MedicalResearch.com: Medical Research Exclusive Interviews November 14 2014

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]

November 14 2014

For Informational Purposes Only: Not for Specific Medical Advice.

mailto:[email protected]

Medical Disclaimer | Terms and Conditions

• The contents of the MedicalResearch.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site!

• If you think you may have a medical emergency, call your doctor or 911 immediately. MedicalResearch.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by MedicalResearch.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of MedicalResearch.comor EDI, or other visitors to the Site is solely at your own risk.

• The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis.

Read more interviews on MedicalResearch.com

Fussy Eating Linked To Constipation in PreschoolersMedicalResearch.com Interview with:

Anne Tharner, PhD andJessica C. Kiefte-de Jong, PhD Department of Epidemiology

Erasmus Medical Center, Rotterdam The Netherlands

• Medical Research: What is the background for this study? What are the main findings?• Response: Constipation is one of the most common health problems in children, and occurs in most

cases without organic reason. In our study, we examined if fussy eating behavior might be related to constipation in children. “Fussy eaters” are children who reject specific foods – often (green and bitter) vegetables – and often compensate this with the intake of less healthy but highly palatable foods (such as fast food or sweets). This kind of diet might be one of the reasons for constipation in children, but at the same time, children might develop difficult eating patterns due to digestive problems such as constipation. Therefore, we examined whether fussy eating and functional constipation mutually affect each other, which might point to the development of a vicious cycle.

• We examined this in a large study including almost 5000 children aged 2-6 years who participated in a longitudinal study in Rotterdam, the Netherlands. Families were regularly followed up starting in pregnancy.

• Our main finding was that fussy eating co-exists with functional constipation and also predicts subsequent development of functional constipation. In addition, we also found evidence for the reverse, as functional constipation predicted subsequent fussy eating behavior. Together with previous studies, our findings suggest that indeed a vicious cycle may develop throughout childhood in which children’s constipation problems and problematic eating behavior mutually affect each other. On the one hand, fussy eating might affect the development of functional constipation via poor dietary quality which is a characteristic for the diet of fussy eaters. On the other hand, our findings show that functional constipation in also predicts future fussy eating. This pathway is less well studied, but it is conceivable that children with constipation and the accompanying abdominal pain and painful defecation may develop problematic eating behavior.

Read the rest of the interview on MedicalResearch.comContent Not Intended as Specific Medical Advice

http://medicalresearch.com/pediatrics/fussy-eating-linked-constipation-preschoolers/8804/

http://medicalresearch.com/pediatrics/probiotics-prevent-infantile-colic-regurgitation-functional-constipation/3377/

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?

• Response: Awareness of the interconnectedness of fussy eating and functional constipation might be beneficial for affected families to better understand both conditions and relieve anxiety and guilt about them. Protocols for the long-term management of constipation already emphasize the importance of behavioral interventions to promote awareness of the condition and its causes, to improve toilet training and dietary habits, and to address anxiety and guilt in parents and children. This aspect of treatment should be further stressed, as longterm use of laxatives might not be an ideal treatment for constipation, particularly in children. Behavioral interventions targeting fussy eating behavior in children might be a useful strategy in the treatment of functional constipation, as fussy eating behavior might be one of the reasons for unhealthy dietary intake involved in constipation. Likewise, awareness of digestive problems in fussy eaters might help to reduce some of the stress related to food fussiness in children. Also, the treatment of fussy eating might be facilitated by the use of laxatives in children with constipation, if fussy eating is in part a learned behavior in response to painful bowel movements.



http://medicalresearch.com/author-interviews/children-may-eat-vegetables-introduced-early-often/5705/






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

• Response: More research is needed to examine both eating behavior as a factor in the development of constipation and vice versa the role of digestive health problems for the development of fussy eating behavior in order to establish whether these two conditions are actually causally related. If this is the case, the effectiveness of behavioral interventions on top of the use of laxatives in the treatment of constipation should be examined. More information regarding how a vicious cycle between problematic eating behavior and digestive problems might develop starting at an even younger age are needed to implement early interventions. Also, related factors such as parenting behavior in general and in regard to feeding might also be examined to be able to develop effective behavioral interventions.

• Citation:

• Bidirectional Associations between Fussy Eating and Functional Constipation in Preschool Children.Tharner, Anne et al. The Journal of Pediatrics

• Published Online: October 28, 2014DOI: http://dx.doi.org/10.1016/j.jpeds.2014.09.028



http://medicalresearch.com/pediatrics/probiotics-helpful-soothing-infants-colic/4570/

http://www.jpeds.com/article/S0022-3476(14)00879-8/abstract






LDL Linked to Acute Kidney Injury in Stent Surgery PatientsMedicalResearch.com Interview with:

Ning Tan, MD, PHDSenior Consultant Cardiologist. Department of Cardiology

Guangdong Cardiovascular InstituteGuangdong General Hospital

• Medical Research: What are the main findings of the study?

• Dr. Tan: In this study, we evaluated whether Low density lipoprotein cholesterol (LDL-C) is an independent risk factor of contrast-induced acute kidney injury (CI-AKI) in patients undergoing percutaneous coronary intervention (PCI). We prospectively enrolled 3236 consecutive patients undergoing PCI in our hospital and demonstrated that LDL-C is significantly and independently associated with CI-AKI in patients undergoing PCI.

Medical Research: What was most surprising about the results?

• Dr. Tan: We might be the first to demonstrate that LDL-C is strongly associated with CI-AKI. In addition, the predictive potential of LDL-C levels was independent of persisting clinical and laboratory-based risk factors of CI-AKI, such as chronic kidney disease, diabetes, age, and Mehran risk score. Furthermore, patients with higher baseline LDL-C levels experienced higher incidence of in hospital composite end points.


http://medicalresearch.com/heart-disease/ldl_linked_to_acute_kidney_injury_in_stent_surgery_patients/8810/

http://medicalresearch.com/heart-disease/bystander-coronary-arteries-treated-time-pci/8691/

http://medicalresearch.com/heart-disease/bad_cholesterol_ldl_linked_to_aortic_valve_disease/8628/



LDL Linked to Acute Kidney Injury in Stent Surgery PatientsMedicalResearch.com Interview with:

Ning Tan, MD, PHDSenior Consultant Cardiologist. Department of Cardiology

Guangdong Cardiovascular InstituteGuangdong General Hospital


Dr. Tan: LDL-C as an adjunct to the established clinical risk factors before PCI appeared to be useful for evaluating the risk of CI-AKI and poor in hospital outcomes. Because LDL-C is readily measured using widely available and relatively inexpensive assays, Clinicians can use this biomarker (LDL-C) to evaluate the risk of CI-AKI in patients before contrast exposure.


• Dr. Tan: We failed to demonstrate that the change of LDL-C was useful to predict CI-AKI. Future research should be performed to evaluate the value of change of LDL-C for predicting CI-AKI in patients undergoing PCI. Furthermore, the present study only demonstrated the level of LDL-C was a risk factor of CI-AKI. However, it remains unclear whether decrease of LDL-C was benefit to prevent CI-AKI. It may be an appealing research topic to explore, since very few therapeutic options of CI-AKI have consistently shown benefit.Citation:LDL cholesterol as a novel risk factor for contrast-induced acute kidney injury in patients undergoing percutaneous coronary intervention Atherosclerosis, 10/20/2014Volume 237, Issue 2, December 2014, Pages 453–459Yuan-hui Liu,Yong Liu,Ji-yan Chen,Ying-ling Zhou,Zhu-jun Chen,Dan-qing Yu,Jian-fang Luo,Hua-long Li,Yi-ting He,Piao Ye,Peng Ran,Wei Guo, Ning Tan

•



http://medicalresearch.com/general-medicine/coronary_stents_and_elective_pci_vary_by_hospital/7090/

http://medicalresearch.com/heart-disease/misinformed_about_benefits_of_pci_for_heart_attack_prevention/7164/

http://www.sciencedirect.com/science/article/pii/S0021915014014592





No Link Found Between Alcohol Use and Hearing Loss in WomenMedicalResearch.com Interview with:

Sharon G. Curhan, MD, ScMChanning Division of Network Medicine

Department of Internal MedicineBrigham and Women’s Hospital

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

• Dr. Curhan: Hearing loss is a highly prevalent and disabling chronic condition that can impair communication, quality of life, and health. Although it is often perceived as an inevitable companion of aging, recent evidence suggests modifiable factors can potentially aid in prevention or slow progression of hearing loss. Alcohol consumption may influence several mechanisms that have been proposed to underlie age-related hearing decline. Although chronic excess alcohol intake has been associated with irreversible hearing loss and acute alcohol intake may temporarily impair auditory function, some evidence suggests that long-term moderate alcohol intake may protect against hearing loss.


http://medicalresearch.com/addiction/alcohol/no_link_found_between_alcohol_use_and_hearing_loss_in_women/8814/

http://medicalresearch.com/general-medicine/eating_fish_may_reduce__risk_of_hearing_loss_in_women/7527/






•Medical Research: What are the main findings?

• Dr. Curhan: Our study prospectively examined the association between total alcohol and individual alcoholic beverage (beer, wine, liquor) consumption and risk of hearing loss in 65,424 women who were participants in the Nurses’ Health Study II (NHS II), aged 27–44 years at baseline (follow-up 1991–2009). During >1 million person-years of follow-up, 12,384 cases of hearing loss were identified.

• After multivariate adjustment, we found no overall association between total consumption of alcohol and the risk of hearing loss. In exploratory analyses, we observed an increased risk of hearing loss associated with consumption of beer, and the risk tended to increase with increasing beer consumption. We also observed an inverse association between wine consumption and risk of hearing loss. Specifically, after adjusting for potential confounders as well as the other alcoholic beverages, compared with women who consumed less than 1 serving of beer per month, the relative risk for hearing loss for those who consumed 5+ servings/week of regular beer was 1.15 (95% CI 1.04,1.28; p trend < 0.001). Compared with women who consumed less than 1 serving of wine per month, the multivariate-adjusted relative risk for hearing loss was 0.84 (95% CI 0.77,0.92) for those who consumed 5+ servings/week (p trend < 0.001). No significant association was observed with consumption of liquor.



http://medicalresearch.com/mental-health-research/depression/depression_and_hearing_loss_in_adults/4071/






• Medical Research: What should clinicians and patients take away from your report?• Dr. Curhan: Acquired hearing loss is a very common and often disabling chronic condition that

affects up to 48 million individuals in the US in at least one ear. Although hearing loss is often considered to be an unavoidable companion to aging, there may be dietary and lifestyle factors that can be modified that may reduce the risk of hearing loss. Our previous research suggests that maintaining a healthy weight and diet, staying physically active, and limiting the use of over-the-counter analgesics, as well as protecting against excessive noise exposure, may all help reduce the risk of hearing loss. In the current study, total alcohol consumption was not associated with risk of hearing loss in women. The modest associations we observed for beer (direct) and wine (inverse) may be due to chance or uncontrolled confounding factors but merit further study.


• Dr. Curhan: Future research that examines these and additional potentially modifiable risk factors for hearing loss, such as diet and lifestyle factors, could provide important insight into potential mechanisms that underlie acquired hearing loss and suggest possible strategies for prevention.

• Citation:• Prospective Study of Alcohol Consumption and Self-reported Hearing Loss in Women.• Curhan, Sharon G. et al.• Received: January 14, 2014; Received in revised form: October 16, 2014; Accepted: October 17,

2014; Published Online: October 31, 2014• DOI: http://dx.doi.org/10.1016/j.alcohol.2014.10.001



http://medicalresearch.com/author-interviews/hearing_loss_contributes_to_personality_changes_in_elderly/4655/



Informal Elder Care By Family and Friends Worth BillionsMedicalResearch.com Interview with:

Dr. Amalavoyal Chari PhDDepartment of Economics, University of Sussex

Brighton UK

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

• Dr. Chari: It is well-known that in the United States, informal (unpaid) caregiving by family members and friends is the primary source of long-term care for the elderly population: Recent estimates indicate that nearly 1 in 5 adults in the United States provides care to an elderly relative or friend over the age of 50.

• Informal care is not really “free”: Rather, it diverts caregivers’ effort from other productive activities, and the value of these displaced activities is the opportunity cost of informal elder-care. Estimates of this cost have been limited by the lack of nationally representative data with detailed information to allow an assessment of the value that caregivers attach to time and time spent providing care. Our study utilizes new and unique data from the American Time Use Survey (ATUS) to remedy this deficit, and to provide careful, up-to-date estimates of the opportunity costs of informal eldercare in the United States.

• We find that informal care is mainly provided by working-age adults, who consequently bear most of the economic burden in terms of opportunity costs. We find that the price tag for informal caregiving of elderly people by friends and relatives in the United States comes to $522 billion a year. Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually.


http://medicalresearch.com/author-interviews/informal_elder_care_by_family_and_friends_worth_billions/8818/





Brighton UK


• Dr. Chari: Quantifying the costs helps stress the importance of informal care: Two and a half times more money is “spent” on informal care compared to spending on formal long-term care services. The time that family and friends spend caring for elder adults is thus a valuable resource and not to be taken lightly. Our report will remind clinicians that their care decisions for elder patients have consequences not only for the patients themselves but also for their informal caregivers. Furthermore, clinicians will be reminded that many of their working age adult patients are giving informal care to elders and that the physical, mental and emotional demands of this care are likely to affect the health of these working age patients. Likewise, our report will remind patients, both elder and working age, that the caregiving relationship has economic value as well as the obvious value to the health of the elder.



http://medicalresearch.com/author-interviews/end_of_life_patients_and_cargivers_may_face_complex_comorbidities_and_medications/6381/





Brighton UK


• Dr. Chari: Our findings touch on a particularly important policy question, namely who should provide elder-care and how informal care should be supported. For example, programs such as Medicaid’s Cash and Counseling program are being piloted that allow family caregivers to be paid for their assistance. Our estimates suggest that, in the aggregate, although the economic value of informal caregiving is substantially greater than what it would cost to replace this care with paid unskilled care, informal caregiving remains more economical than paid skilled care. Therefore, if the beneficiaries enrolled in Cash and Counseling programs prefer to receive care from family members, there may be cost savings to Medicaid relative to a situation in which the care is provided by skilled replacements. This conclusion, however, is predicated on the assumption that compensating informal caregivers will not affect the quality and/or quantity of care provided by them. Careful evaluations of such programs are, however, warranted to examine whether this assumption is justified.

• Citation:

• Chari, A. V., Engberg, J., Ray, K. N. and Mehrotra, A. (2014), The Opportunity Costs of Informal Elder-Care in the United States: New Estimates from the American Time Use Survey. Health Services Research. doi: 10.1111/1475-6773.12238



http://medicalresearch.com/stroke/post-stroke-makes-family-caregivers-happy/4258/

http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12238/full



Telomerator Tool Enhances Construction of Designer DNAMedicalResearch.com Interview with:

Leslie Mitchell, PhDNew York University Langone Medical Center

Boeke Lab, Institute for Systems GeneticsNY NY, 10016


Dr. Mitchell: One of our major interests is building synthetic chromosomes. Typically we construct synthetic chromosomes using a bottom-up approach, first designing the sequence in silico and then synthesizing and piecing together the DNA to build the designer molecule. While eukaryotic chromosomes are usually linear in structure, oftentimes we build our designer synthetic chromosomes as circular molecules to take advantage of cloning technologies available in E. coli, an organism that tolerates only circular chromosomes. We developed the telomerator as a means by which to convert circular synthetic chromosomes into linear molecules, which more closely resemble the native chromosomes found in eukaryotic cells.

• We discovered that the telomerator is an extremely effective tool for generating linear derivatives of circular synthetic chromosomes. There are two main reasons for this.

• First, the action of the telomerator can be assessed using a simple phenotypic assay so it is easy to differentiate cells that encode linear synthetic chromosomes from those with the circular format.

• Second, the telomerator encodes ‘telomere seed sequences’ that are exposed and recognized by the cell upon linearization, thus the ends of a newly linearized chromosome are protected, which ensures its stability over generations. We put the telomerator to the test by integrating it in 54 different positions on a circular synthetic yeast chromosome called synIXR (Dymond et al. 2011). In 51 of the 54 positions we could successfully linearize the synIXR chromosome and recover viable cells, however many of the different linear derivatives conferred growth defects. We determined the mechanism underlying both the growth defects and lethality associated with linearization to be telomere position effect. In other words, when essential genes were re-positioned near telomeres their reduction in expression due to subtelomeric silencing was detrimental to the cell.


http://medicalresearch.com/genetic-research/telomerator-tool-enhances-construction-designer-dna/8820/






• Medical Research: What implications for genetics and medicine in general do you envision from the use of the telomerator?

