MedicalResearch.com: Medical Research Exclusive Interviews June 9 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]

June 2 2015

For Informational Purposes Only: Not for Specific Medical Advice.

mailto:[email protected]

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New Optical Tool May Identify Patients At High Risk Of Recurrent Prostate CancerMedicalResearch.com Interview with: Gabriel Popescu PhDAssociate Professor, Department of Electrical and Computer Engineering & BioengineeringUniversity of Illinois at Urbana-ChampaignBeckman Institute for Advanced Science and Technology Urbana, IL 61801

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

Dr. Popescu: We developed a new optical tool that can identify patients at high risk for recurrence of prostate cancer after undergoing radical prostatectomy as treatment. Early identification of risk for recurrence can allow early treatment of disease.

• Our main finding was that among individuals with worse disease outcomes, the tissue is more disorganized. This manifests as a decrease in anisotropy, or light scattering angle, which reports on nano-scale differences in tissue architecture.

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

http://medicalresearch.com/cancer-_-oncology/prostate-cancer/new-optical-tool-may-identify-patients-at-high-risk-of-recurrent-prostate-cancer/14389/












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





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


• Medical Research: What should clinicians and patients take away from your report?• Dr. Popescu: Scattering anisotropy is a novel biomarker than can help with prognosis of

prostate cancer among individuals with intermediate risk for prostate cancer recurrence. We are now conducting studies to determine if our method can help with prognosis of high grade cancers, and thus prevent over-treatment of those patients.














http://medicalresearch.com/cancer-_-oncology/prostate-cancer/abnormal_lipid_levels_linked_to_greater_risk_of_prostate_cancer_recurrence/8247/







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

• Dr. Popescu: This tool would be truly useful if we could make prognostic predictions before the patient has undergone surgery for treatment. Ideally, we would want to examine patients’ biopsies and determine if they would benefit from surgery or active surveillance. So our main recommendation for future research is to study the applicability of anisotropy as a prognostic marker at the pre-surgical stage.

• Citation:• Prediction of Prostate Cancer Recurrence Using Quantitative Phase Imaging• Shamira Sridharan, Virgilia Macias, Krishnarao Tangella, André Kajdacsy-Balla & Gabriel Popes

cu• Scientific Reports 5, Article number: 9976 doi:10.1038/srep09976• Published 15 May 2015














http://www.nature.com/srep/2015/150515/srep09976/full/srep09976.html










Soy Supplement Did Not Improve Asthma SymptomsMedicalResearch.com Interview with:Lewis J. Smith, MDProfessor of Medicine and Associate Vice President for ResearchNorthwestern University and the Feinberg School of

Medicine Chicago, IL 60611

Medical Research: What is the background for this study? What are the main findings?Dr. Smith: We previously observed in a survey of more than 1,000 patients with asthma that those consuming soy isoflavones in their diet had better lung functioning than their counterparts who consumed little or none. Using a more detailed soy questionnaire, we confirmed the observation in a different group of patients with asthma, and followed that up with laboratory studies. In cell culture studies, we saw that genistein, the major soy isoflavone, at levels that are achieved in individuals consuming a high soy diet, reduces eosinophilic inflammation, a key feature in asthma. In addition, people who consume more soy products, mostly in Japan and parts of China, generally have less asthma than in western countries. Although these data indicate a potential beneficial effect of soy isoflavones in patients with asthma and nutritional supplements are commonly used by people to treat and prevent disease and improve their health, there was little direct data to prove that the supplement is actually effective. As a result, we explored the effects of a soy isoflavone supplement in 386 adults and children aged 12 or older with poorly controlled asthma. All were taking medicine to treat their asthma – either corticosteroids or leukotriene modifiers – but none consumed soy more than once a week. In the randomized, double-blind study, half of the participants took a soy isoflavone supplement twice daily for six months, and the other half took a placebo. We found that the supplement, though able to increase blood levels of genistein, did not improve lung function, symptoms or measures of inflammation in these individuals.


http://medicalresearch.com/asthma/soy-supplement-did-not-improve-asthma-symptoms/14386/









http://medicalresearch.com/genetic-research/epigenetics-more-than-30-genes-affect-allergies-and-asthma/11978/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Smith: This study highlights that other factors may have been at play, such as diet and

lifestyle patterns like eating less meat or exercising frequently, to explain the observed association between soy isoflavone consumption and asthma severity. It also demonstrates why it is so important to perform well-designed, placebo-controlled studies when epidemiologic associations are reported between specific nutrients and disease outcomes.











http://medicalresearch.com/author-interviews/polyphenol-intake-linked-decrease-cardiovascular-mortality/5744/









• Dr. Smith: We will be looking at whether there is a subset of patients with asthma who are likely to respond to soy isoflavones, if there are genetic factors that influence the response or lack of response, and whether the soy isoflavone supplement has other potential beneficial effects that were not measured in this study.

• Citation:• Smith LJ, Kalhan R, Wise RA, et al. Effect of a Soy Isoflavone Supplement on Lung Function an

d Clinical Outcomes in Patients With Poorly Controlled Asthma: A Randomized Clinical Trial. JAMA. 2015;313(20):2033-2043. doi:10.1001/jama.2015.5024.











http://medicalresearch.com/asthma/asthmatic-white-and-hispanic-women-may-be-at-increased-risk-of-adverse-outcomes/11435/

http://jama.jamanetwork.com/article.aspx?articleid=2297169









Some Birth Control Pills Have Slightly Higher Risk Of Venous ThromboembolismMedicalResearch.com Interview with:Yana Vinogradova, Research FellowDivision of Primary Care School of MedicineUniversity of Nottingham


Response: Combined oral contraceptives are an effective method of birth control but do have measurable side effects. One – common to all combined contraceptives and sometimes fatal – is an increased risk of venous thromboembolism (VTE). A number of earlier studies investigated VTE risks for different types of hormonal contraceptives, but all were performed some years ago or had insufficient data to analyse newer preparations, while some included only healthy users and others did not adequately control for lifestyle and health issues. The data used for this study were representative of the UK population and covered all currently prescribed drugs, with results adjusted for the widest possible range of available relevant factors.

• We found that the venous thromboembolism risks of combined oral contraceptives appear to fall into two distinct groups. Newer drugs containing gestodene, desogestrel, drospirenone or cyproterone were associated with risks of VTE between 1.5 and 1.8 times higher than both the older compositions containing norethisterone or levonorgestrel and the relatively newer norgestimate. While our findings are statistical associations between different compositions and venous thromboembolism risks, they do represent more comprehensive and reliable information for doctors making evidence-based prescribing decisions.


http://medicalresearch.com/author-interviews/some-birth-control-pills-have-slightly-higher-risk-of-venous-thromboembolism/14406/











http://medicalresearch.com/author-interviews/depot-birth-control-may-linked-greater-hiv-acquisition-women/10951/







• Medical Research: What should clinicians and patients take away from your report?• Response: Combined oral contraceptives remain effective and relatively safe drugs –

significantly safer in terms of risk of venous thromboembolism than either pregnancy terminations or pregnancy itself. Our findings would translate into extra cases of VTE per year of between 6 and 14 per 10,000 treated women. The findings do suggest, however, that for patients at increased risk of VTE due to other conditions, it may be worth reviewing the formulation of their prescribed pill.













http://medicalresearch.com/author-interviews/nsaids_may_increase_risk_of_venous_thromboembolism/7986/








• Response: Venous thromboembolism is a relatively uncommon event and choice of a contraceptive drug can often depend on a woman’s characteristics. A randomised controlled trial is unlikely to be useful. A comparable study to this one, which included more detail of actual use (our study measured prescriptions) and which could assemble a more complete and wider range of data for all possible factors affecting venous thromboembolism risks and patient choice, may improve the accuracy and reliability of our findings. However it would be challenging and expensive to achieve this for the very large number of patients that would be required for such a study.

• Citation:• Vinogradova Yana, Coupland Carol, Hippisley-Cox Julia. Use of combined oral contraceptives a

nd risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases BMJ 2015; 350 :h2135













http://medicalresearch.com/author-interviews/venous_thromboembolism_associated_with_short_and_long_term_increase_in_mortality/6336/

http://www.bmj.com/content/350/bmj.h2135








Women May Be More Susceptible To Toxic Effects Of Alcohol On HeartMedicalResearch.com Interview with:Alexandra Gonçalves, MD, PhDPostdoctoral Research FellowCardiovascular Department Brigham and Women’s Hospital Boston, MA 02115

• MedicalResearch.com: What is the background for this study? • Dr. Gonçalves: Excessive alcohol consumption is associated with alcoholic cardiomyopathy,

while light to moderate drinking might have benefits in the risk of heart failure (HF). However, the cardiovascular mechanisms and the alcohol dosage associated with risks or potential benefits are uncertain. Furthermore, the variation in the toxic and protective effects of alcohol by sex remains controversial, as women may be more sensitive than men to the toxic effects of alcohol on cardiac function, developing alcoholic cardiomyopathy at a lower total lifetime dose of alcohol compared to men. In this study we assessed the associations between alcohol intake and cardiac structure and function by echocardiography, in elderly men and women in the large, community-based Atherosclerosis Risk in Communities (ARIC) Study.


http://medicalresearch.com/addiction/alcohol/women-may-be-more-susceptible-to-toxic-effects-of-alcohol-on-heart/14360/



















• MedicalResearch.com: What are the main findings?• Dr. Gonçalves: We studied 4466 participants (76±5 years and 60% women) with alcohol

consumption ascertained, who underwent transthoracic echocardiography. Participants were classified into 4 categories based on self-reported alcohol intake: non-drinkers, drinkers of up to 7 drinks per week, ≥7 to 14 and ≥ 14 drinks per week. In both genders, increasing alcohol intake was associated with larger left ventricular (LV) diastolic and systolic diameters and larger left atrial diameter. In men, increasing alcohol intake was associated with greater LV mass and higher E/E’ ratio. In women, increasing alcohol intake was associated with lower LV ejection fraction.





















• MedicalResearch.com: What should clinicians and patients take away from your report?• Dr. Gonçalves: In an elderly community-based population, increasing alcohol intake is

associated with subtle alterations in cardiac structure and function, with women appearing more susceptible than men to the cardiotoxic effects of alcohol. Thus, in spite of potential benefits of low alcohol intake, our findings highlight the possible hazards to cardiac structure and function by increased amounts of alcohol consumption in the elderly, particularly among women. This reinforces the U.S. recommendations stating that those who drink should do so with moderation.





















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

• Dr. Gonçalves: It would be of most interest to perform a longitudinal study regarding the association of alcohol consumption with echocardiography measurements of cardiac structure and function and cardiovascular outcomes. I believe this would highly contribute to enhance our knowledge in this matter.

• Citation:• AHA• Relationship Between Alcohol Consumption and Cardiac Structure and Function in the Elderly

: The Atherosclerosis Risk in Communities Study• Alexandra Gonçalves, Pardeep S. Jhund, Brian Claggett, Amil M. Shah, Suma Konety, Kenneth

Butler, Dalane W. Kitzman, Wayne Rosamond, Flavio D. Fuchs, and Scott D. Solomon• Circ Cardiovasc Imaging.

