-cancer-incidence-rising-in-young-adults/10904/






• MedicalResearch.com: What should patients and clinicians take away from this report:• Dr. Lakoski:• A) The relationship between fitness and prostate cancer risk is controversial. It is possible that men with higher

cardiorespiratory fitness may be more likely to undergo more frequent preventive health care screening and/or detection visits and, thus, had greater opportunity to be diagnosed as having localized prostate cancer relative to men of lower cardiorespiratory fitness. Importantly, men who developed prostate cancer in the current study, had a lower risk of ultimately dying of cancer or cardiovascular disease if ‘fit’ prior to disease onset. This speaks to the importance of being ‘fit’ in mid-life to improve survival even if a man ultimately develops lung, prostate, or colorectal cancer later in life.

• B). Among the men who developed cancer, those who were more fit at middle age had a lower risk of dying from all the three cancers studied, as well as cardiovascular disease. Even a small improvement in fitness (by 1-MET) made a significant difference in survival ─ reducing the risks of dying from cancer and cardiovascular disease by 10 and 25 percent, respectively.

• EXAMPLE of what a 1-MET difference equates to:Running, 5 mph (12 min/mile) = 8 METsRunning, 5.2 mph (11.5 min/mile) = 9 MET

• C) Our findings indicate that cardiorespiratory fitness provides cancer risk prediction information beyond these established lifestyle risk factors. These findings provide support for the utility of cardiorespiratory fitness assessment (via a maximalexercise treadmill test) in preventive health care settings and possibly following a diagnosis of cancer.

• The benefits of measuring fitness include:• 1) Provide accurate and stable marker of exercise exposure and dose.• 2) Measurements can be reproducibly measured over time.• 3) Normative values are available to compare fitness levels of patients to the general population for counseling.• 4) Allows clinicians to prescribe personalized exercise training goals for patients.



http://medicalresearch.com/exercise-fitness/cardiorespiratory-fitness-linked-to-body-composition-in-women/11207/







• Dr. Lakoski: Future studies are needed to test these results across all major cancers in men and women and also address how much an individual must change their fitness to see cancer prevention benefit.

• Citation:

• Lakoski SG, Willis BL, Barlow CE, et al. Midlife Cardiorespiratory Fitness, Incident Cancer, and Survival After Cancer in Men: The Cooper Center Longitudinal Study. JAMA Oncol. Published online March 26, 2015. doi:10.1001/jamaoncol.2015.0226.



http://oncology.jamanetwork.com/article.aspx?articleid=2203829



COPD Patients On Oxygen Therapy Should Be Warned Of Burn RisksMedicalResearch.com Interview with:

Gulshan Sharma, MD, MPHDivision of Pulmonary Critical Care and Sleep Medicine

University of Texas Medical Branch Galveston, TX


Dr. Sharma: Thirty-five years ago, two multicenter trials reported substantial improvements in survival and quality of life with continuous oxygen therapy in the treatment of severe hypoxemia associated with chronic obstructive pulmonary disease (COPD).

• Notably, aside from smoking cessation, no other medical intervention therapy has been shown to improve survival for patients with COPD. It is estimated that upto a third of the patients who are prescribed oxygen continue to smoke.

• Using large claims data of Medicare beneficiaries with COPD, we found that patients with COPD who had a burn injury were more likely to have been prescribed oxygen therapy in the preceding 90 days compared to the control subjects.

• Patients with COPD on oxygen who had burn injury, the face, head and neck region were more commonly involved. In the U.S. oxygen is prescribed to an estimated one million Medicare beneficiaries, based on our estimates a physician would have to treat 1,421 patients with oxygen therapy for one year to cause one burn injury.


http://medicalresearch.com/author-interviews/copd-patients-on-oxygen-therapy-should-be-warned-of-burn-risks/13113/

http://medicalresearch.com/exercise-fitness/copd_more_physical_activity_equals_less_systemic_inflammation/8727/



COPD Patients On Oxygen Therapy Should Be Warned Of Burn RisksMedicalResearch.com Interview with:

Gulshan Sharma, MD, MPHDivision of Pulmonary Critical Care and Sleep Medicine

University of Texas Medical Branch Galveston, TX


• Dr. Sharma: When prescribing oxygen therapy to patient with COPD, health care providers should educate and counsel patients and family members about the potential risk of burn injury, especially in patients who continue to smoke.


• Dr. Sharma: Policy makers should revisit the ethics of prescribing oxygen in patients with COPD who continue to smoke. Countries such as Portugal, Slovakia, England and Canada consider smoking an exclusion or absolute contraindication for oxygen therapy.

• Citation:

• Gulshan Sharma, MD, MPH et al. Burn Injury Associated With Home Oxygen Use in Patients With Chronic Obstructive Pulmonary Disease. Mayo Clinic Proceedings, March 2015 DOI: 10.1016/j.mayocp.2014.12.024



http://medicalresearch.com/author-interviews/healthy-diet-may-lower-copd-risk/11270/

http://medicalresearch.com/weight-research/obesity_lack_of_exercise_linked_to_copd/6402/

http://dx.doi.org/10.1016/j.mayocp.2014.12.024



Possible New Chemotherapy Regimen For Triple-Negative Breast CancerMedicalResearch.com Interview with:

Prof Xi-Chun Hu, Department of OncologyShanghai Medical College

Fudan University, Shanghai 200032, China

• MedicalResearch: What is the background for this study? What are the main findings?