• Dr. Mitchell: Construction of synthetic chromosomes and even synthetic genomes is quickly becoming mainstream due to the ever-decreasing cost of DNA synthesis and the availability of sequencing data. To put it another way, since we can both read and write DNA with relative ease we are now in the position to build new designer DNA molecules of large size. We think the telomerator can play an important tool to aid in the construction of synthetic chromosomes.








• Medical Research: What future research are you planning as a result of this study?

• Dr. Mitchell: Now that we have developed the telomerator and demonstrated its function in yeast, we plan to expand the concept for use in mammalian cells. Generally speaking, mammalian chromosomes are much larger and more complicated than yeast chromosomes. For instance unlike budding yeast that have small ‘point centromeres’ of ~125 base pairs, mammalian centromeres encodes 100 of kilobasepairs of highly repetitive DNA. Therefore, synthetic mammalian chromosome construction has its own unique set of challenges. However we believe that the telomerator mediated linearization of these molecules after construction can have an important impact on stability and gene expression.

• Citation:

• Dymond, J.S. et al. Synthetic chromosome arms function in yeast and generate phenotypic diversity by design. Nature. 477, 471-476, doi:10.1038/nature10403 (2011).



http://www.nature.com/nature/journal/v477/n7365/full/nature10403.html



Low Birth Weight Linked To Increased Adult Hip Replacement RiskMedicalResearch.com Interview with:

Professor Flavia CicuttinSchool of Public Health and Preventive Medicine

Monash University and Alfred HospitalMelbourne, Australia


• Prof. Cicuttin: Previous research found that low birth weight and preterm birth have been linked to hypertension, cardiovascular disease, insulin resistance and reduced bone mass in adulthood. Given these adverse outcomes related to birth weight and preterm birth we set out to investigate if low birth weight and preterm birth also played a role in increase risk of joint replacement surgery as adults.

• We found that low birth weight and preterm birth were associated with a 2-fold increased risk of hip but not knee replacement surgery.


• Prof. Cicuttin: There is increasing evidence that the risk factors for knee and hip osteoarthritis (OA) differ, with the shape of the bones and the joint having a very significant role in hip osteoarthritis compared to knee OA. Both congenital and developmental diseases of the hip, such as mild hip dysplasia, may influence the development of hip osteoarthritis in adulthood. The formation of the acetabulum is incomplete at birth in preterm babies with preterm infants often developing a postural deformation of the legs which persists till early childhood. These factors may influence the development of the hip, resulting in abnormal hip joint shape which has been shown to be an important risk factor for hip preterm birth.


http://medicalresearch.com/pediatrics/low_birth_weight_linked_to_increased_adult_hip_replacement_risk/8824/

http://medicalresearch.com/author-interviews/many_knee_replacement_surgeries_classified_as_inappropriate/6138/

http://medicalresearch.com/author-interviews/osteoarthritis-specific-micro-rnas-predictors-disease-severity/5822/



Low Birth Weight Linked To Increased Adult Hip Replacement RiskMedicalResearch.com Interview with:

Professor Flavia CicuttinSchool of Public Health and Preventive Medicine

Monash University and Alfred HospitalMelbourne, Australia


• Prof. Cicuttin: Clarifying the mechanisms for the relationship between low birth weight and preterm birth and hip OA is important. LBW and preterm birth may result in abnormal hip development because these babies are born early and the acetabulum is underdeveloped. Post-delivery, the hips are extended rather than being maintained in a flexed and abducted in utero position. This altered hip position may potentially be responsible for an increased incidence or severity of acetabular dysplasia. If this is proven to contribute to the development of hip preterm birth, then modifying hip position through postural support and perhaps the use of double nappies may be beneficial for babies born with low birth weight or preterm, and they may need to be targeted for screening and early treatment of hip dysplasia. As the number of low birth weight and preterm births is increasing, if they are proven to be at increased risk of hip OA, the impact of proactive strategies to reduce hip preterm birth, such as the prevention of obesity will be greater.

• Some of the above questions will be able to be answered by examining birth cohorts where the effect of factors in early life on hip structural changes in early adulthood will be able to be examined.

• Citation:

• Sultana Monira Hussain, Yuanyuan Wang, Anita E. Wluka, Jonathan E. Shaw, Dianna J. Magliano, Stephen Graves, Flavia M. Cicuttini. Association of low birth weight and preterm birth with the incidence of knee and hip arthroplasty for osteoarthritis. Arthritis Care & Research, 2014; DOI: 10.1002/acr.22475



http://medicalresearch.com/pediatrics/fast_growth_after_preterm_birth_linked_to_persistent_neurocognitive_ability/8021/

http://dx.doi.org/10.1002/acr.22475



Video Game Violence May Not Increase Violent CrimeMedicalResearch.com Interview with:

Christopher J. Ferguson PhD.Associate Professor and Chair of Psychology

Department of PsychologyStetson University DeLand, FL


• Dr. Ferguson: People have debated whether media violence contributes to societal violence for centuries. A lot of individual laboratory experiments have tried to answer this question, but results have always tended to be inconsistent. Not too much data had yet looked at concordance between media violence and societal violence. In the current study I examined levels of movie violence across the 20th century, and video game violence in the latter part of the 20th, into the 21st century. Results generally indicted that it was not possible to demonstrate that media violence consumption correlated with increased crime in society.


• Dr. Ferguson: I think we have to be much more cautious about trying to link media and societal violence. The data just aren’t there for there to be clear links. That’s not to say people aren’t influenced by media at all, of course, but how we respond to media may be much more complex than simply “monkey see, monkey do.” Different people may respond to the same media very differently. A violent movie might calm one person down, yet agitate another…yet you may see the same response for different people from a non-violent movie. We need to be a lot more sophisticated with the research.


http://medicalresearch.com/general-medicine/video_game_violence_may_not_increase_violent_crime/8828/

http://medicalresearch.com/author-interviews/accidents_and_violence_account_for_most_deaths_among_us_young_people/6142/

http://medicalresearch.com/pediatrics/gun-violence-pg-13-movies-tripled-since-1985/2727/



Video Game Violence May Not Increase Violent CrimeMedicalResearch.com Interview with:

Christopher J. Ferguson PhD.Associate Professor and Chair of Psychology

Department of PsychologyStetson University DeLand, FL


• Dr. Ferguson: It would be really interesting to investigate the interrelationships between how social narratives about media are formed (i.e. video games are bad) and how these social narratives fuel the statements and findings of politicians, advocates and scientists. We really need to understand better the mechanisms by which moral panics form and ultimately decline.

• Citation:

• Ferguson, C. J. (2014), Does Media Violence Predict Societal Violence? It Depends on What You Look at and When. Journal of Communication. doi: 10.1111/jcom.12129

•



http://medicalresearch.com/pediatrics/violent_video_games_linked_to_aggressive_thought_patterns_and_behavior_in_children/4381/



Scientists Identify Factors That Promote Breast Cancer MetastasesMedicalResearch.com Interview with:

Antoine E. Karnoub, Ph.D.Assistant Professor of Pathology

Beth Israel Deaconess Medical CenterHarvard Medical School Center for Life Science 0634


• Dr. Karnoub: The main findings of the study are:

• (1) that the metastatic propensities of cancer cells can be remarkably modulated by otherwise ‘normal’ mesenchymal stem/stromal cells found in their vicinity;(2) that generation of highly malignant tumor-initiating cells can be significantly triggered by microenvironmental cues;(3) that repression of the gene FOXP2 by a miR-199a-led microRNA network enables the propagation of cancer stem cell and metastatic traits in otherwise weakly metastatic cancer cells; and(4) that such a signaling axis appears to forecast poor patient outcome.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/scientists_identify_factors_that_promote_breast_cancer_metastases/8834/






• Medical Research: What was most surprising about the results?

• Dr. Karnoub: There are three surprising aspects of the findings.

• The first was the unexpected identification of a role for FOXP2, a gene that is otherwise linked to vocalization, speech, and language development, in human breast cancer pathogenesis.

• The second was the finding that such a gene was controlled not by one, but a series of interconnected molecules that conspire to inhibit its expression in the context of malignancy – perhaps an indication of multiple fail-safe mechanisms through which malignant cells can attenuate its expression.

• The third was that suppression of FOXP2 was sufficient, on its own, in propagating malignant traits in the cancer cells. These aspects altogether suggest that FOXP2 serves an important and perhaps determining role in malignant breast cancer.









• Dr. Karnoub: There are two aspects of our work that have particular translational pertinence. First, we have identified a new set of players that regulate breast cancer malignancy. We have indicative evidence that the levels of such players, i.e., the levels of miR-199a, its miRnetwork, and FOXP2, in human primary breast tumors correlate with overall patient survival, metastasis outcome, and relapse. Although these findings are consistent with the premise that such molecules are prognostic in breast cancer, more work is needed to affirm this notion in larger clinical cohorts. Then and only then will clinicians be able to use miR-199a and/or FOXP2 levels in tumor biopsies to risk-stratify patients upon diagnosis.

• The second has to do with the therapeutic opportunities of diagnosed patients. It is possible that the sustenance of certain metastases depends upon the abilities of malignant cancer cells in these outgrowths to maintain expression of high levels of miR-199a, and/or low levels of FOXP2. If so, then therapeutics aimed at inhibiting miR-199a levels (therefore restoring FOXP2 normalcy) may prove efficacious in combating metastatic disease.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/gene_associated_with_benign_breast_tumors_discovered/6582/







• Dr. Karnoub: There are a number of questions that need to be answered, and we seem to be only at the beginning of this story. The translational aspects of the work, as we mention above, are useful and important aspects that can impact patient management down the line, and those represent natural avenues for future investigations that will assess the relevance of FOXP2 and its regulatory miR network as biomarkers and therapeutic targets in malignant breast (and perhaps other) cancers. From the pure scientific point of view, there are many questions that need to be investigated, but I think the most important revolves around determining what FOXP2 does in the normal setting, so that we understand how its inhibition promotes cancer progression.

• Citation:

• Benjamin G. Cuiffo, Antoine Campagne, George W. Bell, Antonio Lembo, Francesca Orso, Evan C. Lien, Manoj K. Bhasin, Monica Raimo, Summer E. Hanson, Andriy Marusyk, DorrayaEl-Ashry, Peiman Hematti, Kornelia Polyak, Fatima Mechta-Grigoriou, Odette Mariani, Stefano Volinia, Anne Vincent-Salomon, Daniela Taverna, Antoine E. Karnoub. MSC-Regulated MicroRNAs Converge on the Transcription Factor FOXP2 and Promote Breast Cancer Metastasis. Cell Stem Cell, 2014;DOI: 10.1016/j.stem.2014.10.001



http://medicalresearch.com/author-interviews/pancreatic_canccer_mmp3_drives_progression/5493/

http://dx.doi.org/10.1016/j.stem.2014.10.001



Not All Fat Contributes Equally To Metabolic Syndrome RiskMedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD

Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology Divisions),University of Michigan, Ann Arbor, Michigan and

Dr. Ravi Shah MD Cardiology Division, Department of MedicineMassachusetts General Hospital, Boston, Massachusetts

• Response: Prior studies in Framingham, MESA and other cohorts have demonstrated that obesity is an important risk factor for the metabolic syndrome. However, the observations that many non-obese individuals develop metabolic syndrome and diabetes and, conversely, that not all obese individuals develop these complications has motivated the search for better markers of risk than BMI. More recently, it has been shown that the location of adipose tissue is an important factor. The amount of visceral fat, which is thought to be more harmful from a metabolic perspective, can be accurately quantified with CT imaging. In many prior studies, waist circumference has been used as an approximate measure of visceral adiposity.

• For this study, we analyzed data from the Multi-Ethnic Study of Atherosclerosis (MESA). We found that the amount of visceral fat (as quantified by CT) was an important predictor of metabolic syndrome, even after adjusting for weight, waist circumference, gender, race, smoking, exercise, serum lipids and glucose. Each additional 100 cm2/m of height of visceral fat was associated with a 29% increase in the risk of developing metabolic syndrome. In contrast, subcutaneous fat burden (also quantified by CT) was a much weaker predictor.

• One of the very novel findings of our study arises from an analysis of subjects who had multiple CTs longitudinally in MESA. Using these data, we found that change in visceral fat burden was associated with a corresponding 5% increase in the risk of metabolic syndrome. In part, this is because very small changes in weight could result in very large changes in visceral fat.


http://medicalresearch.com/weight-research/not_all_fat_contributes_equally_to_metabolic_syndrome_risk/8699/

http://medicalresearch.com/diabetes/genetically_elevated_bmi_raises_risks_of_hypertension_and_diabetes/4061/



Not All Fat Contributes Equally To Metabolic Syndrome RiskMedicalResearch.com Interview with: Venkatesh L. Murthy, MD, PhD

Department of Medicine (Cardiovascular Medicine Division) and Department of Radiology Divisions),University of Michigan, Ann Arbor, Michigan and

Dr. Ravi Shah MD Cardiology Division, Department of MedicineMassachusetts General Hospital, Boston, Massachusetts


• Response: Visceral fat is an important predictor of metabolic risk. While CT scans could be used to assess this in a way that might improve risk assessment over standard clinical measures such as weight and waist circumference, this is not yet widely feasible, but may be in the future. When patients gain (or lose weight), the change in the visceral fat compartment are far more important than changes in the subcutaneous fat compartment in terms of metabolic health.


• Response: The weight changes we saw over time were largely outside of organized medical and surgical weight loss programs. Consequently, most patients only had modest weight changes over the study period. It will be interesting to see how these data translate to cohorts losing large amounts of weight using surgical or medical strategies. This could offer insights into the metabolic benefits of these weight loss strategies

• Citation:

• Shah RV, Murthy VL, Abbasi SA, et al. Visceral Adiposity and the Risk of Metabolic Syndrome Across Body Mass Index: The MESA Study. J Am Coll Cardiol Img. 2014;():. doi:10.1016/j.jcmg.2014.07.017.



http://medicalresearch.com/author-interviews/promising-approach-treat-non-alcoholic-fatty-liver-disease-visceral-obesity/3870/

http://medicalresearch.com/weight-research/small_weight_loss_differences_between_brand_diet_plans/7316/

http://imaging.onlinejacc.org/article.aspx?articleID=1921654



Childhood Pneumococcal Vaccine Linked To Sharp Decline In HospitalizationsMedicalResearch.com Interview with:

Marie R Griffin MD MPHDirector, Vanderbilt MPH Program

Department of Health Policy Vanderbilt University Medical Center Nashville TN 37212


Dr. Griffin: In Tennessee, the introduction in 2010 of a new pneumococcal vaccine for infants and young children was associated with a 27 percent decline in pneumonia hospital admissions across the state among children under age 2. The recent decline in Tennessee comes on top of an earlier 43 percent decline across the United States associated with the introduction in 2000 of the first pneumococcal vaccine for children under 2 years of age.


• Dr. Griffin: Pneumococcus (streptococcus pneumoniae) is considered a leading cause of childhood pneumonia. The earlier vaccine (7-valent pneumococcal conjugated vaccine) provided protection against the seven most common strains of the bacterium, while the newer vaccine protects against 13 strains. Use of these vaccines have dramatically reduced the risk for serious pneumonia in young children.


http://medicalresearch.com/infections/childhood_pneumococcal_vaccine_linked_to_sharp_decline_in_hospitalizations/8839/

http://medicalresearch.com/infections/pcv13-pneumococcal-vaccine-markedly-protects-elderly/8375/

http://medicalresearch.com/critical-care-intensive-care-icus/pneumonia-improved-antibiotic-strategies-decreased-mortality/3253/



Childhood Pneumococcal Vaccine Linked To Sharp Decline In HospitalizationsMedicalResearch.com Interview with:

Marie R Griffin MD MPHDirector, Vanderbilt MPH Program

Department of Health Policy Vanderbilt University Medical Center Nashville TN 37212


• Dr. Griffin: The data come from the Tennessee Hospital Discharge Data System, which records data (including diagnosis and procedure codes) from hospitalizations and emergency department visits from all non-federal hospitals in Tennessee. There’s a push for public health practitioners to use data to describe what’s happening locally, and then to react to those data to improve health. Now that these data are available electronically, we should be able to monitor disease trends in a timely way. This should help determine other ways to continue to lower the risk of pneumonia.