2015;8:e002846 originally published May 26, 2015, doi:10.1161/CIRCIMAGING.114.002846















http://circimaging.ahajournals.org/citmgr?gca=circcvim;8/6/e002846











Mayo Researchers Develop Mouse Model To Study ALS and Frontotemporal DementiaMedicalResearch.com Interview with:Dr. Leonard Petrucelli Ph.DMayo ClinicJacksonville, FL 32224

• MedicalResearch: What is the background for this study? • Dr. Petrucelli: According to the ALS Association, more than 30,000 Americans live with

amyotrophic lateral sclerosis (ALS), a condition that destroys motor neuron cells that control essential muscle activity such as speaking, walking, breathing and swallowing. After Alzheimer’s disease, frontotemporal dementia (FTD) is the most common form of early onset dementia. It is characterized by changes in personality, behavior, and language due to loss of neurons in the brain’s frontal lobe. Once considered rare, frontotemporal dementia is now thought to account for up to 10 to 15 percent of all dementia cases, according to the Alzheimer’s Association.

• In 2011, Mayo investigator Rosa Rademakers, Ph.D., identified the most common genetic mutation known to cause ALS and FTD, namely a repeat expansion in the gene C9ORF72. The C9ORF72 repeat expansion leads to the generation of toxic RNA species that form abnormal foci, as well as inclusions of c9RAN proteins in affected cells in the central nervous system. Prior to this research study lead by Leonard Petrucelli, Chair of the Department of Neuroscience at the Mayo Clinic Florida, no animal model existed that fully recapitulated the known clinicopathological features of what is now collectively referred to as c9FTD/ALS. Without such an animal it has remained difficult to identify important mechanisms by which the repeat expansion leads to neurodegeneration and putative therapeutic targets that may mitigate disease in patients where currently there are no curative treatments.


http://medicalresearch.com/neurological-disorders/als/mayo-researchers-develop-mouse-model-to-study-als-and-frontotemporal-dementia/14446/












http://medicalresearch.com/neurological-disorders/a-gene-for-lou-gehrigs-disease-and-frontotemporal-dementia-identified/218/







• MedicalResearch: What are the main findings?• Dr. Petrucelli: Ms. Jeannie Chew, a Mayo Graduate School student and member of Dr.

Petrucelli’s team, developed a mouse model that exhibits the neuropathological and behavioral features associated with c9FTD/ALS by introducing the expanded C9ORF72 sequence in the mouse brain and spinal cord. At six months of age, using the new mouse model, it was demonstrated that the C9ORF72 repeat expansion leads to the generation and aggregation of the toxic RNA foci and c9RAN inclusions in the mouse brain. There were also signs of brain atrophy in the C9orf72 mice such as the loss of neurons, including motor neurons, as well as decreased body and brain weight. Unexpectedly, the new study also provided a link between the C9ORF72 repeat expansion and inclusions of the protein TDP-43, another hallmark feature of ALS and FTD asTDP-43 has long been known to become deregulated in the majority of cases. The C9ORF72 repeat expansion mice also exhibited hyperactivity, anxiety, antisocial behavior and motor deficits. The data therefore indicated that the observed biochemical and pathological changes may be responsible for the observed behavioral deficits and motor impairments akin to those seen in human disease.














http://medicalresearch.com/mental-health-research/alzheimers-dementia/pet-scan-can-detect-amyloid-in-alzheimers-and-other-dementias/14283/







• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Petrucelli: An important take away of our study is that we now have an in vivo model to

work with to advance our understanding of what causes neurodegeneration in c9FTD/ALS. Using this model we can also find new biomarkers that may be important to patient diagnosis and prognosis, as well as identify and develop new therapeutic drugs. Furthermore, the exciting link found here between the C9ORF72 repeat expansion and TDP-43 pathology, indicating that the genetic mutation is upstream, or causative, of the hallmark deregulation of TDP-43, indicate that potential therapeutic approaches to mitigate repeat expansion associated pathologies, would also treat the underlying TDP-43 pathology. Moreover, the new model provides an opportunity to study how TDP-43 becomes deregulated, and that would have important ramifications for an even greater number of patients suffering from ALS and FTD, beyond those with the C9ORF72 genetic abnormality.

• Citation:• C9ORF72 Repeat Expansions in Mice Cause TDP-43 Pathology, Neuronal Loss and Behavioral

Deficits• Jeannie Chew, Tania F. Gendron, Mercedes Prudencio, Hiroki Sasaguri, Yong-Jie Zhang, Monic

a Castanedes-Casey, Chris W. Lee, Karen Jansen-West, Aishe Kurti, Melissa E. Murray, Kevin F. Bieniek, Peter O. Bauer, Ena C. Whitelaw, Linda Rousseau, Jeannette N. Stankowski, Caroline Stetler, Lillian M. Daughrity, Emilie A. Perkerson, Pamela Desaro, Amelia Johnston, Karen Overstreet, Dieter Edbauer, Rosa Rademakers, Kevin B. Boylan, Dennis W. Dickson, John D. Fryer, and Leonard Petrucelli

• Science aaa9344Published online 14 May 2015 [DOI:10.1126/science.aaa9344]Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.













http://www.sciencemag.org/citmgr?gca=sci;science.aaa9344v3















Hospice Care May Decrease Depression in Surviving SpousesMedicalResearch.co Interview with:Katherine Ornstein, PhD MPH Assistant ProfessorBrookdale Department of Geriatrics and Palliative MedicineInstitute for Translational Epidemiology Icahn

School of Medicine at Mount SinaiNew York, NY 10029


Dr. Ornstein: There is an increased focus on the need to support caregivers and families, particularly at the End of Life (EOL). They play a critical role in the care process and decision making, yet this can be a very high stress role with an increased risk for negative consequences. Hospice services, which are increasing, are focused on palliative rather than curative care and include medical services, symptom management, spiritual counseling, social services and bereavement counseling delivered by an interdisciplinary team of professionals for dying patients. An important part of the hospice service is the provision of support to families during illness and after death. Prior research suggests that hospice (which is cost saving, has benefits to patients), may also be beneficial to families. Yet these studies have been largely limited to patients with cancer, have failed to adequately control for differences between patients who do or do not use hospice.

• Overall, there was an increase in depressive symptoms after death. However, surviving spouses of those who used hospice were more likely to have a decrease in depressive symptoms. We found that the positive benefit of hospice was much stronger when we looked at least 1 year after death.


http://medicalresearch.com/cancer-_-oncology/hospice_care_for_advanced_cancer_decreased_aggressive_care_and_costs_in_last_year_of_life/8909/




• Medical Research: What should clinicians and patients take away from your report?• Dr. Ornstein: Hospice provides benefits for caregivers. Given that hospice is an existing

comprehensive care package that helps patients and achieves cost savings any improvements in health for spouses is an added benefit. We should continue to maximize the use of hospice for appropriate patients — it is a high value intervention that can benefit both the patients and their families.

• But we also need to do more within hospice to support families. The majority of surviving spouses regardless of decedent’s hospice use had increased depressive symptoms after death,—-additional supports are needed if the increased depressive symptoms associated with death of spouse are to be substantially reduced. Attention to the quality of caregiver support and bereavement services within hospice will be necessary to increase its benefits for families.


http://medicalresearch.com/cancer-_-oncology/adult_cancer_end_of_life_care_palliative_chemotherapy/4052/





• Dr. Ornstein: Our findings suggest that researchers and policy makers need to start considering the downstream effects of end of life care on families. The impact of health care services may go beyond their influence on the individual patient and additionally impact family caregivers’ own health, healthcare decisions, and future healthcare utilization. While there has been significant attention to the current unsustainable level of spending on healthcare for seriously ill persons in the U.S., or the top 5% fueling U.S. medical spending, these analyses do not even begin to factor in the downstream effects of caregiving for a seriously ill relative on spouses and other family members.

• Furthermore, it is important to see which component of hospice, which is a comprehensive intervention, is most beneficial for families. Symptom burden may be very important, satisfaction with care overall. Other factors such as out of pocket expenses may also play an important role and should be further investigated.

• Citation:• Ornstein KA, Aldridge MD, Garrido MM, Gorges R, Meier DE, Kelley AS. Association Between

Hospice Use and Depressive Symptoms in Surviving Spouses. JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1722.


http://medicalresearch.com/author-interviews/more-adults-homebound-than-in-nursing-homes/14337/

http://archinte.jamanetwork.com/article.aspx?articleid=2296014




Increasing Speed Of Radiology Interpretations Increases Interpretation ErrorsMedicalResearch.com Interview with:Evgeniya Sokolovskaya, DO, MDMonmouth Medical CenterLong Branch, NJ 07740.

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

Dr. Sokolovskaya: As the utilization of diagnostic imaging has continued to increase in recent years, the workload of radiologists has correspondingly risen. Radiologists are under pressure to increase productivity by increasing workload volume. Previous studies have shown that increasing the number of reporting exams per day can affect the accuracy of radiologic interpretations, increase an error rate and degrade radiologists’ performance in the detection of pathology as viewing time per study decreases. The purpose of this pilot study was to determine if faster reporting speed when reading CT imaging studies of the Abdomen and Pelvis, results in higher number of misses and interpretation errors. The results of our study showed that the number of major misses and interpretation errors significantly increased at the faster reporting speed.


http://medicalresearch.com/radiology/increasing-speed-of-radiology-interpretations-increases-interpretation-errors/14472/
















• Medical Research: What should clinicians and patients take away from your report?• Dr. Sokolovskaya: The findings of our study suggest that the increasing speed of radiology

interpretations results in a higher number of major misses and may have a strong impact on the quality of patient care.



















• Dr. Sokolovskaya: A larger, multicenter study with a greater number of cases interpreted by the radiologists and case selection that is similar to the average workload, would be helpful to confirm our findings and better elucidate the implications on patients’ safety of reporting at a faster rate for prolonged periods of time.

• Citation:• The Effect of Faster Reporting Speed for Imaging Studies on the Number of Misses and Interpr

etation Errors: A Pilot Study • Evgeniya Sokolovskaya, DO, MD,

, Tejas Shinde, MD, Richard B. Ruchman, MD, Andrew J. Kwak, MD, Stanley Lu, MD, Yasmeen K. Shariff, MD, Ernest F. Wiggins, MD, Leizle Talangbayan, MD

• Journal of the American College of Radiology• Available online 21 May 2015












http://www.sciencedirect.com/science/article/pii/S1546144015002033













Smoking, Addiction and Mental Health Issues Linked To Frequent Emergency Department VisitMedicalResearch.com Interview with:Jessica Castner, PhD, RN, CENAssistant ProfessorUniversity at Buffalo, New York

• Medical Research: What is the background for this study? • Dr. Castner: There are groups of people more likely to visit the emergency department (ED)

frequently. One of these groups are people insured by Medicaid, the insurance for those with low incomes. By finding what factors increase the risk for frequent emergency department use, healthcare leaders can target interventions to design a more effective and accessible healthcare delivery system. With approximately 12 million ED visits each year related to behavioral health issues, we wanted to investigate how smoking, substance abuse and psychiatric diagnoses increased the risk for repeat ED use for adults insured by Medicaid.

• There are many problems associated with frequent emergency department use, including less than ideal continuity of care, crowding, and cost. Every year, there are over 136 million visits to United States EDs, and 12 million are linked to some sort of behavioral health issue. Unlike primary care, the patient is not likely to see a healthcare provider in the emergency department who knows them or one who may not have access to their complete and up-to-date records. The patient might get conflicting guidance or have tests ordered that duplicate tests recently done in other settings.