• Prof. Hu: Triple-negative breast cancer (TNBC) is associated with higher rates of recurrence, shorter disease free survival, and poorer overall survival. Molecular targeting agents tried against Triple-negative breast cancer have nearly all failed. TNBC, concordant with BRCA-associated and basal-like breast cancer, has abnormal DNA repair and genome-wide instability, supporting the use of DNA-damaging agents such as platinum. However, platinum monotherapy is not very potent, combination with other agents, such as gemcitabine has a synergistic effect.

• The GP regimen could be an alternative or even preferential first-line doublet chemotherapy strategy for patients with mTNBC.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/possible-new-chemotherapy-regimen-for-triple-negative-breast-cancer/13139/

http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast-cancer-7-triple-negative-subtypes-chemotherapy-response/2180/







• Prof. Hu:

• Cisplatin plus gemcitabine is one more option. Our study provides evidence for the establishment of an effective, non-anthracycline and non-taxane combination regimen for patients with triple-negative breast cancer.

• It is a safe approach if doctors combine our data and all other data from different sorts of cancer patients exposed to the doublet.

• Although cisplatin-related hydration can increase hospital stay and may not be cost-effective, it is still acceptable considering its efficacy. It is more applicable in countries, like China, where nearly all intravenous chemotherapy is delivered in wards, not in outpatient clinics.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/triple-negative-breast-cancer-presurgery-chemotherapy-benefits/10232/







• Prof. Hu:

• Translational studies should be done to identify patients who really benefit from platinums.

• NCCN guideline group recommends gemcitabine plus carboplatin, it is very important to determine which one will be the winner in Triple-negative breast cancer.

• To improve the safety profile, hydration with more focus on electrolyte balance and use of new standard anti-emetic measures.

• Citation:

• Cisplatin plus gemcitabine versus paclitaxel plus gemcitabine as first-line therapy for metastatic triple-negative breast cancer (CBCSG006): a randomised, open-label, multicentre, phase 3 trial

• Hu, Xi-Chun et al.

• The Lancet Oncology , Volume 16 , Issue 4 , 436 – 446



http://medicalresearch.com/cancer-_-oncology/imaging-may-predict-breast-cancers-will-respond-chemotherapy/8585/

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)70064-1/abstract





Pesticides In Fruits and Vegetables May Lower Sperm Count In MenMedicalResearch.com Interview with: Jorge E. Chavarro, M.D., Sc.D.

Assistant Professor of Nutrition and EpidemiologyHarvard T.H. Chan School of Public Health Assistant Professor of Medicine

Harvard Medical School Boston, MA 02113


Dr. Chavarro: Previous studies have shown that occupational exposure to pesticides is harmful to sperm production. However, whether the same is true for pesticide residues in our food, the most important source of exposure to pesticides for most people, is unclear.


Dr. Chavarro: Bottom line, men who consumed the greatest amounts of fruits and vegetables with large amounts of pesticide residues had significantly lower sperm counts and fewer morphologically normal sperm.


http://medicalresearch.com/author-interviews/pesticides-in-fruits-and-vegetables-may-lower-sperm-counts/13085/

http://medicalresearch.com/neurological-disorders/parkinson-disease-and-exposure-to-pesticides/769/



Pesticides In Fruits and Vegetables May Lower Sperm Count In MenMedicalResearch.com Interview with: Jorge E. Chavarro, M.D., Sc.D.

Assistant Professor of Nutrition and EpidemiologyHarvard T.H. Chan School of Public Health Assistant Professor of Medicine

Harvard Medical School Boston, MA 02113


• Dr. Chavarro: It is important to remember that lower semen quality does not necessarily imply lower fertility. However, those concerned about how pesticide residues in food might impact their fertility consuming organically grown produce or choosing fruits and vegetables known to have few pesticide residues may be the way to go.


• Dr. Chavarro: As far as we know, this is the first report linking pesticide residues in food to an adverse reproductive health outcome in men. It is therefore important that other studies replicate these findings and establish whether the differences in semen quality observed in our study translate into differences in fertility. It would also be ideal if this relation were examined I randomized trials.

• Citation:

• Fruit and vegetable intake and their pesticide residues in relation to semen quality among men from a fertility clinicY.H. Chiu, M.C. Afeiche, A.J. Gaskins, P.L. Williams, J.C. Petrozza, C. Tanrikut, R. Hauser, and J.E. Chavarro

• Human Reproduction, March 30, 2015, doi:10.1093/humrep/dev064



http://medicalresearch.com/author-interviews/endocrinology-journal-editor-discusses-effects-of-environmental-endocrine-disrupting-chemicals/11340/

http://humrep.oxfordjournals.org/content/early/2015/03/27/humrep.dev064.short?rss=1





It’s Time To Stop Blaming the Moon For Hospital Admissions or BirthsMedicalResearch.com Interview with:

Dr. Jean-Luc Margot PhDProfessor, Department of Earth, Planetary, and Space Sciences and Department of Physics and Astronomy,

University of California, Los Angeles


Dr. Margot: Some professionals who work in emergency rooms or maternity wards believe that the number of hospital admissions or human births is larger during the full moon than at other times. This belief is incorrect. Analysis of the data shows conclusively that the moon does not influence the timing of hospital admissions or human births.