• Citation:

• Declines in Pneumonia Hospitalizations of Children Aged <2 Years Associated with the Use of Pneumococcal Conjugate Vaccines — Tennessee, 1998–2012Morbidity and Mortality Weekly Report (MMWR)

•

• Weekly

• November 7, 2014 / 63(44);995-998



http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6344a3.htm?s_cid=mm6344a3_w







Why Do Women Have A Better Sense of Smell?MedicalResearch.com Interview with:

Prof. Roberto LentDiretor, Instituto de Ciências Biomédicas

Centro de Ciências da Saúde, Bloco K, sala 2-35Universidade Federal do Rio de Janeiro


Prof. Lent: Our group has been studying the absolute numbers of cells in the human brain, using a novel technique that we have developed. We have done it forthe whole male brain, and arrived at a figure of 86 billion neurons and 85billion glial cells, 15% less than the round number that became a neuromyth(one hundred billion neurons). We did it also for the demented brain, inthis case working with females, and showed that it is dementia that isassociated with a loss of neurons, because people with alzheimer, but nodementia, displayed normal numbers of neurons.

• The present paper focuses on sexual dimorphism in the olfactory bulb, andrevealed that women have around 40% more neurons and glial cells than men,what correlates with their superior performance in many olfactoryabilities.


http://medicalresearch.com/author-interviews/women-better-sense-smell/8842/

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



Why Do Women Have A Better Sense of Smell?MedicalResearch.com Interview with:

Prof. Roberto LentDiretor, Instituto de Ciências Biomédicas

Centro de Ciências da Saúde, Bloco K, sala 2-35Universidade Federal do Rio de Janeiro


Prof. Lent: In this work, we have only employed brains of healthy people, so at thispoint there is nothing to say about diseases, yet. However, the olfactorybulb, our target in this paper, is inflicted by Alzheimer‘s pathology, soour next step will be to explore how the disease alters the cellcomposition of this structure.


Prof. Lent: One of the issues that interests us very much is sexual dimorphism, thatis, the differences in brain morphology and human behavior and cognitiondetermined by sex. We plan to explore other regions of the brain for thispurpose. This effort will give us a quantitative scenario concerning themain processing units in the brain, that could be related to thepsychological and psychiatric differences between the sexes.

• Citation:

• Ana V. Oliveira-Pinto, Raquel M. Santos, Renan A. Coutinho, Lays M. Oliveira, Gláucia B. Santos, Ana T. L. Alho, Renata E. P. Leite, José M. Farfel, Claudia K. Suemoto, Lea T. Grinberg, Carlos A. Pasqualucci, Wilson Jacob-Filho, Roberto LentPublished: November 05, 2014 DOI: 10.1371/journal.pone.0111733



http://medicalresearch.com/mental-health-research/alzheimers-dementia/neurotic_symptoms_in_midlife_may_presage_alzheimers_dementia/8108/

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0111733





Young Adults Males Need More Hypertension EducationMedicalResearch.com Interview with:

Heather M. Johnson, MD, MS Assistant Professor of MedicineCo-Director, UW Advanced Hypertension Program

Department of Medicine, Cardiovascular Medicine DivisionUniversity of Wisconsin School of Medicine and Public Health


• Dr. Johnson: Our study addresses the public health burden that young adults have significantly lower hypertension control rates compared to middle-aged and older adults. The development of incident (new) hypertension is an important “teachable moment” to educate young adults about necessary lifestyle changes to lower blood pressure.

• Medical Research: What are the main findings?

• Dr. Johnson: We retrospectively evaluated the electronic health record of 500 randomly selected young adults (18-39 years old) with incident hypertension for documentation of lifestyle modification counseling. Our primary finding is that only 55% of young adults had lifestyle education documented within one year of developing incident hypertension. Young adult males had significantly lower rates of receiving documented education.


http://medicalresearch.com/author-interviews/young_adult_males_need_more_hypertension_education/8844/

http://medicalresearch.com/author-interviews/reimbursing-patients-home-blood-pressure-monitors-may-make-business-sense/6417/



Young Adults Males Need More Hypertension EducationMedicalResearch.com Interview with:

Heather M. Johnson, MD, MS Assistant Professor of MedicineCo-Director, UW Advanced Hypertension Program

Department of Medicine, Cardiovascular Medicine DivisionUniversity of Wisconsin School of Medicine and Public Health

• Medical Research: What should clinicians and patients take away from your report?• Dr. Johnson: For clinicians, our research highlights the need for primary care interventions to provide effective lifestyle

modification counseling with ongoing monitoring and support of behavior change. Primary care providers have a daily challenge of managing multiple competing demands and have very limited time for intensive lifestyle education. In addition, we demonstrate a need to address lower rates of hypertension lifestyle education among young males.

• We would like to encourage patients to discuss their blood pressure during primary care visits. Patients should be aware that healthy behaviors such as regular exercise, weight loss, and a low sodium diet can lower blood pressure and help prevent future heart disease.Medical Research: What should clinicians and patients take away from your report?

• Dr. Johnson: For clinicians, our research highlights the need for primary care interventions to provide effective lifestyle modification counseling with ongoing monitoring and support of behavior change. Primary care providers have a daily challenge of managing multiple competing demands and have very limited time for intensive lifestyle education. In addition, we demonstrate a need to address lower rates of hypertension lifestyle education among young males.

• We would like to encourage patients to discuss their blood pressure during primary care visits. Patients should be aware that healthy behaviors such as regular exercise, weight loss, and a low sodium diet can lower blood pressure and help prevent future heart disease.

• What recommendations do you have for future research as a result of this study?• Dr. Johnson: Future research is needed to identify additional barriers to hypertension control in young adults. Young adults

with hypertension have a significantly elevated risk of cardiovascular events, including stroke and heart failure. Controlling hypertension among young adults will have a significant public health benefit.

• Citation:• Johnson, H.M. et al. Documented Lifestyle Education Among Young Adults with Incident Hypertension. Journal of General

Internal Medicine, November 2014 DOI: 10.1007/s11606-014-3059-7



http://medicalresearch.com/author-interviews/better_fitness_lower_blood_pressure/7598/

http://medicalresearch.com/author-interviews/community_interventions_improved_blood_pressure_control_in_diverse_populations/8561/

http://medicalresearch.com/author-interviews/higher_protein_intake_linked_to_lower_blood_pressure/7765/

http://dx.doi.org/10.1007/s11606-014-3059-7



Does Dental Trauma Play A Role in Oral Cavity Cancer?MedicalResearch.com Interview with:

Brendan J. Perry, BSc, MBBSPrincess Alexandra Hospital

Brisbane, Queensland, Australia

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Brendan J. Perry: Oral cavity cancer is usually attributed to the “Five S’s” – smoking, spirits

(alcohol), spices, syphillis and sharp (or septic) teeth. Cigarettes and alcohol are the most important recognised factors. Spices, such as betel nut, and syphillis are known carcinogens but are not commonly seen in western practice. The role of chronic dental trauma on the mucosa of the mouth to cause cancer has only been examined in a limited number of studies previously and its importance has not been elucidated and has never really affected clinical practice.

• This retrospective review examined the position in the oral cavity where cancers occurred with respects to smoking status and other variables over a 10 year period in a major Australian hospital. The edge of the tongue, a site of potential dental trauma, was the most common site affected, accounting for 35% of oral cavity cancers in smokers. However, in lifelong non-smokers without other significant risk factors, 65% of cancers occurred on the edge of the tongue. A significant number also occurred on the buccal mucosa (inner lining of cheek) which is also exposed to dental trauma, but to a much lesser degree than the more mobile tongue. The floor of the mouth and the alveolar ridge (gums) were also common sites of cancer, but tended to occur in an older age group. This is possibly due to irritation caused by the movement of dentures in this age group against these areas of the mouth.

• We also found that males had an equal chance of developing oral cavity versus oropharyngeal cancer (255 cases vs 265). However, females are almost twice as likely to develop an oral cavity cancer than an oropharyngeal cancer (135 cases vs 69), and this ratio jumps to 4 times the risk for lifelong non-smoking females (53 vs 12). Although a lot of attention has been given to HPV in causing oropharyngeal cancer, for non-smokers, especially females, it appears that oral cavity cancer is a more common disease, and also that chronic dental trauma may be a significant contributing factor.


http://medicalresearch.com/cancer-_-oncology/does_dental_trauma_play_a_role_in_oral_cavity_cancer/8848/






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

• Dr. Brendan J. Perry: Smoking and alcohol still appear to be the most important factors in developing oral cavity cancers. In Queensland currently, a non-smokers is 50% more likely to develop an oral cavity cancer than an oropharyngeal cancer. These cancers are also most likely to occur in areas of the mouth where teeth rub and potentially irritate. In smokers, these cancers are spread diffusely around the mouth reflecting the field change caused by cigarette smoke. However, they also tend to occur more commonly at sites of chronic dental trauma, which may potentiate the effect of cigarettes. A carcinogen is affecting the edge of the tongue, especially in non-smokers, and we purport that dental trauma is the most likely culprit.

• Chronic trauma within the mouth, whether from native teeth rubbing chronically against the tongue or cheek, or from dentures irritating the mucosa of the floor of the mouth or alveolar ridge, may be carcinogenic. Head and neck surgeons, dentists and family doctors should be aware of this potential carcinogen and aim to identify and rectify dental abnormalities occurring in close proximity to pre-malignant and malignant tumours.








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

• Dr. Brendan J. Perry: As dental trauma is not a major recognised carcinogen, most medical records do not record this information. This was apparent in our study. However, in a significant number of cases, dental abnormalities were noted to be in close proximity to the site of tumour development, particularly as our clinicians became more aware of this possible carcinogen. We are currently examining dental histories on these patients to see if any abnormalities were apparent close to cancer site occurrence. Prospectively following patients who have dental work to correct abnormalities in close proximity to pre-malignant lesions may also yield interesting results.

• We are also currently examining our 87 non-smoking oral cavity cancer patients’ pathology to test for HPV status. HPV is known to implant at sites of chronic dental trauma so may be a contributing factor in the carcinogenesis at these irritated sites within the oral cavity.

• Citation:

• Perry BJ, Zammit AP, Lewandowski AW, et al. Sites of Origin of Oral Cavity Cancer in Nonsmokers vs Smokers: Possible Evidence of Dental Trauma Carcinogenesis and Its Importance Compared With Human Papillomavirus. JAMA Otolaryngol Head Neck Surg. Published online November 06, 2014. doi:10.1001/jamaoto.2014.2620.



http://medicalresearch.com/cancer-_-oncology/does_dental_trauma_play_a_role_in_oral_cavity_cancer/8848/ Perry BJ, Zammit AP, Lewandowski AW, et al. Sites of Origin of Oral Cavity Cancer in Nonsmokers vs Smokers: Possible Evidence of Dental Trauma Carcinogenesis and Its Importance Compared With Human Papillomavirus. JAMA Otolaryngol Head Neck Surg. Published online November 06, 2014. doi:10.1001/jamaoto.2014.2620. http:/



Age-Related Macular Degeneration: SD-OCT Imaging Predicts Dry To Wet ProgressionMedicalResearch.com Interview with:

Byers Eye Institute at StanfordStanford University School of Medicine

Palo Alto, CA 94303

• Dr. Leng: What is the background for this study? What are the main findings?

• Medical Research: Age-related macular degeneration (AMD) is the leading cause of blindness and central vision loss among adults older than 65 years. 80-85% of patients have the dry, non-exudative, form of the disease, but the wet, exudative, form of advanced AMD is of primary concern as it accounts for a majority of severe vision loss in Age-related macular degeneration. In wet AMD, abnormal blood vessels grow under the retina and can leak blood and fluid.

• Until now, there has been no effective way to tell which patients with dry AMD are likely to progress to the wet stage. In our recent Investigative Ophthalmology & Visual Science article, we describe a new mathematical model that can predict which patients are likely to progress.

• The predictive model identifies likely progressors by analyzing 3D spectral domain optical coherence tomography (SD-OCT) retinal imaging data that’s routinely obtained during retinal encounters.

• We analyzed data from 2,146 SD-OCT scans of 330 eyes in 244 patients seen at The Byers Eye Institute at Stanford over a five-year period. We found that the area and height of drusen, the amount of reflectivity at the macular surface and the degree of change in these features over time, could be weighted to generate a patient’s risk score. Predictions from the model were compared with cases where patients actually progressed to wet Age-related macular degeneration. Our model accurately predicted every occurrence of progression within a year. There was a false positive rate of around 40%, but we thought this was a good tradeoff because we would not miss any potential progressors by using this sensitivity threshold.


http://medicalresearch.com/ophthalmology/age_related_macular_degeneration_sdoct_predicts_dry_to_wet_progression/8852/

http://www.iovs.org/content/55/11/7093.abstract



Age-Related Macular Degeneration: SD-OCT Imaging Predicts Dry To Wet ProgressionMedicalResearch.com Interview with:

Byers Eye Institute at StanfordStanford University School of Medicine

Palo Alto, CA 94303


• Dr. Leng: Previously proposed predictive models have shown some accuracy over long periods of time, but 3 and 5 year predictions about Age-related macular degeneration progression are not clinically useful when you are trying to schedule a follow up visit for a patient in front of you in clinic. Our model allows the clinician to know with great accuracy, which patients within one year will progress. That will allow retina specialists to better schedule follow up and monitoring visits for their dry Age-related macular degeneration patients.


• Dr. Leng: This was a proof-of-principle study using retrospective data. It will need to be validated by a larger prospective study. We are currently in the planning stages of such a study.

• Citation:

• Quantitative SD-OCT Imaging Biomarkers as Indicators of Age-Related Macular Degeneration Progressionde Sisternes L, Simon N, Tibshirani R, Leng T, Rubin DLInvest Ophthalmol Vis Sci. 2014 Oct 9. pii: IOVS-14-14918. doi: 10.1167/iovs.14-14918. [Epub ahead of print]



http://medicalresearch.com/general-medicine/age-related-macular-degeneration/8658/

http://www.ncbi.nlm.nih.gov/pubmed/25301882





CT Screening For Lung Cancer Can Be Cost-Effective If Right Patients Offered ScreeningMedicalResearch.com Interview with:

William C. Black, MDProfessor of Radiology Department of Radiology

Dartmouth-Hitchcock Medical CenterLebanon, NH 03756


• Dr. Black: Lung cancer is the leading cause of cancer related death in the U.S., killing more people than cancers of the colon, breast, and prostate combined. In 2011, the National Lung Screening Trial (NLST) demonstrated that screening for lung cancer with low-dose CT could reduce lung cancer mortality by 20% in adults at high risk for the disease. Since then, several medical organizations have recommended that eligible adults be offered screening. The U.S. Preventive Services Task Force (USPSTF) released a grade B recommendation for low-dose CT screening in December 2012, which means that private insurers must cover the cost of screening by January 1, 2015. The Centers for Medicare and Medicaid (CMS) is expected to issue a final decision on national coverage for CT screening in February 2015 and a preliminary decision for public comment on November 10, 2014.


• Dr. Black: The main finding in our paper was that CT screening for lung cancer appears to have been cost-effective in the NLST, with an incremental cost-effectiveness ratio of about $81,000 per quality-adjusted life year gained. However, this ratio varied widely in the subset and sensitivity analyses. In other words, for CT screening to be cost effective, the right patients must be offered screening, those who accept must be screened in the proper manner, and treatment must be safe and effective.


http://medicalresearch.com/cancer-_-oncology/lung-cancer/ct_screening_for_lung_cancer_can_be_cost_effective/8858/

http://medicalresearch.com/cancer-_-oncology/lung-cancer-screening-with-low-dose-ct/1295/

http://medicalresearch.com/cancer-_-oncology/lung-cancer/lung-cancer-annual-ct-screening-high-risk-patients/3233/



CT Screening For Lung Cancer Can Be Cost-Effective If Right Patients Offered ScreeningMedicalResearch.com Interview with:

William C. Black, MDProfessor of Radiology Department of Radiology

Dartmouth-Hitchcock Medical CenterLebanon, NH 03756


• Dr. Black: That CT screening for lung cancer can be cost-effective if it is properly implemented. However, screening should only be offered to those who are eligible, patients should be well informed of the expected benefits and harms, and the screening should take place at a facility with a high level of expertise CT screening and coordinated care. For current smokers, the most important thing they can do is stop smoking.


• Dr. Black:

• Close monitoring of screening implementation in the U.S.

• Further investigation of informed decision making.

• Further investigator of CT interpretation and patient management.