• Frequent emergency department visitors also contribute to crowded EDs, where demand outstrips capacity. Studies have shown an association with increased morbidity and mortality for patients treated in the ED during these times of crowding.


http://medicalresearch.com/author-interviews/smoking-addiction-and-mental-health-issues-linked-to-frequent-emergency-department-visit/14474/









http://medicalresearch.com/author-interviews/high-cost-sharing-policies-for-physician-care-may-not-benefit-chronically-ill-patients/13516/







Medical Research: What are the main findings?

Dr. Castner: The main findings of our study include helping to dispel the myth of “inappropriate emergency department use.” Our research analyzed the 2009 Medicaid claims for Erie and Niagara County. Our findings indicate that there is a positive relationship between outpatient visits and frequent emergency department use. In other words, people who are sicker and have more complex illnesses use all services more – both the emergency department and their outpatient care provider. In addition, we found that smoking, substance abuse, and psychiatric diagnoses all substantially increased the odds of frequent emergency department use – or ED bouncebacks. The most surprising finding was that healthy individuals were four times more likely to be frequent ED users if they smoked.











http://medicalresearch.com/addiction/most_emergency_room_super_frequent_users_have_addiction_disorder/5377/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Castner: Our findings continue to justify the need for targeted interventions for

individuals who smoke, those who use or abuse substances, and those with psychiatric diagnoses to reduce frequent treat and-release emergency department use. Brief screening interventions and referrals from the emergency department and community care coordination are essential for these populations.











http://medicalresearch.com/author-interviews/frequent-emergency-department-users-more-likely-to-die-or-be-admitted/14002/








• Dr. Castner: Continued study of additional social variables known to influence emergency department use should be included, such as health literacy, homelessness, social support, or medication use. Additional diagnoses and more detailed analysis of different types of substance abuse or psychiatric diagnoses should continue to be studied. Frequent ED use for specific illnesses, such as pulmonary or cardiac disease may offer additional insights into the need for preventive services.

• Citation:• Nurs Res. 2015 Jan-Feb;64(1):3-12. doi: 10.1097/NNR.0000000000000065.• Frequent emergency department utilization and behavioral health diagnoses.• Castner J1, Wu YW, Mehrok N, Gadre A, Hewner S.











http://medicalresearch.com/author-interviews/neighborhood_socioeconomic_status_impact_on_medicare_rating_for_heart_failure/5240/

http://www.ncbi.nlm.nih.gov/pubmed/25502056










Tall Women More Susceptible To Colon CancerMedicalResearch.com Interview with:Aaron P. Thrift, Ph.D.Assistant Professor, Department of Medicine Dan L. Duncan Cancer CenterBaylor College of Medicine Houston, TX 77030-3498


Dr. Thrift: Greater attained adult height is associated with increased risk of all cancers combined; however, the association may differ by cancer site and between women and men. For colorectal cancer, epidemiological studies suggest that the association with height may be stronger for women than for men. We used data from over 10,000 patients with colorectal cancer and over 10,000 population-based controls and conducted multiple analyses, including using Mendelian randomization (which incorporates genomic data with traditional approaches) to overcome potential issues of confounding and bias in observational studies, to further examine the association between height and risk of colorectal cancer. Overall, we found that taller height was associated with increased risk of colorectal cancer (8% increased risk per 10cm increase in height). When we examined women and men separately, our results strongly suggest that height is causally associated with colorectal cancer risk for women, whereas there was weaker evidence for a causal association between height and colorectal cancer risk for men.


http://medicalresearch.com/cancer-_-oncology/tall-women-more-susceptible-to-colon-cancer/14478/











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







• Medical Research: What should clinicians and patients take away from your report?• Dr. Thrift: Height (in particular, factors associated with height such as number of susceptible

cells in a specific organ or growth-influencing exposures in childhood) is associated with increased risk for colorectal cancer and height may have utility in clinical risk stratification for colorectal cancer. However, height is unlikely to explain the excess incidence of colorectal cancer for men.













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








• Dr. Thrift: Mechanistic studies of the effect of height on colorectal cancer are warranted, and the sex-specific effects of height on risk of colorectal cancer require further investigation in larger studies.

• Citation:• Aaron P Thrift et al• Mendelian randomization study of height and risk of colorectal cancer

Int. J. Epidemiol. first published online May 20, 2015 doi:10.1093/ije/dyv082













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

http://ije.oxfordjournals.org/citmgr?gca=intjepid;dyv082v1








Anticoagulation Bridge Therapy May Be Unnecessary For Low Risk Venous Thromboembolism PatientsMedicalResearch.com Interview with:Nathan Clark, PharmDClinical pharmacy supervisor, anticoagulation and anemia management services and

Thomas Delate, PhD Clinical research scientist Kaiser Permanente Colorado

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

Response: Patients with a history of blood clots are commonly prescribed warfarin, an anticoagulant, to decrease the body’s ability to form additional clots. Clinicians typically stop the use of warfarin in patients to reduce the risk of serious bleeding when invasive procedures, such as colonoscopy or orthopedic surgery are scheduled. However, when warfarin interruptions occur, patients are exposed to an increased risk of blood clots three to five days before and five or more days after invasive procedures. Bridge therapy with another, faster acting anticoagulant is often initiated in an attempt to reduce the patients’ risk for developing blood clots during that gap.

• Bridging has been a part of standard therapy for venous thromboembolism (VTE) patients undergoing invasive procedures for many years. But only limited data outlining the rates of bleeding and VTE recurrence were available to help clinicians analyze the risks and benefits of bridge therapy.


http://medicalresearch.com/author-interviews/anticoagulation-bridge-therapy-may-be-unnecessary-for-low-risk-venous-thromboembolism-patients/14484/
















http://medicalresearch.com/author-interviews/venous_thromboembolism_review_compares_eight_treatment_options/7665/








We examined the electronic medical records of 1,178 patients with VTE who underwent 1,812 invasive diagnostic or surgical procedures between January 2006 and March 2012 that required the interruption of warfarin therapy. Study patients were categorized into three groups based on their annual risk of VTE recurrence without anticoagulant therapy. Within those groups, a total of 555 patients – 28.7 percent of low-risk, 33.6 percent of moderate-risk and 63.2 percent of high-risk patients – received bridging anticoagulant therapy. The 1,257 patients who did not receive bridge therapy interrupted their warfarin use and received no other anticoagulants during the perioperative period. The use of bridge therapy resulted in a 17-fold higher risk of bleeding without a significant difference in the rate of blood clot formation compared to patients who didn’t receive bridge therapy. In addition, there were no significant differences in the rates of blood clot occurrence or death between the bridged and non-bridged patient groups.

























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

Response: This study provides real-world data for clinicians to assess. The rates of bleeding and venous thromboembolism recurrence reported in this study are similar to those that have been reported elsewhere. Multiple researchers have now concluded that bridge therapy may be unnecessary for patients who are at low or moderate risk for recurrent venous thromboembolism. This conclusion has the potential to lead to a major shift in how clinicians deliver a therapy that’s been considered standard for years.

• In addition, the recommendation to stop bridge therapy for low or moderate risk venous thromboembolism patients is supported by the study observation of no significant differences in the rates of blood clot occurrence or death between the bridged and non-bridged patient groups.


















http://medicalresearch.com/author-interviews/venous_thromboembolism_associated_with_short_and_long_term_increase_in_mortality/6336/








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

• Response: The results of this study indicate that bridge therapy may be unnecessary and potentially harmful for patients who are at low or moderate risk of developing blood clots during warfarin interruption. However, the benefits of bridge therapy may outweigh the risks for those patients who are at the highest risk of venous thromboembolism recurrence. In this study, high-risk patients were identified as those who had a greater than 10 percent risk per year of developing a blood clot during the perioperative period. Further research is needed to identify the patient and procedure-related characteristics that place patients at highest risk for venous thromboembolism recurrence where bridge therapy during warfarin interruption may be beneficial.

• Citation:• Clark NP, Witt DM, Davies LE, et al. Bleeding, Recurrent Venous Thromboembolism, and Mort

ality Risks During Warfarin Interruption for Invasive Procedures. JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1843.


















http://medicalresearch.com/heart-disease/unpredictable_anticoagulation_with_warfarin/9788/









MedicalResearch.com Interviews with:Dr. Sunil M. Kurian Ph.D. Lead- Biomarker Discovery at the Laboratory of Functional Genomics and Cell TherapyDr. John J. Friedewald, MD Associate

Professor of Medicine and SurgeryNorthwestern University’s Feinberg School of Medicine

• Editor’s note: These interviews are based on two abstracts presented at the American Transplant Congress 2015.

• MedicalResearch: What is the background for these studies?

• Response: Previous studies by the scientific founders of Transplant Genomics Inc. helped lay the groundwork for the company’s development of genomic biomarker tests for kidney transplant graft status and demonstrated feasibility as noninvasive monitoring tools that could enable differential diagnosis of graft status in kidney transplant recipients.1-3

• These included a study involving five transplant centers published in the American Journal of Transplantation.4 In that study, peripheral blood gene expression profiling was used to classify kidney graft recipients into three key categories of graft status based on gene expression signatures – clinical acute rejection, acute dysfunction no rejection, and stable graft performance - with very high predictive accuracy.


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• STUDY A: Validation of Blood and Biopsy Gene Expression-Based Molecular Diagnostics for Subclinical Acute Rejection: Comparing DNA Microarrays vs. Next-Generation RNA Sequencing

• MedicalResearch: What are the main findings?

• Response: The current study presented recently at the 2015 American Transplant Congress5 validated that gene expression signatures as indicators of kidney graft status can be detected as robustly with RNA sequencing as with microarrays, with implications for reduced cost of analysis, faster turnaround times and improved throughput for sample processing.

• In this study, we substantiated RNA sequencing as an alternative data generation platform for analyzing gene expression profiles in peripheral blood and tissue from kidney transplant recipients. The data validated that gene expression signatures for subclinical acute rejection (a histological acute cellular rejection in the presence of a normal or stable serum creatinine that is associated with decreased graft survival), clinical acute rejection and stable graft performance can be detected as robustly with RNA sequencing as with microarrays.


























• MedicalResearch: What should clinicians and patients take away from your report?• Response: The key point of this study is that gene expression profiles generated and validated

using microarray technology have been successfully translated to a technology platform based on RNA sequencing. Sequencing has the potential to offer advantages such as reduced cost of analysis, faster reporting back to the clinician and improved throughput for sample processing. In addition, it could facilitate development of kits enabling standardized assay performance on local lab-based sequencing systems and expansion of test use worldwide.


























• MedicalResearch: What should clinicians and patients take away from your report?• Response: The key point of this study is that gene expression profiles generated and validated

using microarray technology have been successfully translated to a technology platform based on RNA sequencing. Sequencing has the potential to offer advantages such as reduced cost of analysis, faster reporting back to the clinician and improved throughput for sample processing. In addition, it could facilitate development of kits enabling standardized assay performance on local lab-based sequencing systems and expansion of test use worldwide.


• Response: We recommend that future studies focus on generating comparable data in less time, and further reducing the cost of data generation by sequencing.


