• Results of a new analysis have been published online in the journal Nursing Research. The Nursing Research article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. It reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions.


http://medicalresearch.com/author-interviews/its-time-to-stop-blaming-the-moon-for-hospital-admissions-or-births/13126/







• Dr. Margot: The study illustrates how intelligent and otherwise reasonable people develop strong beliefs that are not aligned with reality.

• While I sought to dispel myths about the moon, I was also motivated by the fact that questionable beliefs are at the root of many of society’s worst problems. Could the lessons learned about flawed beliefs related to the moon be applied to a broader context?

• Beliefs often dictate actions, and the societal costs of flawed beliefs are enormous.

• For example, the recent measles outbreak appears to have been triggered by parents’ questionable beliefs about the safety of the measles vaccine. Vaccines are widely and correctly regarded as one of the greatest public health achievements, yet vaccine-preventable diseases are killing people because of beliefs that are out of step with scientific facts.

• Other examples of damaging, flawed beliefs are listed here.

• A willingness to engage in evidence-based reasoning and admit that your beliefs may be incorrect will produce a more accurate view of the world. Clearer thinking will enable you to make better decisions, which will improve the quality of your life.



http://medicalresearch.com/author-interviews/measles-mumps-rubella-vaccine-adults-cdc-reports-excellent-safety-record/11536/

http://mel.epss.ucla.edu/jlm/epo/FullMoon.html







• Dr. Margot: The absence of a lunar influence on human affairs has been demonstrated in the areas of automobile accidents, hospital admissions, surgery outcomes, cancer survival rates, menstruation, births, birth complications, depression, violent behavior, and criminal activity. It’s time to stop blaming the Moon.

• The cognitive effects that lead to questionable beliefs are much more complex and interesting than the gravitational force exerted by an ordinary natural satellite. Research efforts devoted to understanding these cognitive biases are far more likely to yield productive results than another study of the imagined influence of the Moon on human affairs.

• Citation:

• No Evidence of Purported Lunar Effect on Hospital Admission Rates or Birth Rates.

• Margot JLNurs Res. 2015 Mar 10. [Epub ahead of print]







Raw Milk Link To Higher Risk of Foodborne IllnessesMedicalResearch.com Interview with:

Benjamin Davis BACLF-Lerner Fellow at the Johns Hopkins Center for a Livable Future.


Response: The Food and Drug Administration banned the inter-state sale of raw (i.e. unpasteurized) milk in 1987. Currently 30 states still allow raw milk sales on local farms or in stores. We were requested by the Maryland General Assembly’s Health and Government Operations Committee to conduct a review of the health benefits and risks of raw versus pasteurized milk in response to proposed legislation that would legalize raw milk in the state. After reviewing over 80 scientific articles we concluded that raw milk carries a substantially higher risk of foodborne illness when compared to pasteurized milk. However drinking raw milk may reduce allergies among children in rural settings.


• Response: Clinicians should discourage the consumption of raw milk, particularly for pregnant women and young children. While it is still unclear what the absolute risk of drinking raw milk is, drinking pasteurized milk, which effectively reduces the concentrations of most infectious bacteria, still appears to be a safer choice for a person’s health.


http://medicalresearch.com/infections/raw-milk-link-to-higher-risk-of-foodborne-illnesses/13142/



Raw Milk Link To Higher Risk of Foodborne IllnessesMedicalResearch.com Interview with:

Benjamin Davis BACLF-Lerner Fellow at the Johns Hopkins Center for a Livable Future.


• Response: Further research should be conducted to better understand the relationship between drinking raw milk and reduced allergies. Such studies should consider raw milk consumers in more urban settings. Additional research should also be conducted to identify what components of raw milk could be the underlying cause of such health benefits. Preliminary data from studies we reviewed indicate that a lower heat treatment for pasteurization could maintain such health benefits without increasing the risk of foodborne illness. Further research should focus on comparing raw milk with lower-temperature pasteurized milk.

• Citation:

• A Literature Review of the Risks and Benefits of Consuming Raw and Pasteurized Cow’s Milk

• Benjamin J.K. Davis, Cissy X. Li, Keeve E. NachmanReport, December 8, 2014



http://www.jhsph.edu/research/centers-and-institutes/johns-hopkins-center-for-a-livable-future/research/clf_publications/pub_rep_desc/Literature-Review-Risks-Benefits-Consuming-Raw-Pasteurized-Cow-Milk.html





More Dialysis Patients Becoming PregnantMedicalResearch.com Interview with:

Dr. Mala Sachdeva MDNorth Shore University Hospital, Long Island Jewish Medical Center

Assistant Professor, Nephrology, Internal MedicineHofstra North Shore-LIJ School of Medicine


Dr. Sachdeva: The last study examining pregnancy and dialysis outcomes in the United States was performed more than 15 years ago. Our study was conducted to evaluate practice patterns and to trend maternal and fetal outcomes in the pregnant dialysis female over the past five years. We did a surveymonkey-based survey of American nephrologists on their knowledge of managing pregnancy patients on dialysis.