• Citation:

• William C. Black, M.D., Ilana F. Gareen, Ph.D., Samir S. Soneji, Ph.D., JoRean D. Sicks, M.S., Emmett B. Keeler, Ph.D., Denise R. Aberle, M.D., Arash Naeim, M.D., Timothy R. Church, Ph.D., Gerard A. Silvestri, M.D., Jeremy Gorelick, Ph.D., and Constantine Gatsonis, Ph.D. for the National Lung Screening Trial Research Team

• N Engl J Med 2014; 371:1793-1802November 6, 2014DOI: 10.1056/NEJMoa1312547



http://medicalresearch.com/cancer-_-oncology/selection-criteria-for-lung-cancer-screening/447/

http://www.nejm.org/doi/full/10.1056/NEJMoa1312547






Fast Food Marketing Targets Middle Income, Black and Rural KidsMedicalResearch.com Interview with

Punam Ohri-Vachaspati, Ph.D.,R.D Associate Professor, NutritionArizona State University

School of Nutrition and Health PromotionCollege of Health Solutions Phoenix, AZ 85004


• Dr. Ohri-Vachaspati: Fast food is heavily marketed to kids — with the food industry spending over $700 million each year to market their products specifically to children and adolescents. About half of this money goes towards premiums like toys given away with kids meals. And marketing works –exposure to food marketing is associated with higher fast food consumption among children. Research has shown us that 2-18 year olds consume 13% of their total calories at fast food restaurants. Children who eat at fast food restaurants are likely to have poor diets and worse health outcomes.

• In this study we wanted to examine which communities are more vulnerable to child-directed marketing on the interior and exterior of fast food restaurants. Over a three year period (2010, 2011, and 2012) we sampled nearly 7000 restaurants from a whole spectrum of communities across the US. Child-directed marketing measured inside fast food restaurants included indoor play area and display of kids’ meal toys, and on the exterior included advertisements with cartoon characters, advertisements with movie, TV or sports figures, and advertisements for kids’ meal toys among others.We found that more than a fifth of fast food restaurants used child-directed marketing on the inside or on the exterior of their premises. Middle-income communities, majority black communities and rural areas were disproportionately exposed to this type of child-directed marketing.


http://medicalresearch.com/author-interviews/fast_food_marketing_targets_middle_income_black_and_rural_kids/8867/



Fast Food Marketing Targets Middle Income, Black and Rural KidsMedicalResearch.com Interview with

Punam Ohri-Vachaspati, Ph.D.,R.D Associate Professor, NutritionArizona State University

School of Nutrition and Health PromotionCollege of Health Solutions Phoenix, AZ 85004

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

• Dr. Ohri-Vachaspati: Awareness that fast food marketing to children is prevalent and it can impact children’s diets. Also, that there is higher prevalence of such marketing in middle-income, rural, and majority black communities — communities that are already disproportionately affected by poor diets and health. As clinicians work with children and their parents, they may want to tailor their messages to help parents and children develop strategies to make healthy choices and to help them understand how food marketing can impact their decisions.


• Dr. Ohri-Vachaspati: Future research should continue to track fast food marketing to children on the interior and exterior of fast food restaurants to monitor changes as marketing in other venues and media becomes more restricted as a result of various initiatives. Also, future research should examine the extent to which industry and public policy initiatives address child-directed marketing inside and on the exterior of restaurants.

• Citation:• Fast food marketing for children disproportionately affects certain communities• Punam Ohri-Vachaspati from Arizona State University; Zeynep Isgor, Leah Rimkus, Lisa M. Powell,

and Frank J. Chaloupka from the Institute for Health Research and Policy at the University of Illinois at Chicago; and Dianne C. Barker from Barker Bi-Coastal Health Consultants, Inc. in Calabasas, California.





Surgical Quality Enhanced By Electronics Records DataMedicalResearch.com Interview with:

Jamie Anderson MD MPHDepartment of Surgery

University of California, San Diego

• Medical Research: What is the background for this study? What are the main findings?• Dr. Anderson: Risk adjustment is an important component of outcomes and quality analysis in

surgical healthcare. To compare two hospitals fairly, you must take into account the “risk profile” of their patients. For example, a hospital operating on predominately very sick patients with multiple co-morbidities would be expected to have different outcomes to a hospital operating on relatively healthier patients with fewer co-morbidities. Somewhat counter-intuitively, it is possible that a hospital with a 10% mortality rate may be better than a hospital with 5% mortality rate when you adjust for the risk of the patient population.

• Currently, the “gold standard” database to evaluate surgical outcomes is the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), which includes a number of variables on each patient to perform risk adjustment. However, collecting these variables is costly and time consuming. There is also concern that risk adjusted benchmarking systems can be “gamed” because they include data elements that require subjective interpretation by hospital personnel.

• With the widespread adoption of electronic health records, the aim of this study was to determine whether a number of objective data elements already used for patient care could perform as well as a traditional, full risk adjustment model that includes other provider-assessed and provider-recorded data elements.

• We tested this hypothesis with an analysis of the NSQIP database from 2005-2010, comparing models that adjusted for all 66 pre-operative risk variables captured by NSQIP to models that only included 25 objective variables. These results suggest that rigorous risk adjusted surgical quality assessment can be performed relying solely on objective variables already captured in electronic health records.


http://medicalresearch.com/author-interviews/collecting_data_from_electronic_records_may_enhance_surgical_quality/8802/

http://medicalresearch.com/author-interviews/electronic_health_records_can_present_patient_safety_concerns/5976/


http://medicalresearch.com/author-interviews/simple_nucleic_acid_measurement_may_enhance_bedside_diagnosis/8601/

Surgical Quality Enhanced By Electronics Records DataMedicalResearch.com Interview with:

Jamie Anderson MD MPHDepartment of Surgery

University of California, San Diego

• Medical Research: What should clinicians and patients take away from your report?• Dr. Anderson: By leveraging data that are already regularly collected for patient care, this approach is a

more efficient use of data already collected for patient care. While we are still several steps away from putting these findings into practice, we are hopeful that this research will open the door to expand risk-adjusted quality improvement studies to all hospitals, especially those in rural or underserved areas that don’t have the resources to devote solely to examining their outcomes.

• Medical Research: What recommendations do you have for future research as a result of this study?• Dr. Anderson: The next step will be putting these findings into practice. This requires developing new ways

to easily use electronic health records for quality purposes. Electronic health records are designed to assist with medical communication and billing, but it is not always easy to use this information to evaluate quality and outcomes.

• Furthermore, the private sector has a plethora of databases that could be linked to patient data in innovative ways, from tracking purchasing patterns of healthy food or over-the-counter medicines to using global positioning system (GPS) technology (now embedded in many personal handheld devices) to record patient exercise regimens or identify geographical disease “hot spots.” In our data-driven environment in which technology will continue to become an integral part of our daily lives, the possibilities are endless. In the future, it is not inconceivable that we will be able to perform retrospective analyses of complex databases with the same rigor as prospective trials. Hiring additional personnel for the sole purpose of data collection may become outdated in the era of “big data.” However, with these advances, we must continue to be diligent about protecting patient information.

• Citation:• Anderson JE, Chang DC. Using Electronic Health Records for Surgical Quality Improvement in the Era of Big

Data. JAMA Surg. Published online November 05, 2014. doi:10.1001/jamasurg.2014.947. •


http://medicalresearch.com/author-interviews/collecting_data_from_electronic_records_may_enhance_surgical_quality/8802/

http://medicalresearch.com/infections/hiv/poor_urban_dwellers_at_greater_risk_of_contracting_dying_from_aids/4795/

http://archsurg.jamanetwork.com/article.aspx?articleid=1920836



Living To Extreme Old Age Influenced By Genetics, HDL CholesterolMedicalResearch.com Interview with:

Sofiya Milman, M.D.Assistant Professor of Medicine

Divisions of Endocrinology and GeriatricsAlbert Einstein College of Medicine


• Dr. Milman: Aging is a major risk factor for many diseases, including cardiovascular disease, dementia, and diabetes. Yet, individuals with exceptional longevity delay the onset of most diseases and often escape from age-related illnesses altogether. Exceptional longevity is an inherited trait. A unique cholesterol profile has been previously associated with longevity and specific genetic variations. This profile included elevated levels of high-density lipoprotein (HDL) cholesterol or “good” cholesterol and large HDL particles. The present study explored whether elevated HDL cholesterol levels and genes that control HDL cholesterol can predict survival in individuals age 95 years or older.

• The study found that higher levels of HDL cholesterol were related to longer survival in women, but not in men. Higher HDL cholesterol level was also seen in individuals without cognitive problems and diabetes. On the other hand, both men and women with larger HDL particle size and higher levels of APOA1, a protein component of HDL cholesterol, exhibited longer survival. Variants in two genes, the CETP and APOA1, were related to higher HDL cholesterol levels.


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

http://medicalresearch.com/mental-health-research/alzheimers-dementia/high-ldl-low-hdl-levels-elevated-brain-amyloid/3255/



Living To Extreme Old Age Influenced By Genetics, HDL CholesterolMedicalResearch.com Interview with:

Sofiya Milman, M.D.Assistant Professor of Medicine

Divisions of Endocrinology and GeriatricsAlbert Einstein College of Medicine


• Dr. Milman: Exceptional longevity is influenced by genetics and may in part be mediated through HDL cholesterol. Genetic discoveries made in individuals with exceptional longevity inform us about physiological mechanisms that may protect people from age-related diseases.


• Dr. Milman:

• Explore the effect of these genetic variants on survival and longevity in other populations.

• Evaluate if medications that target the function of these genes result in better health outcomes and longer survival.

• Citation:

• 2014 Gerontological Society of America abstract:

High-density Lipoprotein Cholesterol Phenotype and Genotype Predict Survival in Individuals with Exceptional Longevity



http://medicalresearch.com/exercise-fitness/hdl-function-improved-strength-training-even-overweight/2245/

https://www.geron.org/



Multivitamins May Have Little Influence on Cardiovascular DiseaseMedicalResearch.com Interview with: Susanne Rautiainen, PhD

From the Department of Institute of Environmental MedicineKarolinska Institutet, Stockholm, Sweden

Divisions of Preventive Medicine Department of Medicine,Brigham and Women’s Hospital and Harvard Medical School,


• Dr. Rautiainen: Multivitamins are the most commonly used dietary supplement in the US and other developed countries and it has been shown that many take them with the goal of maintaining or improving their health. Multivitamins typically provide low-doses of essential vitamins and minerals to prevent deficiency. Yet many people who take multivitamins are not deficient. Despite the widespread use, limited number of studies have investigated how multivitamins are associated with major chronic diseases, including cardiovascular disease. We therefore examined how self-reported multivitamin use was associated with both short- and long-term risk of cardiovascular diseases in the Women’s Health Study which is a prospective cohort of 37,193 women aged ≥45 years and free of CVD and cancer at baseline.

• In this study of middle-aged and elderly women who were apparently healthy at baseline and followed for an average of 16.2 years, we observed that multivitamin use was not associated with neither short- nor long-term risk risk of major CVD events, including MI, stroke, or CVD death. Moreover, there was no significant association observed for women who had taken multivitamins for ≥10 years at baseline. There were some important indications that the association between multivitamin use and long-term risk of major CVD events may be modified by age and fruit and vegetable intake, suggesting that women who were older and had low fruit and vegetable intake may benefit more from multivitamin supplement use. However, these results should be interpreted with caution. Moreover, relying on self-reports of multivitamin use may be subject to misclassification, plus other unmeasured factors may have biased the results despite our best effort to account for everything.


http://medicalresearch.com/author-interviews/multivitamins_may_have_little_influence_on_cardiovascular_disease/8876/

http://medicalresearch.com/author-interviews/half_of_adults_use_dietary_supplements_on_a_regular_basis/4917/



Multivitamins May Have Little Influence on Cardiovascular DiseaseMedicalResearch.com Interview with: Susanne Rautiainen, PhD

From the Department of Institute of Environmental MedicineKarolinska Institutet, Stockholm, Sweden

Divisions of Preventive Medicine Department of Medicine,Brigham and Women’s Hospital and Harvard Medical School,

• Medical Research: What should clinicians and patients take away from your report?• Dr. Rautiainen: Taken together, today there is limited evidence to recommend for or against the use

of multivitamins in the prevention of cardiovascular disease. A healthy diet characterized by high amounts of fruits and vegetables, whole grains, and fish should be recommended to avoid nutritional deficiencies and in the prevention of chronic diseases such as cardiovascular disease. Whether multivitamins may be beneficial in preventing cardiovascular disease in particular subgroups of individuals remains unknown and in need of further studies such as large-scale randomized clinical trials. Previous results from clinical trials looking at the effect from single high-dose vitamin supplements should not be generalized to multivitamin supplements since they include a mixture of broad spectrum of low-doses of vitamin and minerals.


• Dr. Rautiainen: There is still a great need for studies to understand whether multivitamin supplements can prevent different cardiovascular diseases or its major risk factors, including hypertension, hypercholesterolemia, and diabetes. Future studies should investigate the importance of nutritional status and whether particular subgroups of individuals should be targeted to take multivitamin supplements – or not.

• Citation:• Multivitamin use and cardiovascular disease in a prospective study of women

Susanne Rautiainen, I-Min Lee, Pamela M Rist, J Michael Gaziano, JoAnn E Manson, Julie E Buring, and Howard D SessoAm J Clin Nutr 2015 ajcn.088310; First published online November 5, 2014. doi:10.3945/ajcn.114.088310



http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast-cancer-mortality-multivitamin-mineral-use/2161/

http://medicalresearch.com/medication-research/women_elderly_minorities_underrepresented_in_cardiovasulcar_studies/7965/

http://ajcn.nutrition.org/content/early/2014/11/05/ajcn.114.088310.abstract





Age-Related Macular Degeneration: Computerized Imaging Predicts Risk ProgressionMedicalResearch.com Interview with:

Daniel L. Rubin, MD, MSAssistant Professor of Radiology and Medicine (Biomedical Informatics)

Department of Radiology | Stanford UniversityStanford, CA 94305-5488


• Dr. Rubin: Age-Related Macular Degeneration is the leading cause of blindness and central vision loss among adults older than 65. An estimated 10-15 million people in the United States suffer from the disease, in which the macula — the area of the retina responsible for vision — shows signs of degeneration. While about one of every five people with AMD develop the so-called “wet” form of the disease that can cause devastating blindness. In wet AMD, abnormal blood vessels accumulate underneath the macula and leak blood and fluid. When that happens, irreversible damage to the macula can quickly ensue if not treated quickly. Until now, there has been no effective way to tell which individuals with AMD are likely to convert to the wet stage. Current treatments are costly and invasive —they typically involve injections of medicines directly into the eyeball — making the notion of treating people with early or intermediate stages of Age-Related Macular Degeneration a non-starter. In our study, we report on a computerized method that analyzes images of the retina obtained with a test called spectral domain optical coherence tomography (SD-OCT), and our method can predict, with high accuracy, whether a patient with mild or intermediate Age-Related Macular Degeneration will progress to the wet stage. Our method generates a risk score, a value that predicts a patient’s likelihood of progressing to the wet stage within one year, three years or five years. The likelihood of progression within one year is most relevant, because it can be used to guide a recommendation as to how soon to schedule the patient’s next office visit. In our study, we analyzed data from 2,146 scans of 330 eyes in 244 patients seen at Stanford Health Care over a five-year period. Patients were followed for as long as four years, and predictions of the model were compared with actual instances of conversion to wet AMD. The model accurately predicted every occurrence of conversion to the wet stage of AMD within a year. In approximately 40% of the cases when the model predicted conversion to wet AMD within a year, the prediction was not borne out, however. We are currently refining the model to reduce the frequency of these false positives.


http://medicalresearch.com/radiology/macular_degeneration_computerized_imaging_predicts_risk_progression/8879/

http://medicalresearch.com/author-interviews/age_related_macular_degeneration_if_one_eye_has_it_the_other_eye_more_likely_to_develop_it_as_well/8617/






•

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

• Dr. Rubin: It is important to be able to stratify Age-Related Macular Degeneration patients into risk categories so that the degree of close follow up can be established. Visual outcomes can be improved when conversion to wet AMD occurs by catching that conversion as early as possible and instituting prompt treatment. It is not feasible to screen all Age-Related Macular Degeneration patients very frequently, so it’s currently up to the patient to detect changes in their vision that may indicate conversion to wet AMD, and often by the time patients are seen by ophthalmologists, the disease has advanced. Using our approach, it may be possible to identify the subset of patients who should be evaluated more frequently by ophthalmologists to catch conversion to wet Age-Related Macular Degeneration at the earliest possible stage and to institute specific treatment for wet AMD.



http://medicalresearch.com/general-medicine/age-related-macular-degeneration/8658/







• Dr. Rubin: Our results to date, while promising, have been obtained on data from one institution. We are now undertaking work to validate our methods on data from other institutions, obtained using different SD-OCT scanners. We are also improving the computational method to improve the reliability of its risk prediction.