• STUDY B: Validation of a Peripheral Blood Gene Expression Profile for Subclinical Acute Rejection in Kidney Transplant Recipients – Findings from the CTOT 08 Study

• MedicalResearch: What are the main findings?• Response: The current study presented recently at the 2015 American Transplant Congress6

validated the use of gene expression signatures for subclinical acute rejection, a histological acute cellular rejection in the presence of a normal or stable serum creatinine that is associated with decreased graft survival.

• In this study, Dr. John Friedewald, colleagues and I analyzed gene expression profiles in blood samples from patients with protocol biopsy proven subclinical acute rejection, clinical acute rejection, or from stable patients. A distinct gene expression profile that classified patients with subclinical acute rejection was discovered in the peripheral blood. The expression profiles were then clinically validated in a separate cohort of samples, where the different phenotypes were distinguished with high accuracy.


























• MedicalResearch: What should clinicians and patients take away from your report?• Response: A noninvasive test for subclinical acute rejection could reduce the need for

protocol biopsies, inform the need for a ‘for cause’ biopsy and help with monitoring and adjustment of immunosuppressive drug therapy. Our study shows the first validated blood-based signature for subclinical acute rejection and demonstrates the potential value of integrating molecular biomarkers into clinical practice to serially monitor kidney transplant patients.



























• Response: We recommend that future studies focus on the clinical utility of a test for subclinical acute rejection. For example, a test for subclinical acute rejection could be useful for monitoring transplant patients serially in a minimally invasive manner, and with greater frequency than is practical with protocol biopsies. Any indication of subclinical acute rejection could be treated early, minimizing the risk of further graft injury.

• Such a test may also be useful for monitoring the success or failure of adjusting immunosuppression. The result could not only specify a diagnosis but also provide a molecular score that indicates the degree of acute rejection in a patient. Such information could help support the physician in making a decision to taper immunosuppression in a personalized and objective fashion.


























• Friedewald J, Kurian S, Levitsky J, et al. Molecular signature in the peripheral blood for sub-clinical acute kidney rejection. Presentation at World Transplant Congress, July 30, 2014.

• Kurian SM, Modena B, Friedewald J, et al. Molecular phenotyping of kidney biopsies by global gene expression tightly correlates with histology phenotypes and long-term outcomes. Poster presentation A495 at World Transplant Congress, July 27, 2014.

• Ventura C, Kurian SM, Gelbart T, David-Neto E, Salomon DR. Discovery of peripheral blood and biopsy-based molecular classifiers in Brazilian kidney transplant patients. Poster presentation A523 at World Transplant Congress, July 27, 2014.

• Kurian SM, Williams AN, Gelbart T, et al. Molecular classifiers for acute kidney transplant rejection in peripheral blood by whole genome gene expression profiling. Am J Transplant 2014;5(14):1164-1172.

• Kurian S, Friedewald J, Harrison F, et al. Validation of a blood and biopsy gene expression-based molecular diagnostics for subclinical acute rejection: comparing DNA microarrays vs. next-generation RNA sequencing. Presentation at American Transplant Congress, May 3, 2015.

• Friedewald J, Kurian S, et al. Validation of a Peripheral Blood Gene Expression Profile for SubClinical Acute Rejection in Kidney Transplant Recipients – Findings from the CTOT 08 Study. Presentation at American Transplant Congress, May 4, 2015.


























• Citation:• Abstracts Presented at American Transplant Congress 2015 • –Validation of Blood and Biopsy Gene Expression-Based Molecular Diagnostics for Subclinical

Acute Rejection: Comparing DNA Microarrays Vs. Next-Generation RNA Sequencing• –Validation of a Peripheral Blood Gene Expression Profile for Subclinical Acute Rejection in

Kidney Transplant Recipients – Findings from the CTOT 08 Study• This research was funded in large part by a grant from the National Institute of Allergy and

Infectious Diseases (NIAID) – http://www.niaid.nih.gov/Pages/default.aspx, as part of the Clinical Trials in Organ Transplantation (CTOT) through a grant (U01 AI084146 – Proteogenomics for Organ Transplantation; Prediction, Diagnosis, Intervention; Principal Investigator: Michael M. Abecassis MD)
























ER Personnel Must Work With Police While Maintaining Patient ConfidentialityMedicalResearch.com Interview with:Brodie Nolan, MD BScPGY3 Emergency Medicine ResidentUniversity of Toronto, Faculty of Medicine

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

Dr. Nolan: Police are commonly encountered in the emergency department (ED). They support EMS, transport patients, are a source of collateral information for health care professionals, and help provide a safe environment for hospital staff. However, there is a potential for conflict due to the nature of police investigation and the emergency physician’s duty to protect patients’ confidentiality and personal health information. Any disclosure of patient information to police without consent could potentially violate the patient’s right to privacy of personal health information.

• Unfortunately, it is not uncommonly the case that patients in the emergency department for whom the police have an interest are unable or unwilling to provide consent. Education for emergency medicine residents on police-physician exchanges is variable however it is important to understand the legislation surrounding these practices to ensure patients’ rights are protected and avoid any potential for litigation.


http://medicalresearch.com/author-interviews/er-personnel-must-work-with-police-while-maintaining-patient-confidentiality/14504/













ER Personnel Must Work With Police While Maintaining Patient ConfidentialityMedicalResearch.com Interview with:Brodie Nolan, MD BScPGY3 Emergency Medicine ResidentUniversity of Toronto, Faculty of Medicine

• Medical Research: What should clinicians and patients take away from your report?• Dr. Nolan: Issues of patient confidentiality with police presence in the emergency department

represent a challenging aspect of emergency medical practice. In cases where patients are unable or unwilling to provide consent to release of information to police, only limited patient information can be disclosed to police in the absence of a search warrant, court order, or subpoena. That information is limited to the patient’s name, next of kin, and medical status described as stable, fair, or critical. Seven provinces mandate reporting of gunshot wounds to police and four provinces require mandatory reporting of stab wounds that are not self-inflicted. Physicians should be aware of the specific legislations that apply to them.

• Strategies aimed at improving communication between police and emergency department staff may improve the process for mental health patients who are brought to hospital by police. Some of these strategies include cross-sectoral training about mental health patients, police calling ahead while en-route to hospital, having an emotionally disturbed person information form that police can fill out to communicate their observations and having adequate staff in the ED to support mental health crisis situations.

• Citation:• Brodie Nolan, Alun Ackery. Collaborating With Police in the Emergency Department While

Maintaining Patient Confidentiality: How Can We Improve? CJEM, 2015; 1 DOI: 10.1017/cem.2015.5










http://medicalresearch.com/mental-health-research/stigma_hampers_patients_from_seeking_mental_health_care/7457/

http://dx.doi.org/10.1017/cem.2015.5






Pacritinib Improved Disease Control In Myelofibrosis and Reduced Need For Blood TransfusionsMedicalResearch.com Interview with: Ruben A. Mesa, MD, FACPConsultant Hematologist Chair, Division of Hematology & Medical Oncology

Deputy Director, Mayo Clinic Cancer Center Professor of Medicine Mayo Clinic Cancer CenterNCI Designated Comprehensive Cancer Center Scottsdale, AZ


Dr. Mesa: Myelofibrosis is a rare and chronic blood cancer associated with significantly reduced quality of life and shortened survival. In patients with this disease, spleen enlargement (splenomegaly) is a very common and debilitating symptom – and as the disease progresses, the body slows production of important blood cells.

• The results presented at ASCO were from the PERSIST-1 study, which is a Phase 3 registration-directed trial designed to compare pacritinib — an investigational oral multikinase inhibitor with specificity for JAK2 and FLT3 – to best available therapy (exclusive of a JAK inhibitor) in patients with myelofibrosis — regardless of their platelet counts. Data from this study showed that compared to best available therapy, pacritinib resulted in a significantly higher proportion of patients with spleen volume reduction and control of disease-related symptoms, regardless of platelet levels at the time of enrollment.


http://medicalresearch.com/author-interviews/pacritinib-improved-disease-control-in-myelofibrosis-and-reduced-need-for-blood-transfusions/14507/

























• Medical Research: What should clinicians and patients take away from your report?• Dr. Mesa: There remains a high need for effective therapies that treat myelofibrosis while

also providing significant improvements in disease-related symptoms without leading to additional treatment-related myelosuppression. These data not only showed improved spleen volume and control of disease-related symptoms, but also improvements in severe thrombocytopenia and severe anemia — eliminating the need for blood transfusions in a quarter of patients who were transfusion dependent at the time of enrollment; this may indicate an improvement in bone marrow function.




















http://medicalresearch.com/genetic-research/two_forms_of_polycythemia_vera_one_indolent_one_aggressive/7207/









• Dr. Mesa: These results warrant further evaluation in patients with myelofibrosis – and across a broad range of hematologic malignancies. In addition, based on data showing improvement in bone marrow function, pacritinib have the potential to modify disease in the sickest patients as monotherapy and warrants further evaluation in combination with other potential disease-modifying agents.

• Citation:• Abstract presented at the 2015 ASCO meeting May 2015• Results of the PERSIST-1 phase III study of pacritinib (PAC) versus best available therapy (BAT)

in primary myelofibrosis (PMF), post-polycythemia vera myelofibrosis (PPV-MF), or post-essential thrombocythemia-myelofibrosis (PET-MF).

























False Positive Mammograms Can Lead To Psychological Distress Regardless of Whether Diagnostic Procedures Are RequiredMedicalResearch.com Interview with:Bruno M. Heleno MD

The Research Unit for General Practice and Section of General PracticeDepartment of Public Health University of Copenhagen

• Medical Research: What is the background for this study? What are the main findings?• Dr. Heleno: False positive mammography causes psychological distress. Several observational

studies have shown this, and their results have been summarized in systematic reviews. However, it was unclear whether women requiring invasive tests (needle or surgical biopsy) were more distressed than women only requiring non-invasive procedures (clinical examination or imaging). Contrary to previous research, we found that these two groups of women were equally distressed during the 36 months of follow-up in our cohort. The best estimate for the difference for 12 related measures of distress was always close to zero.


http://medicalresearch.com/general-medicine/false-positive-mammograms-can-lead-to-psychological-distress-regardless-of-whether-diagnostic-procedures-are-required/14516/


















• Medical Research: What should clinicians and patients take away from your report?• Dr. Heleno: The nature of the diagnostic tests after false-positive mammography does not

help to identify the women that are most distressed. Thus, interventions to limit the psychosocial harm of mammography screening should focus on reducing the total number of false-positive tests because these findings demonstrate that women who require only clinical examination and additional imaging experience the same degree of distress as women who undergo invasive procedures













http://medicalresearch.com/cancer-_-oncology/cancer-screening-trials-weighing-the-harms/1934/









• Dr. Heleno: There is still very little research about the psychological consequences of false-positive screening, although they are probably some of the most common harms of screening. Researchers still need to find what is the minimal clinically important difference for the measures of distress that have been used in research, because that would help clinicians make sense of the research results. Researchers also need to describe the psychological consequence of other screening programmes, e.g. lung cancer screening, where invasiveness of diagnostic tests may actually influence the degree of psychological distress.