• Medical Research: What are the main findings?• Dr. Sachdeva: Over the past five years, more than 59 pregnancies have been reported. During this time

period, almost half of the American nephrologist respondents (43%) have cared for pregnant females on hemodialysis. Hence, we can see that more nephrologists are now faced with taking care of the pregnant dialysis patient. Although a good number of patients initiated dialysis during pregnancy (32%), the majority (58%) of pregnancies occurred within the first five years of being on maintenance dialysis.

• Pregnancy outcomes can improve. Of the reported pregnancies 23% did not result in live births. 50% of the pregnancies were complicated by preeclampsia. There were no maternal deaths.

• Most nephrologists prescribe 4 to 4.5 hours of hemodialysis. 64% of respondents provide dialysis for six days per week. Only 21% aimed for a target predialysis BUN of less than 20 mg/dL while 66% of nephrologists targeted a BUN less than 50mg/dL. 75% of respondents do not have access to fetal monitoring during dialysis for their pregnant patient.

• There are approximately 32% of American nephrologists who are somewhat to very uncomfortable caring for a pregnant woman on hemodialysis. 51% of American nephrologists or a member of their staff counsel their female dialysis patients about contraception.

• So in summary, while majority of the US based nephrologists are trying to dialyze pregnant ESRD patients with more intense prescriptions, there are still some gaps with comfort and knowledge.


http://medicalresearch.com/author-interviews/more-dialysis-patients-becoming-pregnant/13148/







• Dr. Sachdeva: We hope to raise awareness regarding the importance of knowing how to dialyze a pregnant female and would like to stress the importance of having good outcomes when dialyzing a pregnant woman. The close interaction between the nephrologist and the obstetrician is a very important one when managing these patients.

• Formal guidelines outlining the care of the pregnant woman on dialysis need to be established. These can hopefully improve future outcomes.



http://medicalresearch.com/author-interviews/most-kidney-failure-patients-around-world-die-without-access-to-dialysis/12828/







• Dr. Sachdeva: Despite the small response, we will be continuing this survey and we hope to get more responses to this survey so that we can all try to learn from U.S. experience with the goal being to improve maternal and fetal outcomes in our pregnant dialysis patient.

• Citation:

• upcoming NKF abstract Spring 2015 MeetingPREGNANCY OUTCOMES IN HEMODIALYSIS PATIENTS: A NATIONAL SURVEY



http://www.ajkd.org/article/S0272-6386(15)00330-3/abstract



Do Intra-aortic Balloon Pumps Improve Heart Attack Survival?MedicalResearch.com Interview with:

Sayan Sen, PhDInternational Centre for Circulatory Health, National Heart and Lung Institute

Imperial College London London, United Kingdom


Dr. Sayan Sen: Intra-aortic balloon pumps (IABP) are often used in Acute Myocardial Infarction, particularly in patients with cardiogenic shock. We analysed the available Randomized Controlled Trials (RCT) and observational studies, spanning 30 years, to establish the evidence for this use.

• There is no identifiable group of patients with Acute Myocardial Infarction that have been demonstrated to derive a mortality benefit from insertion of an IABP. The studies, including over 17000 patients, have studied mortality in patients receiving IABP in comparison to mortality of patients that received no IABP in the era of no reperfusion, fibrinolysis and primary percutaneous intervention. This lack of mortality reduction with IABP in AMI is consistent in patients with and without cardiogenic shock across both RCTs and observational studies; questioning the continued use of this technology in Acute Myocardial Infarction.


http://medicalresearch.com/heart-disease/do-intra-aortic-balloon-pumps-improve-heart-attack-survival/13154/

http://medicalresearch.com/heart-disease/public-outcomes-reporting-linked-to-risk-aversion-of-sicker-patients/12653/







• Dr. Sayan Sen: Insertion of Intra-aortic balloon pumps in patients with Acute Myocardial Infarction does not reduce mortality regardless of haemodynamic status.

• The observational studies that hinted towards a possible benefit of IABP in patients with AMI and cardiogenic shock were confounded by clear inequality of baseline risk factors of patients between the competing therapies; with clinicians preferentially allocating lower risk patients to Intra-aortic balloon pumps, resulting in apparent lower mortality with IABP. When this is taken into account the same observational studies did not establish a mortality benefit for Intra-aortic balloon pumps in AMI.



http://medicalresearch.com/heart-disease/ballon_pump_may_be_option_for_patients_with_mild_to_moderate_aortic_insufficiency/4554/







• Dr. Sayan Sen: The assessment of the relative efficacy of competing therapies should be established by RCTs. The use of observational data may be appealing as they are easier and cheaper to perform and include ‘real world’ patients that may have been excluded by the strict inclusion and exclusion criteria of RCTs; however, due to a lack of blinding, they are prone to bias that can result in misleading results.

• Whilst RCTs are not vulnerable to this they are more difficult and expensive to perform. RCTs comparing competing therapies in the future should therefore be designed so that they include clinically relevant patients and are of sufficient magnitude to ensure that their results can be extrapolated to the patients seen in clinical practice.