• Citation:

• Quantitative SD-OCT Imaging Biomarkers as Indicators of Age-Related Macular Degeneration ProgressionLuis de Sisternes, Noah Simon, Robert Tibshirani, Theodore Leng, and Daniel L. RubinIOVS November 2014 55:7093-7103; published ahead of print October 9, 2014, doi:10.1167/iovs.14-14918





Septic Shock Patients Often Require Hospital ReadmissionMedicalResearch.com Interview with:

Mark E Mikkelsen, MD, MSCEAssistant Professor of Medicine

Hospital of the University of Pennsylvania


• Dr. Mikkelsen: Sepsis is common, afflicting as many as 3 million Americans each year. It is also costly, both in terms of health care expenditures that exceed $20 billion for acute care and in terms of the impact it has on patients and their families. To date, studies have focused on what happens to septic shock patients during the initial hospitalization. However, because more patients are surviving sepsis than ever, we sought to examine the enduring impact of septic shock post-discharge. We focused on the first 30 days after discharge and asked several simple questions. First, how often did patients require re-hospitalization after septic shock? And second, why were patients re-hospitalized?

• We found that 23% of septic shock survivors were re-hospitalized within 30 days, many of them within 2 weeks. A life-threatening condition such as recurrent infection was the reason for readmission and 16% of readmissions resulted in death or a transition to hospice.


http://medicalresearch.com/infections/septic_shock_patients_often_required_hospital_readmission/8882/

http://medicalresearch.com/heart-disease/lowering_hospital_readmissions_through_peer_to_peer_coaching/8125/



Septic Shock Patients Often Require Hospital ReadmissionMedicalResearch.com Interview with:

Mark E Mikkelsen, MD, MSCEAssistant Professor of Medicine

Hospital of the University of Pennsylvania


• Dr. Mikkelsen: Clinicians who care for patients with septic shock should be mindful of the road that lays ahead for such patients post-discharge. Through thoughtful collaboration with discharge planning experts and outpatient providers, and increased awareness of what patients will encounter, the opportunity to facilitate a safer transition home and more sustained recovery can be achieved.


• Dr. Mikkelsen: There is an urgent need to better understand what care processes during the acute care hospitalization for sepsis result in better long-term outcomes. There is also an urgent need to identify the aspects of sepsis care and/or sepsis itself that lead to adverse outcomes so that we can modify our approach to care delivery in a way that meets our patients needs in the short- and long-term.

• Citation:

• Alexandra Ortego, David F. Gaieski, Barry D. Fuchs, Tiffanie Jones, Scott D. Halpern, Dylan S. Small, S. Cham Sante, Byron Drumheller, Jason D. Christie, Mark E. Mikkelsen. Hospital-Based Acute Care Use in Survivors of Septic Shock. Critical Care Medicine, 2014; 1 DOI: 10.1097/CCM.0000000000000693



http://medicalresearch.com/infections/sepsis_sniffer_tool_better_identifies_patients_requiring_advanced_care/8300/

http://medicalresearch.com/infections/genetic_signature_provides_early_prediction_of_sepsis_and_organ_failure/8555/

http://dx.doi.org/10.1097/CCM.0000000000000693



Breast Cancer: Overcoming Tumor Resistance With Combinatinon TherapyMedicalResearch.com Interview with:

Ruth Keri, PhD, Professor and Vice Chair Department of PharmacologyCase Western Reserve University School of Medicine, and Associate Director for Basic Research in the Case Comprehensive Cancer

Center Case Western Reserve University


• Dr. Keri: Over the last several decades, the discovery of targeted therapies for certain types of breast cancer, and their use in the clinic, have greatly improved the long-term outcome of patients. Yet some breast cancers don’t respond to these therapies, and ones that do often become resistant over time, resulting in patient relapse and metastatic disease. Why does resistance occur? There are many tricks a tumor employs to evade death. When a drug targets a certain protein or pathway the cancer cell relies on for survival, one potential route of resistance is the cancer cell’s ability to adapt and find another pathway to maintain growth. We reasoned that targeting two separate proteins or pathways important for cancer cell growth may be more effective at preventing or delaying this adaptation.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast_cancer_overcoming_tumor_resistance_with_combination_therapy/8889/

http://medicalresearch.com/cancer-_-oncology/breast-cancer/studying-how-to-stop-breast-cancers-from-coming-back/212/







• Dr. Keri: The PI3K/AKT/mTOR pathway is a major regulator of cell survival, and frequently hyperactive in cancer. However, blocking this signal alone has shown limited clinical efficacy. The class of drugs known as mTOR inhibitors (including rapamycin (sirolimus), temsirolimus, everolimus) frequently result in increased signal to AKT (the survival protein) because the drug also blocks the feedback that normally tries to shut down this signal.

• Another family of proteins, src-family kinases (SFKs), is also dysregulated in cancer cells. Using the drug dasatinib, an SFK inhibitor, we were able to block the increased survival signal that occurred with rapamycin treatment, essentially making the mTOR inhibitor a more effective drug. These studies were performed in several different breast cancer cell lines and mouse models of breast cancer.

• What we ultimately found was that these proteins converged on the same pathway, and when they were both inhibited together, the effect was a profound reduction in tumor size and an increase in time to disease recurrence.

• Medical Research: What should clinicians and patients take away from your report?• Dr. Keri: Interestingly, neither mTOR inhibitors nor dasatinib, when used alone, has been very effective for

the treatment of breast cancer. Recent clinical trials have demonstrated their ability to overcome resistance to targeted therapies, such as in the case of HER2+ breast cancer, or hormone-dependent tumors. However, as mentioned earlier, there is another type of breast cancer, often referred to as triple negative breast cancer, for which there currently are no targeted therapies. Some of the breast cancer models we are using represent these types of tumors, and the combination of rapamycin and dasatinibappears to have similar effects in these models. While both of these drugs are already used clinically, the next step will be to test the safety and efficacy of this combination in patients with advanced disease, who have either failed or become resistant to prior standard-of-care therapies.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/links_between_breast_cancer_and_obesity_studied/6193/

http://medicalresearch.com/cancer-_-oncology/breast-cancer/some_triple_negative_breast_cancer_patients_may_benefit_from_immunotherapy/5729/







• Dr. Keri: A major goal of our research has been to identify a combination therapy that is more successful in treating cancer than what is currently available — however, it is important to keep in mind that even within the same type of cancer, be it breast, ovarian, pancreatic or any other — each tumor is very unique. The success of this or any therapy depends on the ability of the unique tumor to respond. This will require a better understanding of each tumor’s “signature” in an attempt to discern whether it may be responsive to this combination therapy. This can be accomplished in the context of a clinical trial whereby genomic and proteomic assays are used to identify tumor markers that can distinguish tumors that respond to the dual therapy versus those that do not.

• Citation:

• Combined SFK/mTOR Inhibition Prevents Rapamycin-Induced Feedback Activation of AKT and Elicits Efficient Tumor Regression

• Yori JL, Lozada KL, Seachrist DD, Mosley JD, Abdul-Karim FW, Booth CN, Flask CA, Keri RA.Cancer Res. 2014 Sep 1;74(17):4762-71. doi: 10.1158/0008-5472.CAN-13-3627. Epub 2014 Jul 14.PMID: 25023728 [PubMed - in process]



http://medicalresearch.com/cancer-_-oncology/ovarian-cancer/ovarian-cancer_adnex_tool_helps_distinguish_benign_from_malignant_ovarian_cysts/8724/

http://cancerres.aacrjournals.org/content/early/2014/08/16/0008-5472.CAN-13-3627.abstract







Vegan Dieters Lost the Most WeightMedicalResearch.com Interview with:

Brie Turner-McGrievy, Ph.D., M.S., R.D.Assistant ProfessorUniversity of South Carolina; Arnold School of Public Health

Department of Health Promotion, Education, and BehaviorColumbia, SC 29208


• Dr. Turner-McGrievy: Several observational studies have examined differences in weight-related outcomes among individuals following vegan, vegetarian, pesco-vegetarian, semi-vegetarian, or omnivorous diets. These studies have found lower body weights and less weight gain over time among vegans as compared to other groups. However, no randomized controlled trials have tested the relationship between these diets and body weight. So the goal of our study was to determine the effect of varying plant-based diets on weight loss. Our study found that a similar relationship of weight loss was found among the five diet groups that has been observed in epidemiological studies, with weight loss going from greatest in the vegan group followed by vegetarian, pesco-vegetarian, semi-vegetarian, and omnivorous. At six months, the vegan group lost significantly more weight (-7.5 ± 4.5%) than the omnivorous (-3.1 ± 3.6%, P=0.03), semi-vegetarian (-3.2 ± 3.8%, P=0.03), and pesco-vegetarian (-3.2 ± 3.4%, P=0.03) groups.


Vegan Dieters Lost the Most Weight Posted on November 10, 2014 Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant Professor University of South Carolina; Arnold School of Public Health Department of Health Promotion, Education, and Behavior Columbia, SC 29208MedicalResearch.com Interview with: Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant Professor University of South Carolina; Arnold School of Public Health Department of Health Promotion, Education, and Behavior Columbia, SC 29208

http://medicalresearch.com/author-interviews/vegetarian-dietary-patterns-and-mortality/854/




Brie Turner-McGrievy, Ph.D., M.S., R.D.Assistant ProfessorUniversity of South Carolina; Arnold School of Public Health

Department of Health Promotion, Education, and BehaviorColumbia, SC 29208


• Dr. Turner-McGrievy: Our traditional weight loss approaches emphasize calorie reduction by encouraging people to self-monitor their diets. This involves daily tracking of energy intake, which can be burdensome for individuals. Also, people on low calorie diets often report being hungry. Plant-based dietary approaches, such as vegan diets, can allow individuals to eat when they are hungry and until they are full, without having to track calories. This type of approach may appeal to patients who are resistant to dietary self-monitoring.


• Dr. Turner-McGrievy: We hope to do a larger trial with longer-term follow-up. This will help provide additional power to assess differences among the groups and will also allow us to study dietary maintenance. In addition, we hope to measure changes in biological markers such as lipids, glucose, and markers of inflammation.

• Citation:

• Comparative effectiveness of plant-based diets for weight loss: A randomized controlled trial of five different dietsTurner-McGrievy, Gabrielle M. et al.

• Nutrition DOI: http://dx.doi.org/10.1016/j.nut.2014.09.002



http://medicalresearch.com/author-interviews/vegetarian-diet-blood-pressure-lowering-effect/3903/

http://medicalresearch.com/weight-research/weight_loss_intermittent_dieting_/6568/

http://www.nutritionjrnl.com/article/S0899-9007(14)00423-7/abstract






Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant ProfessorUniversity of South Carolina; Arnold School of Public HealthDepartment of Health Promotion, Education, and Behavior

Columbia, SC 29208


• Dr. Turner-McGrievy: Several observational studies have examined differences in weight-related outcomes among individuals following vegan, vegetarian, pesco-vegetarian, semi-vegetarian, or omnivorous diets. These studies have found lower body weights and less weight gain over time among vegans as compared to other groups. However, no randomized controlled trials have tested the relationship between these diets and body weight. So the goal of our study was to determine the effect of varying plant-based diets on weight loss. Our study found that a similar relationship of weight loss was found among the five diet groups that has been observed in epidemiological studies, with weight loss going from greatest in the vegan group followed by vegetarian, pesco-vegetarian, semi-vegetarian, and omnivorous. At six months, the vegan group lost significantly more weight (-7.5 ± 4.5%) than the omnivorous (-3.1 ± 3.6%, P=0.03), semi-vegetarian (-3.2 ± 3.8%, P=0.03), and pesco-vegetarian (-3.2 ± 3.4%, P=0.03) groups.


• Dr. Turner-McGrievy: Our traditional weight loss approaches emphasize calorie reduction by encouraging people to self-monitor their diets. This involves daily tracking of energy intake, which can be burdensome for individuals. Also, people on low calorie diets often report being hungry. Plant-based dietary approaches, such as vegan diets, can allow individuals to eat when they are hungry and until they are full, without having to track calories. This type of approach may appeal to patients who are resistant to dietary self-monitoring.


http://medicalresearch.com/author-interviews/vegan_dieters_lost_the_most_weight/8886/

http://medicalresearch.com/author-interviews/vegetarian-dietary-patterns-and-mortality/854/

http://medicalresearch.com/author-interviews/vegetarian-diet-blood-pressure-lowering-effect/3903/




Brie Turner-McGrievy, Ph.D., M.S., R.D. Assistant ProfessorUniversity of South Carolina; Arnold School of Public HealthDepartment of Health Promotion, Education, and Behavior

Columbia, SC 29208


• Dr. Turner-McGrievy: We hope to do a larger trial with longer-term follow-up. This will help provide additional power to assess differences among the groups and will also allow us to study dietary maintenance. In addition, we hope to measure changes in biological markers such as lipids, glucose, and markers of inflammation.

• Citation:

• Comparative effectiveness of plant-based diets for weight loss: A randomized controlled trial of five different dietsTurner-McGrievy, Gabrielle M. et al.

• Nutrition DOI: http://dx.doi.org/10.1016/j.nut.2014.09.002



http://medicalresearch.com/weight-research/weight_loss_intermittent_dieting_/6568/






Eradicating Hepatitis C In Liver Transplant Patients With Less Toxic Combination TherapyMedical Research.com Interview with:

Surakit Pungpapong, M.D.Transplant Hepatologist

Associate Professor of MedicineMayo Clinic, Jacksonville, Fla.


• Dr. Pungpapong: This study reports our multicenter experience from Mayo Clinic’s three sites using sofosbuvir and simeprevir with/without ribavirin for 12 weeks to treat hepatitis C genotype 1 recurrence after liver transplantation. We found that this all-oral interferon-free antiviral regimen was very well tolerated with minimal to mild side effects. It required minimal dose adjustment of immunosuppression and no episode of acute rejection occurred. Overall, sustained virologic response rate was very high, more than 90 percent.


• Dr. Pungpapong: This study is one of the first reports to prove the concept that all-oral interferon-free antiviral treatment for hepatitis C genotype 1 recurrence after liver transplantation is feasible with high efficacy and mild side effects. The results were comparable to those of non-liver transplantation setting, except response rate was slightly lower in the liver transplant recipients with genotype 1a and advanced fibrosis. By removing interferon from the treatment regimen, the risk of rejection was reduced substantially. Eradication of hepatitis C recurrence after liver transplantation is expected to improve both graft and patient survivals after liver transplantation.


http://medicalresearch.com/hepatitis-liver-disease/eradicating_hepatitis_c_in_liver_transplant_patients_with_less_toxic_combination_therapy/8893/

http://medicalresearch.com/hepatitis-liver-disease/hepatitis_c_patient_reported_outcomes_after_treatment/5192/

http://medicalresearch.com/infections/hiv/hepatitis_c_may_be_spread_through_semen/8221/



Eradicating Hepatitis C In Liver Transplant Patients With Less Toxic Combination TherapyMedical Research.com Interview with:

Surakit Pungpapong, M.D.Transplant Hepatologist

Associate Professor of MedicineMayo Clinic, Jacksonville, Fla.


• Dr. Pungpapong: Several new oral direct-acting antiviral agents against hepatitis C virus will likely be approved and available for clinical practice in the next few years. Many combination regimens using these agents are expected to provide similar results. Future studies will clarify which combination regimen yields highest efficacy with the least side effects, and possibly requires shorter duration of treatment.Citation:

• 2014 American Association for the Study of Liver Diseases abstract:

• Combination Therapy Offers Quicker, Less Toxic Eradication of Hepatitis C in Patients with Transplanted Livers



http://medicalresearch.com/hepatitis-liver-disease/hepatitis_c_retreatment_after_relapse/8799/

http://www.aasld.org/LIVERMEETING/ABSTRACTS/Pages/default.aspx

http://www.aasld.org/LIVERMEETING/ABSTRACTS/Pages/default.aspx



Smartphone Ophthalmoscopy Can Screen for Diabetic RetinopathyMedicalResearch.com Interview with:

Dr. Andrea RussoMedico Chirurgo – Specialista in Oculistica

Università degli Studi di Brescia Brescia Italy


• Dr. Russo: When I finished my residency program in Ophthalmology two years ago I realized that many patients were referred to me to assess and classify diabetic and hypertensive retinopathy. Therefore, I started wondering if there was an ophthalmoscopy method to make General Practitioners and Internist Physicians independent for these screening retinal assessments. I thought that we all own a personal computer connected with a (high quality) camera in our pocket and therefore smartphone ophthalmoscopy was feasible. Both the indirect and direct ophthalmoscopy techniques were suitable, however the latter was much easier to obtain. Furthermore, direct ophthalmoscopy can exploit smartphones’ autofocus and flash LED light making the required optics very simple and inexpensive. I purchased my 3D printer and started realizing very first working prototypes. A few months were required to improve the light path to eliminate internal and corneal reflections. Finally, I patented the optical solution and joined my partner Si14 S.p.A. (Padova, Italy) for the industrialization process.