• Citation:• Diagnostic Invasiveness and Psychosocial Consequences of False-Positive Mammography

Ann Fam Med May/June 2015 13:242-249; doi:10.1370/afm.176• Bruno Heleno, Volkert Dirk Siersma, and John Brodersen













http://www.annfammed.org/citmgr?gca=annalsfm;13/3/242








Pre-Operative Low Blood Pressure Linked To Increased Mortality After Surgery and AnesthesiaMedicalResearch.com Interview with:Prof. Dr. Robert Sanders MD

Assistant Professor, Anesthesiology & Critical Care Trials & Interdisciplinary Outcomes Network (ACTION)Department of Anesthesiology University of Wisconsin, Madison, W


Dr. Sanders: While it is known that chronic raised blood pressure exerts important effects on long term health outcomes, it is unclear how pre-operative blood pressure levels effect risk from surgery. In this study we show that after adjustment for other diseases, high blood pressure does not increase perioperative risk. Rather low blood pressure is associated with an increase in risk of death following surgery and anesthesia.

Medical Research: What should clinicians and patients take away from your report?• Dr. Sanders: Based on our study, clinicians and patients should be aware that having

low blood pressure is associated with increased risk of death following surgery. Future research must focus on the mechanisms through which low blood pressure before the operation may lead to increased risk.

• Citation:• presented at this year’s Euroanaesthesia Congress 2015 in Berlin, Germany• ‘Study of over 250,000 patients suggests that, before an operation, low blood pressure rather

than high is a risk factor for death’• ESA (European Society of Anaesthesiology)


http://medicalresearch.com/author-interviews/pre-operative-low-blood-pressure-linked-to-increased-mortality-after-surgery-and-anesthesia/14518/










http://medicalresearch.com/heart-disease/coronary-artery-disease-hypertension-and-prognostic-score/1504/

http://www.esahq.org/euroanaesthesia






Young and Female Low Socioeconomic African Americans At Increased Risk of Cardiovascular DiseaseMedicalResearch.com Interview with:Dr. Samson Y. Gebreab, Ph.D., M.Sc.Lead Study Author and Research ScientistNational Human Genome Research

Institute Bethesda, Maryland

Medical Research: What is the background for this study?

Dr. Gebreab: It is well known that African Americans hold a commanding lead in cardiovascular disease (CVD) mortality and morbidity compared to whites and other ethnic groups. Furthermore, the risk for developing CVD begins early in life and extends over a lifecourse. Previous studies have indicated the influence of both childhood and adult socioeconomic status (SES) on CVD risk. However, the impact of lifecourse socioeconomic status (both childhood and adulthood) on CVD risk in African American population is not fully understood. The purpose of our study was to investigate the associations of different measures of lifecourse socioeconomic status with cardiovascular disease risk in African Americans and whether the associations were modified by sex and/ or age after controlling for known cardiovascular disease risk factors. We analyzed 10-year follow-up data of African American adults who were participating in Jackson Heart Study, Jackson, MS.


http://medicalresearch.com/heart-disease/young-and-female-low-socioeconomic-african-americans-at-increased-risk-of-cardiovascular-disease/14522/



















• Medical Research: What are the main findings?• Dr. Gebreab: Our findings highlights that among those of lower socioeconomic status,

women and younger (<=50 years old) African Americans are at increased risk of CVD, including heart disease and stroke compared to their counterparts of higher socioeconomic status groups.

• African American women in the lowest socioeconomic status, had more than twice the risk of developing cardiovascular disease than those in the highest socioeconomic status group.

• African Americans of 50 years and younger in the lowest socioeconomic status group had more than three times higher risk of experiencing a cardiovascular disease event than those in the highest socioeconomic status group.














http://medicalresearch.com/heart-disease/women_may_have_large_knowledge_gap_of_heart_disease_risks_and_symptoms/6530/








• Medical Research: What should patients and clinicians take away from this report/• Dr. Gebreab: The take-home messages for clinicians is that people with low socioeconomic

status, in particular women and young adult African Americans of low socioeconomic status, should be considered as a high-risk group for developing CVD as such they should be regarded as priority in health care services. They should be targeted for early detection and intervention for the prevention of cardiovascular disease and related risk factors.






















• Response: It would be interesting future research provide additional insights into the specific factors that contribute to the strong socioeconomic status, patterning of CVD risk among young adults of African Americans. We also recommend that further research should be undertaken to clarify the impact of childhood social environments of African Americans on cardiovascular disease risk, including social exposures related to discrimination and segregation.

• Citation:• Samson Y. Gebreab, Ana V. Diez Roux, Allison B. Brenner, DeMarc A. Hickson, Mario Sims,

Malavika Subramanyam, Michael E. Griswold, Sharon B. Wyatt, and Sherman A. James. The Impact of Lifecourse Socioeconomic Position on Cardiovascular Disease Events in African Americans: The Jackson Heart Study. Journal of the American Heart Association, May 2015 DOI: 10.1161/JAHA.114.001553














http://medicalresearch.com/genetic-research/racial-disparities-in-cardiovascular-disease-not-explained-by-genome-studies/12713/

http://dx.doi.org/10.1161/JAHA.114.001553






SIDS: Sudden Infant Death Risk Doubles At High AltitudesMedicalResearch.com Interview with:David Katz, MDDivisions of Cardiology, and Neonatology,University of Colorado School of Medicine Aurora, Colorado


Dr. Katz: Sudden infant death syndrome (SIDS) is the leading cause of infant mortality in the US between 1 month and 1 year of life. This is the first large study to demonstrate an association between high altitude and SIDS. In particular there is a doubling of risk above 8,000 feet of elevation relative to below 6,000 feet.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Katz: There is an association between high altitude residence and Sudden infant death

syndrome (SIDS). The reason for this association is still unknown, but hypoxia may be the common link. While the population living above 8000 feet is small in the US, it is large worldwide. Better understanding this association is of great medical importance.


http://medicalresearch.com/pediatrics/sids-sudden-infant-death-risk-doubles-at-high-altitudes/14524/














SIDS: Sudden Infant Death Risk Doubles At High AltitudesMedicalResearch.com Interview with:David Katz, MDDivisions of Cardiology, and Neonatology,University of Colorado School of Medicine Aurora, Colorado


• Response: Parents living above 8,000 feet should make every effort to minimize the risk of SIDS by focusing on the established risk factors for SIDS. Among other things, putting a baby on its back to sleep every time it sleeps, avoiding blankets, bumper pads and stuffed animals in the crib, avoiding co-sleeping, and keeping the infant’s environment smoke-free. The absolute risk of SIDS is low, even above 8,000 feet, and our research does NOT support abandoning high altitude residences. We hope that this study will make families residing at altitude, and the physicians counseling them, increasingly vigilant about the known risk factors for SIDS in order to minimize risk. Further research is needed to understand the reason for the association between altitude and SIDS.

• Citation:• Sudden Infant Death Syndrome and Residential Altitude• Pediatrics. 2015 May 25. pii: peds.2014-2697. [Epub ahead of print]• Katz D1, Shore S2, Bandle B3, Niermeyer S4, Bol KA5, Khanna A6.











http://pediatrics.aappublications.org/content/early/2015/05/20/peds.2014-2697.abstract




















Immunotherapy Shows Promise In Advanced Head and Neck Squamous Cell CancerMedicalResearch.com Interview with:Tanguy Seiwert, MD Assistant Professor, Dept. of MedicineAssociate Director, Head and Neck Cancer Program Section

of Hematology/OncologyFellow, Institute for Genomics and Systems Biology Speciality Chief Editor Frontiers in Head and Neck CancerUniversity of Chicago Chicago, IL 60637

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

Dr. Seiwert: Recurrent/metastatic Head and Neck Squamous Cell Cancer (HNSCC) remains poorly treatable with a median OS of 10-13 months

• There is evidence of a prominent immune escape observed in squamous cell carcinoma of the head and neck (SCCHN) suggesting that anti-PD1 agents (similar to e.g. melanoma) may be active.

• Medical Research: What are the main findings?

Dr. Seiwert:• One in four patients with Head/Neck cancer treated with pembrolizumab showed marked tumor

shrinkage (so called – partial/complete responses), and 57% of patients experienced any decrease in the size of their tumors.

• Pembrolizumab is broadly active in both HPV(-) and HPV(+) types of squamous cell carcinoma of the head and neck.

• Pemborliuzmab treatment is active in heavily pretreated squamous cell carcinoma of the head and neck patients.

• Responses seem to be durable è 86% of responding patients remain in response.• Treatment overall was well tolerated with less than 10% of patients experiencing severe side

effects (≥Grade 3).


http://medicalresearch.com/cancer-_-oncology/immunotherapy-shows-promise-in-advanced-head-and-neck-squamous-cell-cancer/14382/




























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

• Dr. Seiwert:• Immunotherapy with Pembrolizumab is active in squamous cell carcinoma of the

head and neck, in fact seem to be about twice as active as our currently best targeted therapy – cetuximab.

• There is a high chances that pembrolizumab and similar agents will play a significant role in the treatment of squamous cell carcinoma of the head and neck patients in the near future, as such agents may hold potential to prolong life. Phase III studies have been initiated.

• This is the largest experience of Immunotherapy in SCCHN (N=132 patients























http://medicalresearch.com/cancer-_-oncology/squamous-cell-carcinoma-head-neck-epigenetic-markers/2090/









• Dr. Seiwert: • Given the early, and strong signal of activity – current patients with HNC should be considered for paticipation in clinical trials with immunotherapy agents such as pembrolizumab

• Biomarkers will likely help us further identify which patients are most likely to benefit. In fact in a related abstract a novel biomarker in the form of an immune signature showed great promise accurately predicting patients with or without benefit, and further validation of this new test is ongoing.

• Citation:• 2015 ASCO abstract:• Antitumor activity and safety of pembrolizumab in patients (pts) with advanced squamous

cell carcinoma of the head and neck (SCCHN): Preliminary results from KEYNOTE-012 expansion cohort























http://medicalresearch.com/cancer-_-oncology/twist1-necessary-for-squamous-cell-tumor-formation-and-progression/10601/






Taking A Little More Tissue After Breast Cancer Removal May Save Reduce Need For Further SurgeryMedicalResearch.com Interview with:Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FRCS(C), FACS, Associate Professor, Department of Surgery

Director, The Breast Center — Smilow Cancer Hospital at Yale-New Haven, Assistant DirectorGlobal Oncology, Yale Comprehensive Cancer Center Program Director, Yale Interdisciplinary Breast Fellowship

Yale University School of Medicine Breast CentermNew Haven, CT,Medical Research: What is the background for this study? What are the main findings?