• Citation:

• Ahmad Y, Sen S, Shun-Shin MJ, et al. Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction: A Meta-analysis. JAMA Intern Med. Published online March 30, 2015. doi:10.1001/jamainternmed.2015.0569.



http://archinte.jamanetwork.com/article.aspx?articleid=2210888



Bladder Urine Is Not SterileMedicalResearch.com Interview with:

Alan J. Wolfe PhD, ProfessorDepartment of Microbiology and Immunology

Stritch School of Medicine, Loyola University Chicago Maywood, IL


Dr. Wolfe: Several years ago, Dr. Brubaker and I began a conversation. As a urogynecologist, she was concerned about the general lack of improvement in diagnosis and treatment in her urogynecological practice and thus in clinical outcome. As a microbiologist, I was extremely skeptical of the dogma that urine in the bladder was sterile in the absence of a clinical infection. This skepticism was based upon my former work in bacterial motility and biofilm formation and on the knowledge that most bacteria are not cultured by the standard clinical microbiology urine culture method. With the goal of ultimately improving urogynecological practice, and with the help of our colleagues in the Loyola Urinary Education and Research Collaborative (LUEREC), we decided to test the sterile bladder hypothesis by seeking evidence of bacteria in urine taken directly from the bladder to avoid vulva-vaginal contamination. To detect bacterial DNA, we used high-throughput DNA sequencing technology. To detect live bacteria, we developed an Expanded Quantitative Urine Culture (EQUC) protocol. We applied these complementary approaches to women with and without urgency urinary incontinence (UUI) whose standard clinical urine culture was negative.


http://medicalresearch.com/infections/bladder-urine-is-not-sterile/13160/







Dr. Wolfe: First and foremost, the bladder is not sterile. We can detect bacteria and/or bacterial DNA in most women whether they have urgency urinary incontinence (UUI) or not. Thus, the female bladder contains a resident bacterial community, which we call the female urinary microbiome (FUM). We found that bacterial members of the FUM are distinct from the bacteria that typically cause urinary tract infections (UTI). Thus, the bacteria that make up the FUM are not the bacteria that cause typical UTIs. Indeed, detection of the female urinary microbiome was associated with reduced risk of UTIs that often occur after instrumentation or surgery. We therefore hypothesize that the FUM or some members of the FUM could protect against UTI. We also saw that the FUM in women with UUI differs from the FUM in women without UUI and that certain bacterial species were considerably more common in women with urgency urinary incontinence than in women without urgency urinary incontinence . We hypothesize that some of these bacteria could be causative or contributory to UUI or they could be a consequence of urgency urinary incontinence.



http://medicalresearch.com/allergies/infant-gut-microbiome-linked-to-allergic-predisposition/11949/







• Dr. Wolfe: This is just a beginning. Much more research must be done to be able to bring substantial benefits to patients. However, our work has already altered clinical microbiology laboratory protocol and urogynecological practice at the Loyola University Medical Center and we believe that these changes have made a difference.


• Dr. Wolfe: Most importantly, researchers and clinicians must reassess dogma, etiological theories, diagnostic methods and therapies that are based on the incorrect assumption that the bladder is sterile. For our part, LUEREC has broadened its focus to other disorders of the lower urinary tract, such as painful bladder syndrome and recurrent UTI. We have begun to explore the urinary microbiomes of men and pregnant women. We have begun to investigate the hundreds of different bacteria that we cultured using EQUC, trying to learn as much as we can, especially their interactions with pathogenic bacteria that cause UTI and with the epithelial cells that line the lumen of the bladder

• Citation:

• “Sterile Urine” and the Presence of BacteriaAlan J. Wolfe , Linda Brubaker

• European Urology Available online 12 March 2015








Insulin May Be Better Than Glyburide For Some With Gestational DiabetesMedicalResearch.com Interview with:

Dr. Michele Jonsson Funk, PhDandDr. Wendy Camelo Castillo, MD, PhD


Response: Gestational diabetes is a condition that affects between 8-11% of pregnant women worldwide. In the United States, the prevalence of gestational diabetes has more than doubled since the 1990’s. Most women can control their blood glucose levels with changes in diet and exercise, but approximately 10% need to take medication during pregnancy. Over the last decade, the use of glyburide (a pill) to manage gestational diabetes has increased and it is now used more often than insulin (an injectable).


Response: Treatment with glyburide (compared with insulin) was associated with higher risks of admission to the neonatal intensive care unit (NICU) (by 41%), respiratory distress (by 63%), hypoglycemia in the newborn (40% ), birth injury (35% ) and being large for gestational age (43% ). The risk of NICU admission, large for gestational age and respiratory distress between glyburide and insulin treated women was increased by 3.0%, 1.4% and 1.1% respectively.


http://medicalresearch.com/diabetes/insulin-may-be-better-than-glyburide-for-some-with-gestational-diabetes/13157/



Insulin May Be Better Than Glyburide For Some With Gestational DiabetesMedicalResearch.com Interview with:

Dr. Michele Jonsson Funk, PhDandDr. Wendy Camelo Castillo, MD, PhD


• Response: These outcomes seem to be related to poor glucose control during pregnancy rather than to a direct adverse effect of the medication. Therefore, not all women treated with glyburide may be achieving the desired glucose levels during pregnancy.