• The main findings are that that smartphone ophthalmoscopy with the D-Eye system can accurately detect retinal lesions for grading diabetic retinopathy. Furthermore, we noticed an amazing convenience in the assessment of babies, since they seem to be spontaneously attracted by the non-disturbing light emitted by the device, making the fundus acquisition straightforward. The advantages of smartphone-based retinal image acquisition for remote, non-hospital settings include portability and immediate upload/analysis. Indeed, telemedicine has the potential to reach patients and communities that currently receive negligible or suboptimal eye care as a result of geographic or sociocultural barriers, or both.


http://medicalresearch.com/ophthalmology/smartphone_ophthalmoscopy_can_screen_for_diabetic_retinopathy/8912/

http://medicalresearch.com/author-interviews/telemedicine-supported-chronic-disease-management-except-frail-elderly-patients/7634/



Smartphone Ophthalmoscopy Can Screen for Diabetic RetinopathyMedicalResearch.com Interview with:

Dr. Andrea RussoMedico Chirurgo – Specialista in Oculistica

Università degli Studi di Brescia Brescia Italy


• Dr. Russo: The take home message of my report is that smartphone ophthalmoscopy is a convenient and valid technique to perform screenings for retinal diseases like diabetic retinopathy. The combination of affordability, portability, connectivity, and easy-to-use features of this ophthalmoscopy system provides a foundational platform, based on which a number of revolutionary screening programs can potentially be designed.


• Dr. Russo: Our study had some limitations. The smartphone ophthalmoscopy was performed by a retina specialist, therefore the reported results can not be directly transposed to a non-ophthalmologist technician. Therefore, future research is needed to deeper validate smartphone ophthalmoscopy, especially among non-ophthalmic physicians and personnel. Given the easiness to visualize and record the optic nerve head with undiluted pupil in just a few seconds, future studies should also consider the opportunity to screen for glaucoma.

• Citation:

• Comparison of Smartphone Ophthalmoscopy with Slit-lamp Biomicroscopy for Grading Diabetic Retinopathy

• Russo, Andrea et al. American Journal of Ophthalmology Published Online: November 07, 2014DOI: http://dx.doi.org/10.1016/j.ajo.2014.11.008



http://medicalresearch.com/diabetes/diabetes_how_long_from_onset_to_retinopathy/4671/

http://medicalresearch.com/ophthalmology/detecting-glaucoma-before-it-blinds/248/

http://www.ajo.com/article/S0002-9394(14)00713-2/abstract






Should Beta-Blockers Be Used After Myocardial Infarction?MedicalResearch.com Interview with:

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory,Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology,

Associate Professor of Medicine,New York University School of Medicine,


• Dr. Bangalore: The evidence to support beta blocker use for patients with myocardial infarction stems from outdated studies performed in the era prior to modern reperfusion and modern medical therapy. It is not know if the mortality benefit of beta blockers for MI are seen in the modern era.

• Our data from randomized trials suggest a significant interaction between reperfusion era status and beta blocker benefit such that in the modern era beta blockers provide no mortality benefit when compared with controls. However, they are associated with short term (30-days) benefit for reduction in recurrent MI and angina but at the expense of increase in the risk of heart failure, cardiogenic shock and drug withdraw due to adverse events. The benefits were only short term (30-days).


• Dr. Bangalore: Clinician should weigh the risks and benefits of using beta blocker therapy and recognize that the data for the benefit is derived from outdated studies.


• Dr. Bangalore: Clinical trials addressing the question of benefit and the duration of benefit of beta blockers for MI in the modern era are urgently needed.

• Citation:

• Clinical Outcomes with β-Blockers for Myocardial Infarction: A Meta-analysis of Randomized TrialsBangalore S, Makani H, Radford M, Thakur K, Toklu B, Katz SD, DiNicolantonio JJ, Devereaux PJ, Alexander KP, Wetterslev J, Messerli FHAm J Med. 2014 Oct;127(10):939-53. doi: 10.1016/j.amjmed.2014.05.032. Epub 2014 Jun 11.


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





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

Laundry Detergent Pods Can Be Lethal To KidsMedicalResearch.com Interview with: Marcel J Casavant MD FACEP FACMT

Chief of Toxicology, Nationwide Children’s HospitaMedical Director, Central Ohio Poison Center

Clinical Professor, The Ohio State University Colleges of Medicine & PharmacyColumbus OH USA 43205-2696


• Dr. Casavant: Laundry detergent pods reached the US market shelves in early 2012; almost immediately parents started calling poison control centers about their children’s exposures to these products. Since then the CDC, the CPSC, the American Association of Poison Centers, and others have issued warnings about these products. Several papers and numerous abstracts have described injuries to various groups of children; we therefore chose to analyze and describe what happened to all US children with exposure to one of these products reported to a poison control center in 2012 and 2013. The main finding: these products are dangerous to children! Over those two years we found more than 17,000 young children exposed to pods, more than 6,000 seen in an emergency department, more than 700 admitted to a hospital, and among these, more than half required intensive care. Two young children died, both in 2013. Our study was published in the November 10, 2014 issue of Pediatrics (http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Laundry-Detergent-Pods-Can-Be-a-Serious-Poisoning-Risk-in-Children.aspx ).


http://medicalresearch.com/pediatrics/laundry-detergent-pods-can-lethal-kids/8902/

http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Laundry-Detergent-Pods-Can-Be-a-Serious-Poisoning-Risk-in-Children.aspx







• Dr. Casavant: Clinicians need to take seriously every one of these exposures. Exposure to traditional laundry detergent powder or liquid is generally a benign event, especially an exploratory exposure by a young child. Exposure to the laundry detergent pods, however, is potentially life-threatening event – two children died due to exposure to laundry pods. Many of the children in our study were sent to the ED for evaluation of significant symptoms, and when children needed to be admitted to hospital, more than half required the critical care unit. Breathing trouble, vomiting, and CNS depression were common findings.

• Parents need to be extra vigilant with these laundry detergent pod products. Really, parents of young children should stick to the traditional laundry detergent liquids or powders; the extra convenience of the pods comes at a very high price of danger to children. If parents choose to have these laundry pods in their home, the pods should be stored both out of sight and out of reach of children. However, this is not enough. Many children in our study were poisoned when the parent had removed a pod from the package while doing the laundry. In the process of loading the washer a good parent can be distracted just long enough for a “helping” child to grab the pod from the countertop.








• Medical Research: What should parents do if a child gets into a pod?

• Dr. Casavant: Many of these children will require an emergency department visit; of these some will require hospital admission. The best thing for a parent or caregiver to do is to immediately call the local poison control center. In the USA, we all share the same telephone number: 1-800-222-1222. That call will immediately put the parent in touch with a nurse, pharmacist, or physician who is skilled at assessing all sorts of poison exposures and providing free, confidential, immediate, expert advice.


• Dr. Casavant: The most important research needed here is for manufacturers to find safer chemicals for doing the laundry, safer pods which make it more difficult for children (and adults – though we didn’t include them in this study) to be poisoned, safer packaging so fewer children can access the pods. After an exposure to one of these pods has occurred, the emergency physician can usually determine which patients need endotracheal intubation (due to airway or lung injury, or for airway protection after CNS depression), hospital observation, or critical care unit admission, but we need more research into the role and timing of interventions including endoscopy and bronchoscopy. On a cellular and tissue level, it’s not yet clear which specific ingredients of these pods are causing the various clinical effects, such as the coma and intracranial bleeding, but also the extent of tissue injury.

• Citation:

• Pediatric Exposure to Laundry Detergent Pods

• Amanda L. Valdez, Marcel J. Casavant, Henry A. Spiller, Thiphalak Chounthirath, Huiyun Xiang, and Gary A. Smith

• Pediatrics peds.2014-0057; published ahead of print November 10, 2014, doi:10.1542/peds.2014-0057



http://pediatrics.aappublications.org/citmgr?gca=pediatrics;peds.2014-0057v1





Type 2 Diabetes: U-shaped Association of BMI With All-Cause MortalityMedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA

Assistant professor & DirectorChronic Disease Epidemiology Lab

Adjunct assistant professor, School of Public HealthLSU Health Sciences Center


• Dr. Hu: Many previous studies had small samples, and thus lacked adequate statistical power when the analysis was focused on those who are extremely obese (BMI ≥40 kg/m2). In addition, most epidemiological studies only use a single measurement of BMI at baseline to predict risk of all-cause mortality, which may produce potential bias. The current study indicated a U-shaped association of BMI with all-cause mortality risk among African American and white patients with type 2 diabetes. A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2.


• Dr. Hu: A significantly increased risk of all-cause mortality was observed among African Americans with BMI<30 kg/m2 and BMI ≥35 kg/m2, and among whites with BMI<25 kg/m2 and BMI ≥40 kg/m2 compared with patients with BMI 30-34.9 kg/m2. Since our study samples are diabetic, patients need to use drug treatment to control glucose, blood pressure, lipids and kidney disease and also need to do lifestyle intervention to increase exercise and modify diet to control diabetic complication.


http://medicalresearch.com/diabetes/type-2-diabetes-u-shaped-association-bmi-cause-mortality/8922/

http://medicalresearch.com/diabetes/genetically_elevated_bmi_raises_risks_of_hypertension_and_diabetes/4061/




Type 2 Diabetes: U-shaped Association of BMI With All-Cause MortalityMedicalResearch.com Interview with: Gang Hu, MD, MPH, PhD, FAHA

Assistant professor & DirectorChronic Disease Epidemiology Lab

Adjunct assistant professor, School of Public HealthLSU Health Sciences Center


• Dr. Hu: The future studies are needed to study the potential explanations and mechanism of this U-shaped association between BMI and all-cause mortality risk among patients with type 2 diabetes.

• Citation:

• Body Mass Index and the Risk of All-Cause Mortality Among Patients with Type 2 Diabetes

• Wenhui Zhao, Peter T. Katzmarzyk, Ronald Horswell, Yujie Wang, Weiqin Li, Jolene Johnson, Steven B. Heymsfield, William T. Cefalu, Donna H. Ryan, and Gang Hu

• Circulation. 2014;CIRCULATIONAHA.114.009098published online before print November 5 2014, doi:10.1161/CIRCULATIONAHA.114.009098



http://medicalresearch.com/weight-research/cvd-risk-metabolic-health-not-bmi-determined-risk-in-young-women/1672/

http://circ.ahajournals.org/citmgr?gca=circulationaha;CIRCULATIONAHA.114.009098v1





Brief Mediterranean Diet Intervention May Have Long Term BenefitsMedicalResearch.com Interview with:

Dr. Markos KlonizakisCentre for Sports and Exercise Science

Sheffield Hallam University, UK


• Dr. Klonizakis: It is widely accepted that populations in the Eastern Mediterranean sea have historical lower rates of cardiovascular disease, diabetes and cancer. This has been attributed to a great extent, at following a diet based on dishes and ingredients, which are common in this region and are collectively known as “Mediterranean diet”. Taking into consideration that cardiovascular disease is on the rise, particularly in the Western world, it did make sense to see if such a diet can be adapted for a population that has a largely different culinary tradition and what the results would be if this is combined with exercise of moderate-intensity. We therefore, designed and implemented an 8-week intervention, aiming at older, healthy but previously untrained people, comparing an exercise-only group vs one where exercise was combined with Mediterranean diet. Our work has shown that benefits of this intervention are still evident in the vascular function (measured by the function of the inner vein lining, called the endothelium) and the cardiopulmonary fitness, one year after the end of the intervention.


http://medicalresearch.com/author-interviews/brief_mediterranean_diet_intervention_may_have_long_term_benefits/8924/

http://medicalresearch.com/author-interviews/olive_oil_mediterranean-diet-metabolic-syndrome/8208/







• Dr. Klonizakis: It would be clearly a mistake to think that following 8 weeks of a combined Mediterranean diet and exercise intervention would suffice for years to come. Having said that however, our study shows that such an intervention does offer longer –term benefits to our endothelium and cardiopulmonary fitness, which can be sustained with some effort. Taking into consideration the importance of our endothelium in our overall wellbeing, our study provides some comfort at least in the sense that it shows that moderation in implementing an adapted Mediterranean diet and exercise, will support a healthier, later life. This should encourage people to lead a healthier lifestyle, based on the Mediterranean diet and regular – but not necessary intensive – bouts of exercise.



http://medicalresearch.com/pediatrics/mediterranean_diet_in_children_found_protective_against_obesity/5530/







• Dr. Klonizakis: As a next step it would be necessary to look into attributing specific Mediterranean Diet components to our findings – this would allow scientists and clinicians to develop more specific lifestyle interventions, which would also be easier to implement. This is important for a number of reasons: firstly, certain Mediterranean diet ingredients are easier to incorporate than others to non-Mediterranean / Western-type diets. Also, some ingredients are easier to find or simply less expensive than others.

• It would be also interesting to implement similar interventions in patient populations and not just older-but-healthy, sedentary participants. The possibilities are endless – what is missing is the adequate funding.

• Citation:

• Long-term effects of an exercise and Mediterranean diet intervention in the vascular function of an older, healthy populationKlonizakis M, Alkhatib A, Middleton GMicrovasc Res. 2014 Sep;95:103-7. doi: 10.1016/j.mvr.2014.07.015. Epub 2014 Aug 7.



http://medicalresearch.com/diabetes/never-late-switch-healthy-mediterranean-diet/3328/






Hospice Care For Advanced Cancer Decreased Aggressive Care and Costs in Last Year of LifeMedicalResearch.com Interview with:

Ziad Obermeyer, MD, MPhilEmergency Medicine, Brigham & Women’s Hospital

Assistant Professor, Harvard Medical School


• Dr. Obermeyer: More patients with cancer use hospice today than ever before, but there are indications that care intensity outside of hospice is increasing, and length of hospice stay decreasing. We examined how hospice affects health care utilization and costs and found that, in a sample of elderly Medicare patients with advanced cancer, hospice care was associated with significantly lower rates of both health care utilization and total costs during the last year of life.

• Patients who did not enroll in hospice had considerably more aggressive care in their last year of life—most of it related to acute complications like infections and organ failure, and not directly related to cancer-directed treatment. Hospice and non-hospice patients had similar patterns of health care utilization until the week of hospice enrollment, when care began to diverge. Ultimately, non-hospice patients were five times more likely to die in hospitals and nursing homes. These differences in care contributed to a statistically-significant difference in total costs of $8,697 over the last year of life ($71,517 for non-hospice and $62,819 for hospice).


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

http://medicalresearch.com/author-interviews/hospice-care-discussed-earlier-physicians-enroll-terminally-ill/3112/



Hospice Care For Advanced Cancer Decreased Aggressive Care and Costs in Last Year of LifeMedicalResearch.com Interview with:

Ziad Obermeyer, MD, MPhilEmergency Medicine, Brigham & Women’s Hospital

Assistant Professor, Harvard Medical School


• Dr. Obermeyer: Our results highlight the importance of honest discussions between doctors and patients about our patients’ goals of their care at the end of life, relating to treatment decisions and quality of life. This is of particular importance now, in light of the ongoing policy discussions around reimbursing providers for advance care planning.


• Dr. Obermeyer: There is an urgent need for more research on interventions to promote earlier and better discussions around end of life care between doctors and patients. Hospice is not for everyone, but patients who want that option—with or without concurrent cancer-directed therapy—should know that it exists.

• Citation:

• Association Between the Medicare Hospice Benefit and Health Care Utilization and Costs for Patients With Poor-Prognosis Cancer

• Obermeyer Z, Makar M, Abujaber S, Dominici F, Block S, Cutler DM.

• JAMA. 2014;312(18):1888-1896. doi:10.1001/jama.2014.149



http://medicalresearch.com/author-interviews/race_ethnicity_affect_end_of_life_care_preferences/7159/

http://medicalresearch.com/author-interviews/end_of_life_patients_and_cargivers_may_face_complex_comorbidities_and_medications/6381/

http://jama.jamanetwork.com/multimediaPlayer.aspx?mediaid=7894879





High Preterm Birth Rates Persist In Upwardly Mobile African American WomenMedicalResearch.com Interview with: Paula Braveman, MD, MPH

Director, Center on Social Disparities in HealthProfessor, Family and Community Medicine

University of California San FranciscoSan Francisco, CA 94118


• Dr. Braveman: There were a couple of striking findings from this study of preterm birth (PTB) among non-Latino White and Black women born in the U.S..