Response: Every year in the US, nearly 300,000 women are diagnosed with breast cancer — the majority of these will have early stage breast cancer, and will opt for breast conserving surgery to remove their disease. The goal of this operation is to remove the cancer with a rim of normal tissue all the way around it (i.e., a margin), but sadly, 20-40% of women will have cancer cells at the edge of the tissue that is removed, often mandating a return trip to the operating room to remove more tissue to ensure that no further disease is left behind. No one likes to go back to the operating room — so we asked the question, “How can we do better?”. Surgeons have debated various means of obtaining clear margins. Some have advocated taking routine cavity shave margins — a little bit more tissue all the way around the cavity after the tumor is removed at the first operation. Others have argued that this may not be necessary; that one could use intraoperative imaging of the specimen and gross evaluation to define where more tissue may need to be removed (if at all) — i.e., selective margins. We conducted a randomized controlled trial to answer this question. We told surgeons to do their best operation, using intraoperative imaging and gross evaluation, and removing selective margins as they saw fit. After they were happy with the procedure they had performed and were ready to close, we opened a randomization envelope intraoperatively, and surgeons were either instructed to close as they normally would (“NO SHAVE”), or take a bit more tissue all the way around the cavity (“SHAVE”).


http://medicalresearch.com/cancer-_-oncology/taking-a-little-more-tissue-after-breast-cancer-removal-may-save-reduce-need-for-further-surgery/14528/



























Yale University School of Medicine Breast CentermNew Haven, CT,Patients in both groups were evenly matched in terms of baseline characteristics. The key finding was that patients who were randomized to the “SHAVE” group half as likely to have positive final margins and require a re-operation than patients in the “NO SHAVE” group. On their postoperative visit, we asked patients, before they knew which group they had been randomized to, what they thought of their cosmetic results. While the volume of tissue excised in the “SHAVE” group was higher than in the “NO SHAVE” group, the distribution of patient-perceived cosmetic outcomes were identical in both groups. Complication rate was also no different between the two groups. We will be following patients for five years for long-term cosmetic and recurrence outcomes.





























Yale University School of Medicine Breast CentermNew Haven, CT,• Medical Research: What should clinicians and patients take away from your report?• Response: The key take away is that this relatively simple technique, which takes only a few

extra minutes in the OR and can be done without any fancy technology or intraoperative frozen sections, can cut in half the positive margin and reoperation rate without altering patient cosmesis nor increasing complication rates. This is truly practice changing — it is hard to ignore level 1 evidence that such a simple technique can have such a big impact for patients.





























Yale University School of Medicine Breast CentermNew Haven, CT,• Medical Research: What recommendations do you have for future research as a result of

this study?• Response: There remain many unanswered questions — what will be the longterm outcomes

in terms of cosmesis related to taking more tissue, particularly after radiation therapy? We are following patients for 5 years to answer this question. We found that in 12% of patients who had a negative margin (prior to randomization), more cancer was found in the cavity shave margins (which were taken solely due to the randomization). This calls into question the impact of finding this otherwise occult disease. Are there molecular markers that can predict this? Could this result in long term higher local recurrence rates? Or perhaps in the modern era of nearly ubiquitous systemic and adjuvant therapy, it is of no consequence? Again, we are following patients out for 5 years to try to obtain some of these answers. And finally, what are the implications of routine cavity shave margins in terms of cost and value? How will this impact our healthcare system? We are actively looking at this as well.

• Citation:• A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer• Anees B. Chagpar, M.D., M.P.H., Brigid K. Killelea, M.D., M.P.H., Theodore N. Tsangaris, M.D.,

Meghan Butler, Karen Stavris, R.N., M.S.N., Fangyong Li, M.P.H., Xiaopan Yao, Ph.D., Veerle Bossuyt, M.D., Malini Harigopal, M.D., Donald R. Lannin, M.D., Lajos Pusztai, M.D., D.Phil., and Nina R. Horowitz, M.D.

• May 30, 2015DOI: 10.1056/NEJMoa1504473






















http://www.nejm.org/doi/full/10.1056/NEJMoa1504473











Genes Associated With High Triglycerides May Be Protective Against DiabetesMedicalResearch.com Interview with:Yann Klimentidis Ph.D.Assistant ProfessorMel and Enid Zuckerman College of Public Health University of Arizona


Dr. Klimentidis: Previous studies have hinted at the possibility that genes which are associated with higher triglyceride levels may also be associated with lower type-2 diabetes. We set out to test this hypothesis in multiple prospective cohort studies, in European-Americans and in African-Americans. We found that on a collective basis, the alleles which are associated with higher triglycerides are also associated with reduced type-2 diabetes risk. We also identified some individual genetic variants which are driving this trend.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Klimentidis: It is still too early for this research to have any impact on clinical practice.

However, it does point to how genetic association studies can reveal important molecular and physiological mechanisms which could be investigated in greater depth, and then potentially be acted upon in the context of prevention and therapeutic strategies.


http://medicalresearch.com/diabetes/genes-associated-with-high-triglycerides-may-be-protective-against-diabetes/14500/

















Genes Associated With High Triglycerides May Be Protective Against DiabetesMedicalResearch.com Interview with:Yann Klimentidis Ph.D.Assistant ProfessorMel and Enid Zuckerman College of Public Health University of Arizona


• Dr. Klimentidis: Further research is needed to identify the physiological mechanisms that might result in this association, as well as to understand the functional impact of the individual genetic variants associated with triglyceride levels. We also need more clarity regarding the causal relationship between type-2 diabetes and lipid levels.

• Citation:• Yann C. Klimentidis, Akshay Chougule, Amit Arora, Alexis C. Frazier-Wood, Chiu-Hsieh Hsu.

Triglyceride-Increasing Alleles Associated with Protection against Type-2 Diabetes. PLOS Genetics, 2015; 11 (5): e1005204 DOI: 10.1371/journal.pgen.1005204














http://dx.doi.org/10.1371/journal.pgen.1005204






Indoor Air Purifiers Reduce Cardiopulmonary Effects Of Severe Air PollutionMedicalResearch.com Interview with:Dr. Renjie Chen PhD and Dr. Haidong Kan, PhDSchool of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Fudan

University, Shanghai, China

• MedicalResearch: What is the background for this study? What are the main findings?• Response: Although several previous studies in developed countries with cleaner air have

reported health benefits due to air filtration, no such interventional studies were conducted in a developing country with much severer air pollution problems. Our main findings suggested that even a short-term intervention (2 days) could significantly reduce indoor air pollution and improve cardiopulmonary health among healthy young adults.


http://medicalresearch.com/heart-disease/indoor-air-purifiers-reduce-cardiopulmonary-effects-of-severe-air-pollutio/14404/





















• MedicalResearch: What should clinicians and patients take away from your report?• Response: Our study demonstrated that the use of indoor air purifiers was a practical way to

reduce the potential cardiopulmonary risks associated with outdoor particulate air pollution in a country with severe air pollution problems. Clinicians should advise their patients with cardiopulmonary diseases to stay indoors and use an air purifier when outdoor particulate air pollution level was beyond the national standard limit.
























• Response: Future studies should further evaluate the potential health benefits of long-term air purification among more vulnerable populations, such as children, older adults, or patients with cardiopulmonary diseases. Besides, the effectiveness of other potential individual interventions (face mask and dietary supplements such as fish oil) should also be evaluated in future research.

• Citation:Chen R, Zhao A, Chen H, et al. Cardiopulmonary Benefits of Reducing Indoor Particles of Outdoor Origin: A Randomized, Double-Blind Crossover Trial of Air Purifiers.J Am Coll Cardiol. 2015;65(21):2279-2287. doi:10.1016/j.jacc.2015.03.553.
















http://content.onlinejacc.org/article.aspx?articleID=2297637









New Technology May Allow Urine Sampling Rather Than Blood TestingMedicalResearch.com Interview with:R. Kenneth Marcus, FRSC & FAAASProfessor of ChemistryClemson University


Prof. Marcus: We had previously shown that chromatographic columns formed from aligned capillary-channeled polymer (C-CP) fibers were highly effective in analytical scale and preparative separations of proteins from diverse media. The C-CP fibers are extracted from commodity fibers such as polyester, nylon, and polypropylene. The key aspects in using the C-CP fibers are very high bed porosity and rapid protein-surface mass transfer, this allows for very rapid separations. Packing of the fibers in narrow-bore polymer tubing (0.8 mm id x 1 cm long) allows them to be fixed to the end of a micropipette tip. Urine samples of 10 microliter-to-milliliter volumes can be spun through on a microcentrifuge, washed with DI-water, and then eluted with a solvent. Thus the proteins are isolated and pre-concentrated on the fiber surface. The elution solvent can be chosen based on the analytical method employed (e.g., MALDI- or ESI-MS).


http://medicalresearch.com/author-interviews/new-technology-may-allow-urine-sampling-rather-than-blood-testing/14496/













• Medical Research: What should clinicians and patients take away from your report?• Prof. Marcus: What we have developed is best termed an enabling technology. The use of

urine rather blood as a sampling medium has obvious advantages. Proteins in urine are very efficiently collected for subsequent survey and quantitative analysis in terms of identifying potential biomarkers. In the case of sample-limited analysis, single nanomolar concentrations of spiked proteins can be extracted and detected by MALDI-MS from 1 microliter certified urine sample volumes. Sensitivity can obviously be improved using larger volumes.
















• Prof. Marcus: Our group is looking for substantive collaborations with clinicians who are looking to expand their portfolio of urine-based biomarkers. There are certainly other methods (which we have in-house), for adding molecular selectivity to the protein capture step. There are any number of additional detection methods that can be applied following C-CP fiber capture, including ESI-MS, LC-coupled mass spectrometry, fluorescence, and indeed immunoassay approaches. Collaboration and development agreements with sample preparation/clinical diagnostic supply companies is also of interest as there are existing patents that cover the underlying intellectual property.

• Citation:• Benjamin T. Manard, Sarah M. H. Jones, R. Kenneth Marcus. Capillary-channeled polymer (C-

CP) fibers for the rapid extraction of proteins from urine matrices prior to detection with MALDI-MS. PROTEOMICS – Clinical Applications, 2015; DOI: 10.1002/prca.201400081









http://dx.doi.org/10.1002/prca.201400081






Weight Reduction Lowers Risk of Atrial FibrillationMedicalResearch.com Interview with: Christopher X Wong MBBS MSc PhDClinical Research Fellow | Clinical Trial Service Unit, OxfordClinical Senior Lecturer | Centre for Heart Rhythm Disorders, Adelaide

Clinical Trial Service Unit, University of OxfordRoosevelt Drive, Oxford

• Medical Research: What is the background for this study? What are the main findings?• Dr. Wong: Atrial fibrillation is an increasingly common heart rhythm disorder. This study

demonstrates that even small increments in obesity are associated with a significantly increased risk of atrial fibrillation. Our data suggest that for every 1 unit reduction in body mass index there may be a 3-5% reduction in atrial fibrillation; for every 5 unit reduction, there may be 10-29% reductions. It should also be noted that this is likely to be a significant underestimate of the effect of weight reduction on atrial fibrillation rates as weight control has favourable effects on other risk factors for atrial fibrillation, such as hypertension and diabetes. Given the more than 45 million people with atrial fibrillation worldwide, even small but widespread reductions in obesity would thus help contain this ‘epidemic’ of atrial fibrillation.


http://medicalresearch.com/weight-research/weight-reduction-lowers-risk-of-atrial-fibrillation/14502/












http://medicalresearch.com/stroke/despite-high-risk-of-stroke-some-atrial-fibrillation-patients-not-adequately-anticoagulated/12852/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Wong: While atrial fibrillation is commonly viewed as only an ‘electrical problem’ of the

heart, our data support the growing body of evidence that suggests these electrical problems can be fueled by potentially modifiable risk factors such as obesity. One take home-message for patients is that a lower risk of developing heart rhythm disorders such as atrial fibrillation can be added to the list of health benefits from weight reduction. Another important implication from our analysis, however, is that weight reduction in patients who already have established atrial fibrillation is also likely to be beneficial. Thus, early diagnosis, weight reduction, and other risk factor modification in patients with established atrial fibrillation is also an important message.














http://medicalresearch.com/heart-disease/fat-around-heart_increases_risk_of_atrial_fibrillation/9143/









• Dr. Wong: Given the burgeoning ‘epidemic’ of atrial fibrillation, future research should further investigate the effects of different weight reduction strategies on the development and recurrence of atrial fibrillation.