• Response: Due to the large increase in the prevalence of gestational diabetes and the ease of use and low cost of oral agents, we need more evidence regarding their effectiveness. It would be important to identify which women can be treated effectively with glyburide, considering not only the short term but also the long term effects that these treatments may have on the health of their newborns.

• Citation:Camelo Castillo W, Boggess K, Stürmer T, Brookhart M, Benjamin DK, Jr, Jonsson Funk M. Association of Adverse Pregnancy Outcomes With Glyburide vs Insulin in Women With Gestational Diabetes. JAMA Pediatr. Published online March 30, 2015. doi:10.1001/jamapediatrics.2015.74.



http://archpedi.jamanetwork.com/article.aspx?articleid=2211139



β-carotene From Green and Yellow Vegetables May Improve Insulin SensitivityMedicalResearch.com Interview with:

Isao Saito, MD, PhDDepartment of Basic Nursing and Health Science,

Ehime University Graduate School of Medicine Toon, Ehime


Response: Type 2 diabetes is a major lifestyle-related disease with a rapid increasing prevalence in Japan. One meta-analysis of six cohort studies showed that an increase in daily food intake of 1.15 servings of green leafy vegetables was associated with a 14% reduction in the incidence of type 2 diabetes. Therefore, it is evident to think that green and yellow vegetables have beneficial effects against type 2 diabetes. Nonetheless, the relationship of their nutritive content with insulin resistance is poorly understood.

• We conducted the Toon Health Study initiated in 2009, which was a prospective cohort study of the Japanese general population. The cohort study was intended to characterize environmental risk factors related to incident diabetes and cardiovascular disease. Participants were recruited from the general population aged 30–79 years who were living in Toon City, Ehime Prefecture, Japan.

• Of them, we investigated 951 Japanese men and women aged 30–79 years who were not undergoing treatment for diabetes and measured their serum β-carotene and retinol concentrations. A 75-g oral glucose tolerance test was performed and the Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and the Matsuda Index were calculated as measures of insulin resistance.

• Multivariable-adjusted odds ratios of the highest quartile of serum β-carotene compared with the lowest quartile for HOMA-IR >1.6 and Matsuda Index <4.9 were 0.56 (95% confidence interval, 0.34–0.94) and 0.62 (0.37–1.02), respectively. When stratified by sex and overweight status, these associations were observed for women and non-overweight individuals. Serum retinol concentration was not associated with either index. Furthermore, according to the nutritional survey, serum β-carotene concentration was associated with green and yellow vegetable intake (p = 0.01).


http://medicalresearch.com/diabetes/%CE%B2-carotene-from-green-and-yellow-vegetables-may-improve-insulin-sensitivity/13170/

http://medicalresearch.com/diabetes/risk-of-incident-diabetes-among-patients-treated-with-statins/747/

http://medicalresearch.com/author-interviews/hearing-loss-dietary-antioxidants/2677/







• Response: This study provided that a higher serum β-carotene concentration was associated with protection against insulin resistance, while serum retinol concentrations were not associated either way in middle-aged Japanese. The findings thus suggest that serum β-carotene, due to higher intake of green and yellow vegetables, confers beneficial effects against insulin resistance.

• The effect of β-carotene on insulin sensitivity was apparent among women or non-overweight individuals in present study. Although we did not deny the association for men or overweight individuals, health professionals should encourage them primarily to take more green and yellow vegetables for diabetes prevention.



http://medicalresearch.com/stroke/stroke_risk_reduced_by_increased_fruit_and_vegetable_consumption/5162/







• Response: Since the present report was based on a cross-sectional design, the causality remains unclear. Although we consider that it seems reasonable to conclude that serum β-carotene concentration depends on green and yellow vegetable intake, which may prevent development of insulin resistance, a future prospective study is needed to confirm the association.

• We consider that high serum β-carotene concentration was due to high intake of green and yellow vegetables and found the moderate association between them in present study. However, we could not suggest the recommended amount of green and yellow vegetable intake to keep adequate serum β-carotene concentration, especially for Japanese.

• Furthermore, there may be residual confounding factors related to socioeconomic status (SES) that influences the intake of vegetables. According to the National Health and Nutrition Survey of Japan, higher income was related to higher vegetable intake. We hypothesize that inequity of health is derived largely from low SES, resulting in low intake of green and yellow vegetable and increasing diabetes in Japan.

• Citation:• Associations of serum β-carotene and retinol concentrations with insulin resistance: the Toon

Health Study• Kana Higuchi, M.S. Isao Saito, M.D., Ph.D. Koutatsu Maruyama, Ph.D. Eri Eguchi, M.P.H., Ph.D.