• First, we found that women who were poor or socioeconomically disadvantaged in other ways (who had not or whose parents had not graduated from high school or who lived in neighborhoods (census tracts) with highly concentrated (25% or more of residents) poverty) had similarly high preterm birth rates. In addition, we found that while preterm birth rates among White women consistently improved as their socioeconomic status (SES) improved, higher-SES Black women generally did no better –and sometimes did worse—than lower-SES Black women.


http://medicalresearch.com/author-interviews/high_preterm_birth_rates_persist_in_upwardly_mobile_african_american_women/8935/

http://medicalresearch.com/pediatrics/risk-of-adverse-pregnancy-outcomes-anemia-and-prenatal-iron-use/1001/






• Medical Research: What was most surprising about the results?

• Dr. Braveman: For decades, it has been observed that non-Latino Black women have 2-3 times the rate of preterm birth (PTB) as non-Latino Whites; some researchers and clinicians have assumed this must reflect differences in underlying biology. We found, however, that there was no Black-White disparity in preterm birth among highly disadvantaged women; poor White and Black women had similar high rates of preterm births. The disparity in preterm births was confined to less disadvantaged women. This does not rule out genetic differences but is difficult to explain without invoking an important role for social factors.



http://medicalresearch.com/weight-research/bariatric-surgery-risk-preterm-babies/2716/







• Dr. Braveman: The patterns we observed are complex and there is no simple answer to this. Clinicians and patients should be aware that this study adds to an accumulating body of evidence indicating an important role for social factors in preterm births. Addressing the social factors that have powerful influences on health, including preterm births, is not clinicians’ primary role, but they can be crucial voices supporting their institutions adopting or enhancing; as informed citizens, clinicians and patients can support social policies likely to have an impact, at least in the long run. Interpreting our findings in light of the literature, we believe that the absence of improvement in preterm births with improved SES among Black women is consistent with a theory articulated by a number of scholars, that the “costs of upward mobility” for Blacks may take a substantial physiologic toll, through pathways involving stress. Improved income and education alone may not be sufficient to improve Black women’s preterm birth rates, if our society does not address the myriad ways –both subtle and overt– in which racial discrimination can operate and take a toll on health.


• Dr. Braveman: We need to know more about the biologic mechanisms leading to preterm birth overall, and what could explain the perplexing social patterns –by race and by SES– that we and other researchers have found. The basic science research is critical, but it will not be enough; our study adds to a body of knowledge that calls out for research that will link the social and the biologic phenomena.

• Citation:

• Braveman, Heck, Egerter, et al., The role of socioeconomic factors in Black-White disparities in preterm birth, American Journal of Public Health 2014, published online Sept. 11, 2014 ahead of print




http://medicalresearch.com/diabetes/pregestational_diabetes_mellitus_preconception_care_may_improve_outcomes_and_save_billions/8660/




Improved Longevity of Hepatitis C Patients Who Respond To TherapyMedicalResearch.com Interview with:

Adriaan J. van der Meer, MD, PhDDepartment of Gastroenterology and Hepatology

Erasmus MC University Medical Center Rotterdam,Rotterdam, the Netherlands


• Dr. van der Meer: This study was performed in order to assess the association between the virological response to antiviral therapy and the long-term clinical outcome among patients with advanced liver disease, who have the highest risk of cirrhosis-related complications and death due to their chronic viral infection. At the time this study was initiated there was scarce data on the relation between a sustained virological response (SVR; sustained elimination of hepatitis C RNA) and reduced all-cause mortality, the most definite clinical endpoint. With our large international multicenter cohort study we were able to show this association. After 10 years of follow-up the cumulative mortality rate was 9% among patients with SVR as compared to 26% among patients without SVR after antiviral therapy (p<0.001). The current JAMA research letter concerns a related analyses, in which we compared the survival among patients included in our cohort with that of an age- and sex-matched general population. Importantly, the survival among patients with SVR was comparable to the general population, despite the fact that all these patients had histological proof of advanced hepatic fibrosis. In contrast, the survival among patients without SVR was markedly lower as compared to the general population.

•


mailto:http://medicalresearch.com/hepatitis-liver-disease/improved_longevity_of_hepatitis_c_patients_who_respond_to_therapy/8899/


http://medicalresearch.com/hepatitis-liver-disease/improved_longevity_of_hepatitis_c_patients_who_respond_to_therapy/8899/





• Dr. van der Meer: With this follow-up analyses, we further establish SVR as a relevant endpoint of antiviral therapy. Patients and physicians should take away from our report that antiviral therapy is needed in order to improve the clinical outcome of the population with chronic HCV infection. Even in case of advanced liver disease, patients should thus be referred for antiviral therapy. The result should stimulate a wide range of heatlh care workers to be alert for hepatitis C infection, as major clinical benefits may be achieved in adequate therapy. Currently, underdiagnosis of this disease remains one the most important reasons why only a small proportion of the hepatitis C-infected population is treated.



http://medicalresearch.com/hepatitis-liver-disease/hepatitis_c_successful_treatment_without_interferon_for_hcv_3/5138/







• Dr. van der Meer: As soon as the direct antivirals are widely implemented, SVR rates are expected to rise above 90% even for patients with cirrhosis. Future studies need to follow-up these patients to determine if the beneficial clinical outcome following SVR remains when interferon is no longer used. Also, these new antiviral treatment regimens are expected to cure patients with more advanced liver disease and may be applied in patients with comorbidities which contraindicated interferon-therapy. Current results thus need to reconfirmed in the nearby future. As only few patients will not attain SVR, and those who do fail interferon-free therapy are likely to be biased, comparisons between patients with SVR and general populations will continue to be relevant.

• Citation:

• van der Meer AJ, Wedemeyer H, Feld JJ, et al. Life Expectancy in Patients With Chronic HCV Infection and Cirrhosis Compared With a General Population. JAMA. 2014;312(18):1927-1928. doi:10.1001/jama.2014.12627.



http://medicalresearch.com/hepatitis-liver-disease/hepatitis_c_retreatment_after_relapse/8799/

http://jama.jamanetwork.com/article.aspx?articleid=1930807



Omega-3 Fish in Diet May Reduce Cancer RiskMedicalResearch.com Interview with:

James J. DiNicolantonio, PharmDAssociate Editor BMJ Open HeartCardiovascular Research Scientist

Saint Luke’s Mid America Heart Institute


• Dr. DiNicolantonio: Daily low-dose aspirin has been shown to decrease the risk for cancer in a meta-analysis of randomized controlled trials, which is likely attributable to its ability to modestly decrease the activity of cyclooxygenase-2 (cox-2), anenzyme which contributes importantly to the genesis and progression of adenocarcinomas. Adenocarcinomas are cancer of the glands, the most common type of breast cancer (invasive ductal carcinoma) is an adenocarcinoma, additionally many cancers of the lung, intestine, esophagus, colon are adenocarcinomas.

• We show that an ample dietary intake of long-chain omega-3 fats—the type prominent in fatty fish—would oppose cox-2 activity. Additionally, we cite numerous evidence that a higher intake of long-chain omega-3 fats has been found to reduce the risk for numerous types of cancer – especially when looking at trials that excluded fried or preserved fish (or fish high inomega-6), excluded trials with a high background intake of omega-6, and included trials where the “high” intake group –actually ate 2 servings of fish or more per week. Additionally, basic science as well as randomized data showing that long-chain omega-3s can reduce the number and size of colon polyps supports this argument.

• Medical Research: What should clinicians and patients take away from your report?• Dr. DiNicolantonio: Eating the right kind of fish (i.e. high in omega-3 low and low in omega-6) such as salmon (not farm-

raised), in the right quantity (at least 2 servings per week), prepared the right way (baked not fried) may help to prevent adenocarcinoma.


• Dr. DiNicolantonio: Large randomized trials testing increased long-chain omega-3 intake and reducing omega-6 intake would provide further insight.

• Citation:• A Higher Dietary Ratio of Long-Chain Omega-3 to Total Omega-6 Fatty Acids for Prevention of COX-2-Dependent

AdenocarcinomasDiNicolantonio JJ1, McCarty MF, Chatterjee S, Lavie CJ, O’Keefe JHNutr Cancer. 2014 Oct 30:1-6. [Epub ahead of print]


http://medicalresearch.com/cancer-_-oncology/omega3_fish_in_diet_may_reduce_cancer_risk/8947/


http://medicalresearch.com/cancer-_-oncology/fish-intake-and-risk-of-breast-cancer/944/

http://medicalresearch.com/diabetes/omega-3-fatty-acids-mi-risk-diabetic-non-diabetic-patients-cad/2323/





http://medicalresearch.com/cancer-_-oncology/omega3_fish_in_diet_may_reduce_cancer_risk/8947/

Colon Cancer: Improved Screening and Chemotherapy Contribute To Improved SurvivalMedicalResearch.com Interview with:

Xianglin L. Du, MB, MS, Ph.D. Professor of Epidemiology,Department of Epidemiology, Human Genetics, and Environmental Sciences,

The University of Texas School of Public Health,Houston, TX 77030, USA.


• Dr. Du: Widespread use of screening and advances in screening strategies played a key role in colorectal cancer survival improvement. With the increasing evidence on the benefit of fecal occult blood test and sigmoidoscopy during 1990s, the U.S. Preventive Service Task Force for the first time in 1996 recommended the annual use of fecal occult blood test, periodic use of sigmoidoscopy, or routine use of both modalities for all persons aged 50 or older. Because colonoscopy is able to detect lesions in the entire colon and has a high sensitivity for lesions of over 10mm in size, Medicare began to cover colonoscopy since 2001 for individuals with average-risk of colorectal cancer. Advances in chemotherapy, particularly some new therapeutic regimens approved by Food and Drug Administration (FDA) over the past decades also played a key role in survival improvement for patients with colorectal cancer. However, the overall impact of newly approved chemotherapy regimens on survival in population-based elderly patients remains unclear. It is also unknown what proportion of survival improvement was attributable to changes in tumor stage and size due to screening, and what proportion was attributable to more effective chemotherapy regimens. Hence, we studied a large nationwide and population-based cohort of elderly colorectal cancer patients to examine the changes in tumor stage and tumor size from 1992 to 2009, and to further quantify the effects of changes in stage/size and chemotherapy regimens on improved survival over the two decades.


http://medicalresearch.com/cancer-_-oncology/colon-cancer/colon_cancer_improved_screening_and_chemotherapy_contribute_to_improved_survival/8950/

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







• Dr. Du: Study periods were categorized into three periods according to the major changes or advances in screening and chemotherapy regimens:1) Period-1 (1992-1995), during which there was no evidence-based recommendation for routine colorectal cancer screening and 5-fluorouracil was the mainstay for chemotherapy; 2) Period-2 (1996-2000), during which evidences and guidelines supported the use of fecal occult blood test and sigmoidoscopy for routine colorectal cancer screening; and3) Period-3 (2001-2009), during which Medicare Program added the full coverage for colonoscopy screening to average-risk individuals, and several newly developed chemotherapy regimens were approved.

• Compared to Period-1 (1992-1995), the likelihood of being diagnosed with early stage colorectal cancer increased by 20% in Period-2 (1996-2000) and 30% in Period-3 (2001-2009); and the likelihood of being diagnosed with small-size colorectal cancer increased by 60% in period-2 and 110% in period-3. Similarly, 5-year overall relative survival increased from 51% in period-1 to 56% in period-2 and 60% in period-3. Increase in survival attributable to migration in stage/size was 9% in period-2 and 20% in period-3, while the remaining survival improvement during period-2 and period-3 were largely attributable to more effective chemotherapy regimens (≥71.6%) and about 25% of improvement in overall survival were explained by treatment factors other than chemotherapy, including improved management in chronic diseases among elderly colorectal cancer patients.



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







• Dr. Du: Overall, improvements in early detection or screening for colorectal cancer and chemotherapy regimens over the past two decades have had led to the real world effectiveness in prolonging survival for elderly patients. Improvements in colorectal cancer screening resulted in a change of colorectal cancer towards earlier tumor stage and smaller size, which contributed to 20% or less of survival increase. Survival improvement over the past 2 decades was largely explained by more effective chemotherapy regimens and other treatment factors, including improved management in chronic diseases. Therefore, strategies to improve both cancer screening and chemotherapy regimens will continue to be of great importance and guidelines to minimize the underuse of chemotherapy in elderly patients is also important.



http://medicalresearch.com/cancer-_-oncology/blacks-and-hispanics-at-higher-risk-for-precancerous-colorectal-polyps/375/







• Dr. Du: Future studies may need to take into consideration of changes in stage and size affected by misclassification bias because of advances in screening technology and changes in stage definition over time. Studies also need to incorporate the information on early detection rates and screening-detected tumors when possible, and to obtain the data that may allow researchers to better quantify the contribution of specific treatment modalities and other helpful strategies from providers and patients to survival improvement.

• Citation:

• Tong L, Ahn C, Symanski E, Lai D, Du XL. Relative impact of earlier diagnosis and improved treatment on survival for colorectal cancer: A US database study among elderly patients. Cancer Epidemiology. 2014 Nov 7. [Epub ahead of print]. http://dx.doi.org/10.1016/j.canep.2014.10.004.)..



http://dx.doi.org/10.1016/j.canep.2014.10.004



HIV Transmitted To Woman Via Manicure ToolsMedicalResearch.com Interview with:

Luís Fernando de Macedo Brígido M.D. Ph.D.Núcleo de Doenças de Vinculação Sanguínea e Sexual

Centro de Virologia Instituto Adolfo LutzSão Paulo Brasil

• Medical Research: What is the background for this study? What are the main findings?• Response: Fomite transmission of HIV, especially in occupational exposure, have been reported, but

the use of manicure utensils has not been previously associated to HIV transmission. We report a case where none of the classical modes of transmission were identified, and a detailed review of clinical history and phylogenetic analysis allowed the association of the case’s infection to manicure care episodes at home with an HIV infected women many years ago.

• Medical Research: What should clinicians and patients take away from your report?• Response: The possibility of transmission of HIV and other agents should be considered when an

adequate microbial inactivation of instruments used in tattooing, manicure care or alike are not enforced.


• Response: The extension of this mode of transmission is not known. As previous sexual activity with a partner without known HIV status is so common, alternative modes of transmission are not usually considered. The consideration of this possibility in the evaluation of new infections may allow further understanding of the relevance of this mode or transmission.

•

• Citation:• An HIV-1 Transmission Case Possibly Associated with Manicure Care • Matsuda EM1, Coelho LP, Pimentel VF, Onias HB, de Macedo Brigido LF.

AIDS Res Hum Retroviruses. 2014 Nov;30(11):1150-3. doi: 10.1089/aid.2014.0264.


http://medicalresearch.com/infections/hiv/hiv-transmitted-woman-via-manicure-tools/8952/

http://medicalresearch.com/infections/hiv/death_rate_from_hiv_aids_continue_to_drop/6471/

http://medicalresearch.com/infections/hiv/hiv-self-testing-increased-number-adults-starting-treatment/6518/

http://medicalresearch.com/infections/hiv/hiv-and-human-herpesviruses-in-the-semen-of-effectively-treated-hiv-1-infected-men-who-have-sex-with-men/652/






Rheumatoid Arthritis: Evaluating Combination Therapies With Non-BiologicsMedicalResearch.com Interview with:

Diederik De CockPhD student – CareRA project

Department Rheumatology

• Medical Research: What is the background for this study? What are the main findings?• Response: Rheumatoid Arthritis (RA) is a chronic systemic auto immune disease characterized by pain and swelling in the

joints, mostly in arms and legs. Around 1% of the world population is affected by this hazardous disease. Left untreated thiscan lead in the short term to loss of quality of life and in the long term to major bone damage and immobility. Rheumatoid Arthritis can not be cured, but the disease can be suppressed.

• International guidelines recommend to treat a patient with Rheumatoid Arthritis early, intensive and to target low disease activity, but leave much freedom in choice of medication and strategy. Our CareRA ( Care in early RA) research group, under the leadership of Prof Dr Verschueren and Prof Dr Westhovens tried to untangle long standing questions regarding the management of Rheumatoid Arthritis.

• In this RCT, we want to question the benefit of a combination of disease modifying anti rheumatic drugs compared to monotherapy and the benefit of a high starting dose of glucocorticoids versus moderate dose. We choose glucocorticoid therapy over biological therapy because of its widespread use in RA and cost-effectiveness compared to the expensive biological therapy.