• Citation:• Obesity and the Risk of Incident, Post-Operative, and Post-Ablation Atrial Fibrillation: A Meta-

Analysis of 626,603 Individuals in 51 Studies• Christopher X. Wong, MBBS, MSc; Thomas Sullivan, BMa&CompSci(Hons); Michelle T. Sun, M

BBS; Rajiv Mahajan, MD, PhD; Rajeev K. Pathak, MBBS; Melissa Middeldorp; Darragh Twomey, MBBS; Anand N. Ganesan, MBBS, PhD; Geetanjali Rangnekar, BSc; Kurt C. Roberts-Thomson, MBBS, PhD; Dennis H. Lau, MBBS, PhD; Prashanthan Sanders, MBBS, PhD

JACCCEP. 2015,(): doi:10.1016/j.jacep.2015.04.004














http://medicalresearch.com/general-medicine/women-with-atrial-fibrillation-at-greater-risk-of-stroke-than-men/11921/

http://electrophysiology.onlinejacc.org/mobile/article.aspx?articleid=2299812













Blood Biomarker Ubiquitin Elevated In Traumatic Brain Injury MedicalResearch.com Interview with: Yuyuan Li, PhDLiaoning Provincial Key Laboratory of Brain DiseasesInstitute for Brain Disorders, Dalian Medical University

College of Basic Medical Sciences, Dalian Medical UniversityDalian China


Dr. Li: Traumatic brain injury (TBI) will become the leading cause of death and lifelong disability in the general population by the year 2020. Early determination of prognosis based on epidemiological data is the key to inform care of these patients. Neurobiochemical markers, like Ubiquitin C-terminal Hydrolase-L1 (UCH-L1) have shown a prognostic value for outcome prediction. Recently, several studies have investigated the correlation between serum UCH-L1 concentrations and TBI, however the results thus far have been inconsistent. In the present study, we conducted a systematic review and meta-analysis to evaluate the prognostic value of serum UCH-L1 concentrations after traumatic brain injury. Five studies (including 673 TBI and 1004 controls) were included in the meta-analysis and the overall results reveal that the serum UCH-L1 level was significantly higher in patients with traumatic brain injury compared to those of the control group. Importantly, there was no statistical evidence of a publication bias among the contributing studies from the result of Egger’s test either.


http://medicalresearch.com/author-interviews/blood-biomarker-ubiquitin-elevated-in-traumatic-brain-injury/14543/













http://medicalresearch.com/author-interviews/chronic-inflammation-of-traumatic-brain-injury/10834/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Li: Elevated UCH-L1 serum levels might be negatively correlated with traumatic brain

injury. This suggests that UCH-L1 serum levels might be closely associated with the progression of traumatic brain injury and could be a useful biomarker for the diagnosis and prognosis of TBI. However, more complementary researches may be required to confirm our results due to the limitations of this study. Additionally, no single predictor of outcome should be used alone to decide on therapies for an individual patient; there must always be a series of parameters taken into account.















http://medicalresearch.com/author-interviews/traumatic_brain_injury_raises_dementia_risk_in_elderly/8553/









• Dr. Li: Future research should further investigate the relationship between UCH-L1 levels and severity of injury and prognosis, which may help to improve traumatic brain injury diagnosis and outcome prediction. Besides, the biomarker value against other measures of injury severity such as duration of coma and duration of posttraumatic amnesia should also be assessed in the future studies.

• Citation:• Serum ubiquitin C-terminal hydrolase-L1 as a biomarker for Traumatic Brain Injury: a systemat

ic review and meta-analysisThe American Journal of Emergency Medicine, 06/01/2015Li J, et al















http://medicalresearch.com/mental-health-research/cognitive-function-and-other-risk-factors-for-mild-traumatic-brain-injury-in-young-men/473/

http://www.ajemjournal.com/








Health Diet May Lower Risk of Prostate CancerMedicalResearch.com Interview with:Meng Yang, PhD MPHResearch FellowHarvard T. H. Chan School of Public Health


Dr. Yang: There are nearly 3 million American men living with prostate cancer. However, there is very little information for patients and clinicians about how to manage patients’ lifestyles, like diet, after prostate cancer diagnosis to decrease the risk of death due to this disease and improve their survivorship.

• The most important finding is that men initially diagnosed with prostate cancer without metastases whose diet was more “Westernized”, i.e. higher processed meats, refined grains, potatoes and high-fat dairy, had a significantly higher prostate cancer-related death and all cause mortality. Men whose diet was more “prudent”, i.e. higher intake of vegetables, fruits, fish, whole grains and healthy oils had a lower risk of death.


http://medicalresearch.com/cancer-_-oncology/prostate-cancer/health-diet-may-lower-risk-of-prostate-cancer/14545/








http://medicalresearch.com/weight-research/trial-of-current-dietary-guidelines-reduced-waistlines-and-cardiovascular-risk-markers/12898/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Yang: For clinicians and patients, our results suggest that the same dietary

recommendations that are made to the general population primarily for the prevention of cardiovascular disease may also decrease the risk of dying from prostate cancer among men initially diagnosed with non-metastatic disease.


• Dr. Yang: The main point that research community may take from our findings is that diet and lifestyle factors after prostate cancer diagnosis could make an impact on disease progression and that we should probably pay more attention to this understudied area. Our team continues to evaluate how dietary, lifestyle and metabolic factors influence survival among men with prostate cancer. Our long-term goal is to be able to provide evidence-based nutritional and lifestyle recommendations to men facing prostate cancer and their health providers.










http://medicalresearch.com/cancer-_-oncology/prostate-cancer/prostate-cancer-obesity-diagnosis-increases-mortality-risk/2457/

http://medicalresearch.com/cancer-_-oncology/prostate-cancer/targeted-mr-ultrasound-biopsy-may-improve-prostate-cancer-diagnosis/11109/







• MedicalResearch: Are there any other points you would like to discuss? • Dr. Yang: I would like to caution that in the current study most men are Caucasian physicians.

Therefore our results need to be replicated in independent populations with more diverse socioeconomic and racial/ethnic backgrounds.

• Citation:• Dietary Patterns after Prostate Cancer Diagnosis in Relation to Disease-Specific and Total Mort

ality• Meng Yang, Stacey A. Kenfield, Erin L. Van Blarigan, Julie L. Batista, Howard D. Sesso, Jing Ma,

Meir J. Stampfer, and Jorge E. Chavarro• Cancer Prev Res June 2015 8:545-551; doi:10.1158/1940-6207.CAPR-14-0442










http://cancerpreventionresearch.aacrjournals.org/content/8/6/545.abstract










Brain Activity Recordings Predict Developmental Risk in Preterm InfantsMedicalResearch.com Interview with:Prof. Michael Breakspear MB BS, Ba(Hons), Bsc(Med), PhDQIMR Berghofer Medical Research InstituteRoyal Brisbane Hospital


Prof. Breakspear: The first 72 hours following complicated full-term or premature delivery of a newborn represents a critical window in which survival and long term brain development hangs in the balance. During this window of time, there does not currently exist a reliable, non-invasive, real-time measure of neuropathology that provides neurologists and neonatologists prognostic indicators of clinical outcome. We developed a tool that draws on techniques in physics used to characterize naturally occurring phenomena, such as earthquakes and avalanches, to analyze brain activity recordings of preterm infants. Our tool allows early identification of preterm infants at significant risk of developing poor long-term neurodevelopmental outcomes, such as cerebral palsy and learning difficulties at two years of age.


http://medicalresearch.com/pediatrics/brain-activity-recordings-predict-developmental-risk-in-preterm-infants/14549/















http://medicalresearch.com/pediatrics/hospitals-vary-in-treatment-of-22-24-week-preterm-infants/14016/







• Medical Research: What should clinicians and patients take away from your report?• Prof. Breakspear: Our assessment of cortical burst dynamics from brain activity recordings

produces clinically novel markers of neurodevelopment within the first hours of life. This tool enables an automated analysis of short recordings, rather than a continuous, time consuming visual assessment. This allows clinicians to have prognostic markers of brain activity immediately at hand, which may in turn accelerate treatment and management of at-risk newborns.
























• Prof. Breakspear: This tool would be very useful for prognostic purposes during bedside monitoring in neonatal intensive care. Future research should consider prospective studies which assess the real-time application of the tool in combination with other vital monitoring, such as cardiorespiratory measurements and ventilation.

• Citation:• Cortical burst dynamics predict clinical outcome early in extremely preterm infants

Kartik K. Iyer , James A. Roberts , Lena Hellström-Westas , Sverre Wikström , Ingrid Hansen Pupp , David Ley , Sampsa Vanhatalo , Michael Breakspear

• Brain DOI: http://dx.doi.org/10.1093/brain/awv129First published online: 23 May 2015

















http://dx.doi.org/10.1093/brain/awv129






Melanoma Survival Improved By Cancer-Killing VirusMedicalResearch.com Interview with:Howard L. Kaufman, MD, FACSRutgers Cancer Institute of New JerseyNew Brunswick, NJ


Response: The study clearly demonstrated that advanced melanoma patients achieved a significant improvement in both response rate and durable response rate with Talimogene laherparepvec, or T-VEC. T-VEC is the first oncolytic virus to show a clinical benefit in a randomized phase 3 clinical trial for the treatment of cancer. Patients who received T-VEC also had an improved progress-free and overall survival with nearly 11% obtaining a complete response. T-VEC is an oncolytic virus that mediates anti-tumor activity by directly killing injected tumor cells and by initiating a systemic immune response. Treatment was also associated with few side effects, which were mostly low grade fever, fatigue, chills, nausea and pain at the injection site.


http://medicalresearch.com/author-interviews/melanoma-survival-improved-by-cancer-killing-virus/14573/













• Medical Research: What should clinicians and patients take away from your report?• Response: T-VEC is important because it provides physicians and melanoma patients with

another effective treatment for melanoma. While we have seen several new drugs in the last four years approved for melanoma, many patients either do but respond or can relapse after treatment. Thus, the anticipated approval of T-VEC will be an important advance in bringing new effective options with limited toxicity to patients. Future studies will extend trials of T-VEC to patients with other types of cancer and in combination trials that are already underway and showing promise in melanoma.









http://medicalresearch.com/genetic-research/targeted-melanoma-panel-identifies-genetic-subsets-of-melanoma/13422/








• Response: The real benefit of T-VEC is that it provides melanoma patients with another treatment option that had the potential to induce a complete response, with limited adverse effects and can be easily administered in the clinic and allow patients to maintain their quality of life.