Hiromi Mori, Ph.D. Sakurako Tanno, M.D., Ph.D. Susumu Sakurai, Ph.D. Taro Kishida, Ph.D. Wataru Nishida, M.D., Ph.D. Haruhiko Osawa, M.D., Ph.D. Takeshi Tanigawa, M.D., Ph.DNutrition Available online 24 March 2015








Random Stem Cell Divisions May Play Role in Persistent HPV InfectionsMedicalResearch.com Interview with:

Marc Ryser PhDVisiting Assistant Professor Department of Mathematics

Duke University Durham, North Carolina

• Medical Research: What is the background for this study

• Dr. Ryser: Infection with the human papillomavirus (HPV) is responsible for approximately 5% of all cancers worldwide. In addition to cervical cancers, HPV is associated with various other female and male cancers, including cancers of the anus and oropharynx. Despite expansive screening and vaccination programs, HPV-related cancers remain a serious public health concern in the US and abroad. To further improve public health interventions against HPV, a thorough understanding of the underlying biology is critical.

• The lifetime risk of getting infected with HPV is as high as 80%, yet most individuals remain asymptomatic and clear the virus after 1-2 years. However, if an infection with a high-risk type of HPV persists, the virus can interfere with the replication mechanism of the host cells, and initiate tumor growth. Even though our understanding is incomplete to date, clearance of HPV infections is primarily attributed to an effective immune response.

• Interestingly, recent studies about the stem cell dynamics in epithelial tissues – the types of tissues that are affected by HPV – have shown that the fate of these stem cells is random: most of the time, a stem cell divides into a new stem cell and a differentiating daughter cell; however, every now and then, a stem cell divides either into two stem cells, or into two differentiating daughter cells. These dynamics have not been acknowledged by the HPV community, and our goal was to develop mathematical models to examine whether the random division patterns of stem cells could play a role in the clearance of HPV infections.


http://medicalresearch.com/stem-cells/random-stem-cell-divisions-may-play-role-in-persistent-hpv-infections/13172/

http://medicalresearch.com/author-interviews/strong-evidence-hpv-vaccination-highly-effective-outside-trial-settings/12380/







Dr. Ryser: We developed a probabilistic model of HPV infection at the tissue level and accounted both for the random division patterns of stem cells and the immune response. Combining the model with data from a longitudinal study of HPV-infected individuals, we found that the random division patterns may contribute quite substantially to the process of clearance. In fact, our results seem to suggest that they may contribute even more to clearance than the immune response.


• Dr. Ryser: Most people clear their HPV infection, while others develop long-lasting infections that can lead to cancer. Our study suggests that chance – in the form of random stem cells divisions – may play an important role in deciding which infections persist, and which ones are cleared. Our model-based predictions need to be confirmed by experimental studies first, but if they are correct, they may help explain controversial epidemiological findings and suggest novel treatment modalities for HPV infections.



http://medicalresearch.com/author-interviews/hpv-16-18-vaccine-provides-some-cross-protection-to-other-cancer-causing-subtypes/11990/

http://medicalresearch.com/author-interviews/new-ninevalent-hpv-vaccine-gives-greater-protection-against-cervical-cancer-and-genital-warts/12147/







• Dr. Ryser: If our model predictions are correct, there are several possible implications that call for more research.

• First, modulation of the stem cell dynamics may provide a fruitful avenue for treatment of HPV infections. For example, increasing the likelihood of symmetric division patterns in these cells would accelerate clearance of the virus.

• Second, our results may help explain controversial findings about the association of long-term use of oral contraceptives and cervical cancer risk.

• Finally, whether HPV infections can lie dormant for extended periods of time and then re-emerge is debated among experts. Our findings may be able to shed light onto this controversial aspect of the natural history of HPV infections, and hence help improve public health measures against the disease.

• Citation:

• HPV Clearance and the Neglected Role of Stochasticity

• Marc D. Ryser , Evan R. Myers, Rick DurrettPublished: March 13, 2015DOI: 10.1371/journal.pcbi.1004113



http://medicalresearch.com/cancer-_-oncology/new-hpv-vaccine-potential-prevent-nearly-cervical-pre-cancers/7994/

http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1004113

http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1004113



Oral Health Often Overlooked By Health Care PractitionersMedicalResearch.com Interview with:

Judith Haber, PhD, APRN, BC, FAANAssociate Dean, Graduate Programs

The Ursula Springer Leadership Professor in Nursing New York, NY 10003


Dr. Haber: The background of the project originally aligns with publication of the Surgeon General’s Report (2000), challenging health providers to think about the “mouth as a window to the body”. More recent Institute of Medicine (IOM) reports, Advancing Oral Health in America (2011) and Improving Access to Oral Health Care for Vulnerable and Underserved Populations (2011) highlighted the extant problems with oral health access, oral health disparities and outcomes and the potential role of the primary care workforce in addressing this population health issue. However, there is a dearth of curricular focus on oral health in the curriculum of health professionals. The IOM challenged the Health Resource and Service Administration (HRSA) to convene an Expert Panel to develop interprofessional oral health core clinical (IPOHCC) competencies; the report, Integrating Oral Health and Primary Care Practice, delineating the IPOHCC competencies, was published in 2014. Our HRSA funded initiative, Teaching Oral-Systemic Health (TOSH), focuses on building interprofessional oral health workforce capacity with a special focus on the nursing, medical and dental professions. We have operationalized the IPOHCC competencies by transforming the HEENT component of the health history, physical exam, risk assessment, diagnosis, and management plan, including collaboration and referral, to the HEENOT approach. When a health professional uses the HEENOT approach, he or she cannot forget about oral health.