• Therefore, 290 patients with the presence of poor prognostic markers (disease activity, erosions and serum markers RF/ACPA) were randomzied into 1 of 3 medication schemes:1. Cobra Classic: methotrexate + sulphasalazine + 60mg glucocorticoid starting dose2. Cobra Slim: methotrexate + 30mg glucocorticoid starting dose3. Cobra Avant-Garde: methotrexate + leflunomide + 30 mg glucocorticoid starting doseThe glucocorticoid doses were tapered every week. After 6 or 7 weeks, they were on maintenance dosage and discontinued after 28 weeks.All patients are followed in a tight control schedule ( a close follow-up scheme), aiming for low disease acitvity.

• After 16 weeks, 7 out of 10 patients were in remission, a state where the disease is clinically suppressed. No differences inefficacy outcomes were observed between the three groups. However, the safety profile of the Cobra Slim group is much more favourable because only half of the number of adverse events were observed in this group compared to Classic and Avant-Garde.


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

http://medicalresearch.com/author-interviews/rheumatoid-arthritis-remission-sustainable-tapering-biologics/8791/







• Response: First of all, remission rates are internationally the highest reported after 16 weeks of Rheumatoid Arthritis treatment. Thus, our three intensive treatment schedules are all valuable in daily clinical practice to treat patients.

• Secondly, the treatment schedules are much cheaper compared to biological therapy and have at least a comparable safety profile again compared to biological therapy. Thus, healthcare systems can save a lot while not sacrifycing any clinical efficacy.

• Thirdly, our study shows that Methotrexate alone is comparable to combination therapy when combined with a bridging scheme of glucocorticoids. Hence, this results is good for patients struggling with the more and more emerging problem of polypharmacy.

• Lastly, our results indicate that a moderate or high starting dose of glucocorticoids does not matter.



http://medicalresearch.com/weight-research/obesity_increases_risk_or_rheumatoid_arthritis/6785/







• Response: Our results should of course be confirmed after 1 and 2 year follow-up. Future research should focus on the period after initial intensive treatment. How can we help the 30% of patients who fail this therapy? Can we perhaps identify these patients and adapt therapy? These studies could perhaps show the way to individualized RA treatment. Our CareRA research group will continue to study these problems and we hope to deliver answers to these questions!Citation:

• Methotrexate in combination with other DMARDs is not superior to methotrexate alone for remission induction with moderate-to-high-dose glucocorticoid bridging in early rheumatoid arthritis after 16 weeks of treatment: the CareRA trial.P Verschueren, D De Cock,et al

• Ann Rheum Dis annrheumdis-2014-205489Published Online First: 30 October 2014 doi:10.1136/annrheumdis-2014-205489



http://ard.bmj.com/citmgr?gca=annrheumdis;annrheumdis-2014-205489v1





Dialysis Patients Generally Unprepared For Natural DisastersMedicalResearch.com Interview with:

Naoka Murakami MD PhDMount Sinai Beth Israel Department of Medicine

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

• Dr. Murakami: Dialysis patients live in a complex sociomedical situation and are highly dependent on technologies to sustain their lives; such as transportation, electricity and water for the dialysis apparatus. Interruption of this infrastructure by a natural disaster can result in devastating outcomes.

• During triage of patients arriving at Mount Sinai Beth Israel in the immediate aftermath of hurricane Sandy, we observed that many dialysis patients did not know about their medications, their comorbid conditions nor their dialysis prescriptions. Therefore we conducted a cross-sectional follow-up study of 357 hemodialysis patients in five dialysis units in lower Manhattan, New York. Using checklists prepared by the National Kidney Foundation and the Department of Homeland Security, we found that 26.3% subjects missed dialysis sessions and 66.1% received dialysis at non-regular dialysis unit(s). We observed that the distribution of a “Dialysis emergency packet” significantly improved retention of medical records at home. Analysis showed that dialysis-specific preparedness, racial ethnicity (non-African American, Hispanic or Caucasian), reception of dialysis in affiliated units, and older age, were associated with a significant reduction in missed dialyses.


http://medicalresearch.com/author-interviews/hemodialysis_patients_generally_unprepared_for_natural_disasters/8939/



Dialysis Patients Generally Unprepared For Natural DisastersMedicalResearch.com Interview with:

Naoka Murakami MD PhDMount Sinai Beth Israel Department of Medicine

• Medical Research: What is the key conclusion?

• Dr. Murakami: Hemodialysis patients are generally unprepared for natural disasters and there is a need to strengthen both patient and dialysis facility disease-awareness and preparedness to improve outcomes in natural disasters.

• Medical Research: Are there additional impacts?

• Dr. Murakami: Our survey showed a positive effect, for patients and providers, on being prepared of the distribution of a “Dialysis emergency packet”, (listing medication list, dialysis prescription, comorbid conditions and geographical/contact information for dialysis centers) and we propose that this be more conveniently located on a mobile electronic application.

• Citation:

• 2014 American Society of Nephrology abstract November 14 2014

• Impact of Hurricane Sandy on Hemodialysis Patients and Preparedness for Natural Disasters,





Abdominal Aortic Aneurysms: What Are Risk Factors For ExpansionMedicalResearch.com Interview with:

Rachel Bhak MSDepartment of Veterans Affairs Cooperative Studies Program Coordinating Center

West Haven, Connecticut


Dr. Bhak: Abdominal aortic aneurysms (AAA) and their rupture are potentially fatal, so monitoring and understanding their expansion is of utmost importance. This study sought to characterize factors associated with Abdominal aortic aneurysms expansion, as well as their different growth patterns. The main findings are that current smoking and diastolic blood pressure are associated with increased linear expansion rate, diabetes with a decreased linear expansion rate, and diastolic blood pressure and baseline abdominal aortic aneurysms diameter with an accelerated expansion rate.


• Dr. Bhak: Clinicians and patients should understand that risk factors have been found to be associated with increased Abdominal aortic aneurysms expansion, which include smoking, elevated diastolic blood pressure, and baseline Abdominal aortic aneurysms diameter, so careful surveillance of these are important in reducing risk of rupture. They should also be aware that there are different growth patterns, and these risk factors can help determine what sort of growth trajectory the AAA diameter may follow.


http://medicalresearch.com/author-interviews/abdominal_aortic_aneurysms_what_are_risk_factors_for_expansion/8982/

http://medicalresearch.com/tobacco-research/smoking/cigarette_smoking_prevalence_varies_by_gender_and_occupation/7803/

http://medicalresearch.com/author-interviews/better_fitness_lower_blood_pressure/7598/



Abdominal Aortic Aneurysms: What Are Risk Factors For ExpansionMedicalResearch.com Interview with:

Rachel Bhak MSDepartment of Veterans Affairs Cooperative Studies Program Coordinating Center

West Haven, Connecticut


• Dr. Bhak: The findings of clinical risk factors associated with AAA expansion seem to be mostly consistent across studies, so the next step in better understanding this expansion would be to focus on the shape of growth, i.e. linear, accelerating, or other patterns. Our shape factor analysis was limited in sample size, so a larger sample with more observations per patient could provide more precision and clarity to this matter.

• Citation:

• Factors Associated With Small Abdominal Aortic Aneurysm Expansion Rate

• Rachel H. Bhak, MS; Michael Wininger, PhD; Gary R. Johnson, MS; Frank A. Lederle, MD; Louis M. Messina, MD; David J. Ballard, MD, MSPH, PhD; Samuel E. Wilson, MD; for the Aneurysm Detection and Management (ADAM) Study Group

• JAMA Surg. Published online November 12, 2014. doi:10.1001/jamasurg.2014.2025

•









Statins May Impede Growth of Uterine FibroidsMedicalResearch.com Interview with:

Mostafa Borahay, MD, FACOGAssistant Professor, Director of Simulation Education

Department of Obstetrics and GynecologyUniversity of Texas Medical BranchCo-director of Minimally Invasive Gynecologic Surgery University of Texas Medical Branch


• Dr. Borahay: Uterine fibroids are the most common type of tumor in the female reproductive system, accounting for half of the 600,000 hysterectomies done annually in the U.S. Their estimated annual cost is up to $34 billion in the U.S. alone. Despite this, the exact cause of these tumors is not well understood, as there are several genetic, familial and hormonal abnormalities linked with their development. Even more, we currently don’t have a satisfactory medical treatment for these tumors.

• Our team investigated the impact of simvastatin on human uterine fibroid cell growth. Statins, such as simvastatin, are commonly prescribed to lower high cholesterol levels. Statins work by blocking an early step in cholesterol production. Beyond these well-known cholesterol-lowering abilities, statins also combat certain tumors. Statins have previously been shown to have anti-tumor effects on breast, ovarian, prostate, colon, leukemia and lung cancers. However, the effect of statins on uterine fibroids was unknown.

• We found that simvastatin impedes the growth of uterine fibroid tumor cells. We also studied the way simvastatin works to suppress these tumors. Simvastatin was shown to inhibit ERK phosphorylation, which is a critical step in the molecular pathway that prompts the growth of new cells. In addition, simvastatin stops the progression of tumor cells that have already begun to grow and induces calcium-dependent cell death mechanisms in fibroid tumor cells. Therefore, we identified a novel pathway by which simvastatin induces the death of uterine fibroid tumor cells.


http://medicalresearch.com/author-interviews/statins-may-impede-growth-uterine-fibroids/8985/

http://medicalresearch.com/author-interviews/neurofibromatosis-simvastatin-cognitive-deficits/2438/







• Dr. Borahay: It might be a bit early to give recommendations for clinicians and patients. We expect that female users of statins to have lower incidence of uterine fibroids. This is the first study to demonstrate this effect on fibroid tumor cells. We recently completed another study examining the effects of statins in an animal model of uterine fibroids. The results of this new study will be presented to scientists and researchers in the coming few days and we expect to publish it soon. After these studies, and human studies are completed, then we can translate these novel findings to clinical practice.



http://medicalresearch.com/diabetes/statins-may-additional-lipid-profile-benefit-pre-diabetes/7813/







• Dr. Borahay: Our research team is currently working on developing methods to selectively deliver high doses of the statins to the fibroid tumors. This includes adopting nanotechnology and developing a medicated intra-uterine device to locally deliver the statin. We are also planning to perform clinical trials to examine effects of statins on patients with uterine fibroids. Statins have been in clinical use for years so their safety profile is well known, which gives the findings of our research special clinical significance.

• Citation:

• Simvastatin Potently Induces Calcium-Dependent Apoptosis of Human Leiomyoma CellMostafa A. Borahay, Gokhan S. Kilic, Chandrasekha Yallampalli, Russel R. Snyder, Gary D.V. Hankins, Ayman Al-Hendy, and Darren BoehningBiol. Chem. jbc.M114.583575. First Published on October 30, 2014, doi:10.1074/jbc.M114.583575



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

http://www.jbc.org/citmgr?gca=jbc;M114.583575v1

http://www.jbc.org/citmgr?gca=jbc;M114.583575v1



Tdap Vaccination Safety During Pregnancy StudiedMedicalResearch.com Interview

Elyse O. Kharbanda MD MPHHealthPartners Medical and Dental Group


• Dr. Kharbanda: In 2010, due to a pertussis outbreak and neonatal deaths, the California Department of Public Health recommended that the Tdap vaccine be administered during pregnancy. Tdap is now recommended by the Advisory Committee on Immunization Practices (ACIP) for all pregnant women during each pregnancy. We wanted to assess the impact of this recommendation.

• The main findings were that Tdap vaccination during pregnancy was not associated with increased risk for hypertensive disorders of pregnancy, preterm birth, or having a baby who is small for his or her gestational age.

• The study found a small increased risk for being diagnosed with chorioamnionitis, an inflammation of the fetal membranes caused by bacterial infection. These findings should be interpreted with caution as the magnitude of the risk was small. In addition, there was no associated risk for preterm birth, which often occurs as a result of chorioamnionitis. Furthermore, among the subset of women with a chorioamnionitisdiagnosis whose charts were reviewed, many did not have a clinical picture that was clearly consistent with chorioamnionitis.


http://medicalresearch.com/pediatrics/tdap_vaccination_safety_during_pregnancy_studied/8862/

http://medicalresearch.com/author-interviews/tdap_vaccine_during_pregnancy_safety_and_efficacy/5128/



Tdap Vaccination Safety During Pregnancy StudiedMedicalResearch.com Interview

Elyse O. Kharbanda MD MPHHealthPartners Medical and Dental Group


• Dr. Kharbanda: This study provides important information on the safety of Tdap vaccination during pregnancy. It is particularly significant because there is limited prior safety data, along with continued widespread pertussis transmission. In addition it provides validation for the current recommendations to routinely vaccinate during pregnancy.


• Dr. Kharbanda: This study describes the safety of Tdap vaccination in women not previously vaccinated. As current ACIP recommendations are that women receive Tdap during every pregnancy, continued monitoring of repeated Tdap doses during subsequent pregnancies will be important.

• Citation:

• Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Evaluation of the Association of Maternal Pertussis Vaccination With Obstetric Events and Birth Outcomes. JAMA. 2014;312(18):1897-1904. doi:10.1001/jama.2014.14825.



http://medicalresearch.com/pediatrics/fewer-infant-hospitalizations-whooping-cough-tdap-universal-recommendation/2318/

http://medicalresearch.com/infections/whooping-cough-can-still-cause-significant-cough-even-fully-vaccinated-children/6042/

http://jama.jamanetwork.com/article.aspx?articleid=1930817



Semen Impairs Efficacy of HIV MicrobicidesMedicalResearch.com Interview with

Prof. Dr. Jan MünchInstitute of Molecular VirologyUlm University Medical Center

Ulm, Germany

•

Medical Research: What is the background for this study?

• Dr. Münch: Most anti-HIV microbicides have potent antiviral activity in vitro but were largely inactive in clinical trials. Here we set out to explore whether the HIV infection enhancing activity of amyloid fibrils in human semen interferes with the antiviral efficacy of microbicidesand antiviral drugs.


Dr. Münch: We found that all microbicides that target viral components (such as polyanionsand neutralizing antibodies as well reverse transcriptase, integrase and protease inhibitors) are less effective in the presence of semen. Thus, the antiviral activity of microbicidesdetermined in standard in vitro infection assays greatly underestimates the concentration of drug that is required to block HIV infection in the presence of semen. The only drug that blocked semen- and medium-exposed virus infection with similar antiviral efficacy was Maraviroc, a drug that prevents HIV cell entry by binding to the cellular CCR5 coreceptor.


http://medicalresearch.com/infections/hiv/hiv_impairs_efficacy_of_hiv_microbicides/8973/

http://medicalresearch.com/infections/hiv/oral_hiv_prophylaxis_may_also_provide_some_protection_against_herpes/6152/

http://medicalresearch.com/infections/hiv/much-hiv-transmission-driven-herpes-co-infection/6251/



Semen Impairs Efficacy of HIV MicrobicidesMedicalResearch.com Interview with

Prof. Dr. Jan MünchInstitute of Molecular VirologyUlm University Medical Center

Ulm, Germany


• Dr. Münch: Clinicians and patients that are involved in clinical trials aiming at evaluating topical microbicides should be aware that the drug levels that are required to prevent HIV-1 infection in vivo may be several times higher than those determined in cell culture in the absence of semen.


• Dr. Münch: The antiviral activity of all future microbicides should be determined under conditions allowing to measure the infectivity enhancing effects of semen. In addition, only those microbicides should enter clinical trials that are active in the presence of semen. Finally, antagonizing or destroying seminal amyloid might not only decrease viral infectivity but also increase the antiviral efficacy of drugs.

• Citation:

• Semen enhances HIV infectivity and impairs the antiviral efficacy of microbicides

• Onofrio Zirafi, Kyeong-Ae Kim, Nadia R. Roan, Silvia F. Kluge, Janis A. Müller, Shibo Jiang, Benjamin Mayer, Warner C. Greene, Frank Kirchhoff, and Jan Münch

• Sci Transl Med 12 November 2014 6:262ra157. [DOI:10.1126/scitranslmed.3009634]



http://medicalresearch.com/infections/hiv/hiv-and-human-herpesviruses-in-the-semen-of-effectively-treated-hiv-1-infected-men-who-have-sex-with-men/652/


http://stm.sciencemag.org/content/6/262/262ra157





Date post:	11-Jul-2015
Category:	Healthcare
Upload:	marie-benz-md-faad
View:	290 times
Download:	3 times

MedicalResearch.com: Medical Research Exclusive Interviews November 14 2014

Healthcare