• Citation:• Talimogene Laherparepvec Improves Durable Response Rate in Patients With Advanced Mela

noma • Robert H.I. Andtbacka, Howard L. Kaufman, Frances Collichio, Thomas Amatruda, Neil Senzer,

Jason Chesney, Keith A. Delman, Lynn E. Spitler, Igor Puzanov, Sanjiv S. Agarwala, Mohammed Milhem, Lee Cranmer, Brendan Curti, Karl Lewis, Merrick Ross, Troy Guthrie, Gerald P. Linette, Gregory A. Daniels, Kevin Harrington, Mark R. Middleton, Wilson H. Miller Jr, Jonathan S. Zager, Yining Ye, Bin Yao, Ai Li, Susan Doleman, Ari VanderWalde, Jennifer Gansert, and Robert Coffin

• JCO JCO.2014.58.3377; published online on May 26, 2015;









http://jco.ascopubs.org/content/early/2015/05/22/JCO.2014.58.3377.abstract














US Surgery Patients Report More Pain, Receive More OpioidsMedicalResearch.com Interview with:Winfried Meissner, M.D.Dep. of Anesthesiology and Intensive CareJena University HospitalUniversity Hospital Jena, Germany

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

Dr. Meissner: Post-operative pain is managed inadequately worldwide. There are probably many reasons for this, one of which may be lack of evidence about outcomes of treatment in the clinical routine.

• PAIN OUT was established as a multi-national research network and quality improvement project offering healthcare providers validated tools to collect data about pain-related patient reported outcomes and management after surgery. Patients fill in a questionnaire asking for pain intensity, pain interference and side effects of pain management. The questionnaire has now been translated into 20 languages. Data are collected electronically and clinicians are provided with feedback about management of their own patients, compared to similar patients in other hospitals. Furthermore, the findings are used for outcomes and comparative effectiveness research. PAIN OUT is unique in that outcomes of postoperative pain management can be examined internationally.

• PAIN OUT was created in 2009 with funds from the European Commission, within the FP7 framework and has now been implemented in hospitals in Europe, USA, Africa and SE Asia. The findings allow us to gain insights as to how pain in managed in different settings and countries.

• For this particular study, we compared management of pain in the US to other countries. We assessed a large group of patients who underwent different types of orthopedic surgery and compared their patient reported outcomes and management regimens. We included 1011 patients from 4 hospitals in the USA and 28,510 patients from 45 hospitals in 14 countries (“INTERNATIONAL”).


http://medicalresearch.com/pain-research/us-surgery-patients-report-more-pain-receive-more-opioids/14566/

















• Medical Research: What are the main findings?

Dr. Meissner: Postoperative pain intensity of US patients was higher than in INTERNATIONAL patients; they felt more often negatively affected by pain-associated anxiety and helplessness, and more US patients stated they wished to have received more pain treatment. However, other patient-reported outcomes like time in severe pain or the level of pain relief did not differ.

• We found that treatment regiments of American patients differed compared to INTERNATIONAL patients. More US patients received opioids, and their opioid doses were higher compared to INTERNATIONAL patients. In contrast, INTERNATIONAL countries use more nonopioid medications intraoperatively and postoperatively. Thus, under-supply with opioids cannot explain our findings.

• Mean BMI of US patients was 30.3 while for INTERNATIONAL it was 27.4. However, insufficient evidence exists that this finding might account for differences in pain intensity.

• Routine pain assessment was performed in almost all US patients, in contrast to about 75% in the INTERNATIONAL group. Obviously, routine pain assessment, as practiced in the United States, fails to result in lower postoperative pain. Perhaps it has the opposite effect by directing patients’ attention to the pain.













http://medicalresearch.com/pain-research/orthopedic-patients-and-their-families-at-risk-for-opioid-abuse/14019/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Meissner: It could be that the differences are cultural. Perhaps patients’ understanding of

pain scores and their expectations regarding pain reduction differ between North America and some other countries.

• Much time, effort and funding has been spent over the last 20 years in the USA and Europe introducing measurement of pain into the clinical routine, so much so that it is regarded by some as the ‘5th vital sign’. But it is likely that it is carried out in a mechanistic way, often required by accreditation agencies and not done for providing good management of pain. Therefore, routine pain assessment does not guarantee improvement of quality. Furthermore, frequent pain assessments might draw attention to instead of deviating from pain.

• It is possible that high doses of opioids sensitise some aspects of the post-surgical experience of pain.

• Additional research and analysis is needed to understand the findings.• Participation in a project like PAIN OUT, which addresses patient-reported outcomes instead

focusing on processes might help clinicians to get a realistic picture of quality of care.













http://medicalresearch.com/author-interviews/us-opioid-death-rate-flattens-heroin-deaths-increase/11098/







• For patients: • Quality improvement activities should be based on outcomes that are meaningful for the

patients instead of ticking “checklists” of surrogate indicators. Patient-reported outcomes should be part of quality assessment – because it’s the patient who should be in the centre of care. Ask you healthcare provider!




















• Dr. Meissner: The current findings are based on findings from the first post-operative day. It would be interesting to follow patients over several post-operative days and assess whether the same pattern of response continues. Are patients’ understanding of pain score and their expectations of pain management different between countries and cultures?

• We invite clinicians to come and join the PAIN OUT network to continue working on questions such as these, so that they obtain new insights more about management of their patients, insights which should, hopefully lead to better management of pain.

• Citation:• Research presented at this 2015 Euroanaesthesia conference in Berlin













http://www.esahq.org/euroanaesthesia






JAK1 Inhibitors May Be New Option To Treat Resistant MelanomaMedicalResearch.com Interview with:Prof. Ze’ev Ronai Ph.DScientific DirectorSanford-Burnham’s La Jolla

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

Prof. Ronai: There is an urgent need to find new approaches to treat melanoma in patients that are resistant to current therapeutic regimes—and this represents a significant percent of melanoma patients. We used samples from patients with drug resistant tumors to study the molecular basis of resistance and screened for genes involved in the process.

• We have identified a new player in melanoma resistance to therapy—a molecular target, which provides the basis for clinical trials with drugs currently available to these targets. We found that JAK1 kinase is one target that is upregulated in the resistant tumors. Inhibiting JAK1 kinase can effectively overcome such resistance.


http://medicalresearch.com/author-interviews/jak1-inhibitors-may-be-new-option-to-treat-resistant-melanoma/14561/













http://medicalresearch.com/genetic-research/melanoma-assaying-multiple-proteins-helps-identify-braf-inhibitor-resistance/12331/







• Medical Research: What should clinicians and patients take away from your report?• Prof. Ronai: There is a new option for treating patients with melanoma resistance to

vemurafenib, by targeting the JAK1 signaling pathway, possibly in combination with targeting of BRAF and EGFR. Also, there is a way to identify the patients that would respond to such combination therapy by assessing the levels of components we have identified in this regulatory axis – including RNF125, JAK1 and EGFR.















http://medicalresearch.com/author-interviews/melanoma-targeting-macrophages-increased-braf-inhibitors-effectiveness/12812/








• Prof. Ronai: The next step is to validate our findings in independent cohorts of tumors resistant to drugs commonly used in melanoma, including MEK and BRAF inhibitors, and assess whether administration of JAK1 inhibitors could serve to prevent the emergence of resistant tumors.

• Citation:• Downregulation of the Ubiquitin Ligase RNF125 Underlies Resistance of Melanoma Cells to

BRAF Inhibitors via JAK1 Deregulation• Hyungsoo Kim,Dennie T. Frederick,Mitchell P. Levesque,Zachary A. Cooper,Yongmei

Feng,Clemens Krepler,Laurence Brill,Yardena Samuels, Nicholas K. Hayward,Ally Perlina,Adriano Piris,Tongwu Zhang,Ruth Halaban,Meenhard M. Herlyn,Kevin M. Brown, Jennifer A. Wargo, Reinhard Dummer, Keith T. Flaherty, Ze’ev A. Ronai

• Cell Reports: DOI: http://dx.doi.org/10.1016/j.celrep.2015.04.049















http://dx.doi.org/10.1016/j.celrep.2015.04.049






Risk-Benefit of Pre-Surgery Beta Blockers Varies By Cardiac ProfileMedicalResearch.com Interview with:Mark L. Friedell, MD, FACSChairman Department of SurgeryUniversity of Missouri Kansas City School of Medicine Kansas City, MO 64108


Response: The controversial practice of administering pre-surgery beta-blockers to patients having noncardiac surgery was associated with an increased risk of death in patients with no cardiac risk factors but it was beneficial for patients with three to four risk factors, according to a report published online by JAMA Surgery.

• Pre-surgery β-blockade is a widely accepted practice in patients having cardiac surgery. But its use in patients at low risk of heart-related events having noncardiac surgery is controversial because of the increased risk of stroke and hypotension (low blood pressure).

• Because of the persistent controversy, researcher Mark L. Friedell, M.D., of the University of Missouri-Kansas City School of Medicine, and coauthors analyzed data from the Veterans Health Administration to examine the effect of perioperative β-blockade on patients having noncardiac surgery by measuring 30-day surgical mortality.

• The analysis included 326,489 patients: 314,114 (96.2 percent) had noncardiac surgery and 12,375 (3.8 percent) had cardiac surgery. Overall, 141,185 patients (43.2 percent) received a β-blocker. Of the patients having cardiac surgery, 8,571 (69.3 percent) received a β-blocker and 132,614 (42.2 percent) of the patients having noncardiac surgery got one.


http://medicalresearch.com/heart-disease/risk-benefit-of-pre-surgery-beta-blockers-varies-by-cardiac-profile/14439/



















• The unadjusted 30-day mortality rates among patients having noncardiac surgery for those not receiving β-blockers were 0.5 percent for patients with no cardiac risk factors, 1.4 percent for patients with one to two risk factors and 6.7 percent for patients with three to four risk factors. For those patients having noncardiac surgery who did receive β-blockers, the unadjusted 30-day mortality rates for patients with no cardiac risk factors, one to two risk factors and three to four risk factors were 1 percent, 1.7 percent and 3.5 percent, respectively, according to the results.

• The results suggest that among patients with no cardiac risk factors having noncardiac surgery, those patients receiving β-blockers were 1.2 times more likely to die than those not receiving β-blockers. The risk of death decreased for those patients with one to two risk factors but the reduction was not significant. However, for patients having noncardiac surgery with three to four cardiac risk factors, those receiving β-blockers were significantly less likely to die than those not receiving β-blockers, the authors found. The authors did not observe similar results in patients having cardiac surgery.

• “β-blockade is beneficial perioperatively for patients with three to four cardiac risk factors undergoing NCS [noncardiac surgery] but not in patients with one to two cardiac risk factors. Most important, the use of β-blockers in patients with no cardiac risk factors appears to be associated with a higher risk of death, which has, to our knowledge, not been previously reported,” the study concludes.















http://medicalresearch.com/heart-disease/should_beta_blockers_be_used_after_myocardial_infarction/8905/







• Medical Research: What should clinicians and patients take away from your report?• Response: Patients undergoing noncardiac surgery who have no cardiac risk factors should

not be started on a perioperative Beta Blocker. Patients with one to two risk factors should not be started since there were no statistically significant differences in outcome whether or not Beta Blockers were used.

• However, the current cardiology consensus is that any patient on a Beta Blocker as a home medication should continue on it in the perioperative period. This was not part of the study.















http://medicalresearch.com/heart-disease/beta_blockers_with_without_prior_myocardial_infarction/8114/








• Response: There are no recommendations for future research on perioperative Beta Blockade as a result of this study.

• Citation:• Friedell ML, Van Way CW, III, Freyberg RW, Almenoff PL. β-Blockade and Operative Mortality i

n Noncardiac Surgery: Harmful or Helpful?. JAMA Surg. Published online May 27, 2015. doi:10.1001/jamasurg.2015.86.















http://archsurg.jamanetwork.com/article.aspx?articleid=2294293
































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