http://medicalresearch.com/author-interviews/oral-health-often-overlooked-by-health-care-practitioners/13183/

http://medicalresearch.com/diabetes/oral-health-diabetes-effects-health-coaching/3750/







• Dr. Haber: Primary care clinicians, physicians, nurse practitioners, midwives, nurses, and physician assistants, need to “put the mouth back in the head” by recognizing that oral health is a Healthy People 2020 Leading Health Topic, integrating the IPOHCC competencies, including the HEENOT approach, as a standard component of their electronic health record (EHR), as an integral component of each patient encounter and management of the patient’s overall health. As consumers, patients should expect that assessment of their oral cavity, screening for oral health issues such as oral cancer, smoking cessation, and periodontal disease, and oral health preventive interventions, and referrals to dental providers are standard features of their primary care visits.



http://medicalresearch.com/author-interviews/dietary_sugar_increases_dental_decay_even_with_fluoride_use/7704/







• Dr. Haber: Recommendations include the need to integrate interprofessional oral health competencies into the faculty development, curriculum, and best clinical practices of primary care providers. Link integration of IPOHCCs with the Interprofessional Education Competencies (IPEC) and prepare a collaborative practice ready primary care workforce that has a collective impact on improving oral health access, reducing oral health disparities, and improving oral health and overall health outcomes. Since all of the health professions have to provide evidence of meeting interprofessional accreditation criteria for their future accreditation reports and site visits, we recommend that oral-systemic health is the perfect exemplar for operationalizing the IPEC competencies across the health professions

• Citation:

• Putting the Mouth Back in the Head: HEENT to HEENOTHaber J1, Hartnett E, Allen K, Hallas D, Dorsen C, Lange-Kessler J, Lloyd M, Thomas E, Wholihan D.

• Am J Public Health. 2015 Mar;105(3):437-41. doi: 10.2105/AJPH.2014.302495. Epub 2015 Jan 20.

•








Some Medicaid Programs Offer Peer-Review For Pediatric Atypical Antipsychotic MedicationsMedicalResearch.com Interview with:

Dr. Julie Magno Zito, PhDUniversity of Maryland, Baltimore, MD 21201

• MedicalResearch: What is the background for this study?

• Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’.


http://medicalresearch.com/mental-health-research/some-medicaid-programs-offer-peer-review-for-pediatric-atypical-antipsychotic-medications/13187/

http://medicalresearch.com/mental-health-research/program-aims-to-ensure-atypical-antipsychotics-used-appropriately-in-children/12273/





• Method and Findings:

• Dr. Zito: The continued expansion in atypical antipsychotics use for behavioral conditions, particularly in poor and foster care youth prompted several government reports asking states to implement oversight programs. In our survey of state Medicaid agencies, we identified programs implementing a new and promising approach to increase the likelihood that these medications are used appropriately. These ‘peer review’ programs have been launched in 15 of the 31 prior authorization state Medicaid programs. There is a distinct advantage in having a qualified peer review, on a case-by-case basis, of the rationale for use of an atypical antipsychotic in a condition or age group that is ‘off-label’ according to the FDA product information label.



http://medicalresearch.com/mental-health-research/antipsychotics-financial-incentives-improve-medical-adherence/2276/





• MedicalResearch: What should patients and clinicians take away from this report?

• Dr. Zito: After a medication is marketed, additional information (post-marketing surveillance) is warranted but generally not widely undertaken. Families should be encouraged and trained to help clinicians evaluate the benefits and monitor the potential risks of these potent but problematic medications. Treating ‘behavior’ is a complicated matter and multiple perspectives (including teachers) along with research evaluations are needed for comprehensive short and long-term benefit to risk assessments.







• MedicalResearch.com: What recommendations for future research do you have as a result of this work?

• Dr. Zito: Promulgating this study information widely, our goal is to inform pediatric researchers and funding agencies of the need to conduct robust, well designed impact studies to learn about the effectiveness of peer review in advancing quality psychopharmacologic treatment of behavioral conditions.

• In addition, policy makers can ensure compliance with laboratory monitoring at baseline and with repeated antipsychotic use in youth, so that youth for whom an atypical is warranted, will avoid unnecessary cardiometabolic risk.

• Finally, we call for a broad national conversation on the current underlying model of behavioral and emotional treatments of youth (known as ‘biological psychiatry’) which should be widely discussed among stakeholders in terms of its limitations in the management of pediatric behavioral and mental health conditions. Returning to a ‘biopsychosocial’ model would encourage non-pharmacologic as well as psychopharmacologic interventions to support community-based effectiveness and safety studies in a post-marketing surveillance approach to biomedical science.

• Citation:

• Schmid I, Burcu M, Zito JM. Medicaid Prior Authorization Policies for Pediatric Use of Antipsychotic Medications. JAMA. 2015;313(9):966-968. doi:10.1001/jama.2015.0763.



http://medicalresearch.com/wp-admin/edit.php?s=zito&post_status=draft&post_type=post&action=-1&m=0&cat=0&seo_filter&paged=1&mode=list&action2=-1













































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MedicalResearch.com: Medical Research Exclusive Interviews April 1 2015

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