MedicalResearch.com Top Medical Research Interview August 14 2015

MedicalResearch.comExclusive Interviews with Medical Research and

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

Editor: Marie Benz, MD [email protected]

August 14 2015

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 MedicalResearch.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

Gene Signature Identifies Five Risk Subtypes of Prostate CancerMedicalResearch.com Interview with:

Dr Helen Ross-AdamsCancer Research UK, London

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

Dr. Ross-Adams: Prostate cancer is the most common non-skin cancer in men in both the UK and US. At the moment, prostate cancer is diagnosed and monitored mainly on the basis of blood tests for prostate specific antigen (PSA), a protein in the blood. MRI scans and examination of biopsy tissue samples under a microscope are also used to decide on the best course of action for each patient.

• Despite all this, as a community, we still struggle to reliably predict which men with an initial diagnosis of prostate cancer will go on to have a fast-growing, aggressive form of the disease (a ‘tiger’) from men who will have a much slower-growing form of the disease that won’t really cause problems in the man’s lifetime (a ‘pussycat’). This means some men may get treatment they don’t need, while others could benefit from earlier, more intensive treatment.

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

http://medicalresearch.com/cancer-_-oncology/prostate-cancer/gene-signature-identifies-five-risk-subtypes-of-prostate-cancer/16425/

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




• With this in mind, we studied a total of 250 men with prostate cancer and tested their tumour and healthy tissues at the molecular level. The idea was two-fold:

• Could we identify different sub-types of prostate cancer using this genetic information, and

• Could we link any of the sub-types we did find with other patient characteristics that clinicians would normally have, like histological staging information or PSA test results?

• We looked at their DNA, to see whether any regions were deleted or repeated (copy number alterations), and we also measured the activity levels of thousands of genes in the tumourand healthy prostate tissues (gene expression). Each of these approaches on their own can be used to stratify patients, but we decided to combine this information and hopefully find genes that had a big impact on prostate cancer.



http://medicalresearch.com/cancer-_-oncology/prostate-cancer/understanding-psa-controversy-does-not-deter-men-from-getting-tested/14225/





• Using this approach, we identified five different subtypes of prostate cancer, each with their own ‘molecular profile’:

• One group had lots of DNA deletions and only low levels of certain genes

• Another had lots of repeated DNA with high levels of associated genes

• Two more groups had very ‘quiet’ genomes, with very few changes at the DNA level, and not much disruption at the gene expression level

• The fifth and final group had an intermediate amount of copy number changes (DNA level), but no major changes at the gene expression level (mRNA level)

• When we correlated these different molecular subtypes with the patients’ standard post-surgery follow-up data (the results of 6-monthly PSA tests), we found that these subtypes predicted how well a patient would do after surgery. We ultimately identified 100 key genes (a gene signature) that were most useful in classifying men into one of the 5 cancer subtypes we identified.







This was derived from 150 men in Cambridge, UK. To check our findings, we repeated the same work in a group of 100 men from Stockholm, Sweden who had also had prostate surgery, and found that the 100 gene signature worked just as well – it subdivided the men into 5 different groups, each with different rates of relapse. In both cases, men with the most genetic alterations had the greatest chance of relapsing after surgery.







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

• Dr. Ross-Adams: The idea is that this gene signature would be used alongside current clinical tests like the Gleason score and PSA test, to give doctors a better idea of how patients will do after surgery to remove their prostate – which men are most at risk of relapse? This extra molecular information would give doctors a more accurate idea of what’s happening in a specific patient’s tumour, so the patient could be provided with more appropriate (’personalised’) treatment advice.

• We’re obviously very excited with these results, but as with most research, there are some caveats; we still need to do more research before doctors in the hospital could use this technique routinely.







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

• Dr. Ross-Adams: So, these findings are based on patients who’d already had surgery for their prostate cancer, and have given us some important insights into which types of cancers are more likely to come back after treatment. But because these weren’t samples taken at the time they were initially diagnosed, there’s work to do to see whether this gene signature can be used to divide prostate cancer patients into different groups based on diagnostic biopsies, and whether it should be used to determine treatment early on. One key thing here is whether we can get enough genetic material from a diagnostic biopsy to be able to do this analysis. Also, we need to be sure that the sample taken at biopsy is representative of the cancer cells in the tumour; targeted biopsies (using MRI) may help with this.







• An essential next step is to confirm these findings in much larger studies, and in other ethnic groups, and really examine each molecular subtype in depth. This information would be invaluable in identifying more effective ways to treat prostate cancer patients, and develop new treatments for each subtype.

• Citation:

• Ross-Adams et al. Integration of copy number and transcriptomics provides risk stratification in prostate cancer: a discovery and validation cohort study. DOI: 10.1016/j.ebiom.2015.07.017.

• http://www.cdc.gov/cancer/prostate/statistics/

• http://www.cancerresearchuk.org/about-cancer/type/prostate-cancer/



http://dx.doi.org/10.1016/j.ebiom.2015.07.017

http://www.cdc.gov/cancer/prostate/statistics/

http://www.cancerresearchuk.org/about-cancer/type/prostate-cancer/



Triple Anticoagulation Therapy Raises Bleeding Risk in Elderly Patients with AFib and Heart AttackMedicalResearch.com Interview with:

Connie N. Hess, MD, MHSDuke Clinical Research Institute

Duke UniversityDurham, North Carolina


Dr. Hess: Guidelines recommend the use of anticoagulation for thromboembolic prophylaxis in atrial fibrillation and also recommend use of dual antiplatelet therapy to reduce cardiovascular events after myocardial infarction and percutaneous coronary intervention. The use of triple therapy in patients with indications for DAPT and anticoagulation is challenging due to the increased bleeding risk associated with this regimen. The optimal antithrombotic regimen in this population has not yet been defined.

• This study specifically focused on older patients, a population that is at greater risk for Atrial Fibrillation-related stroke and recurrent events after MI but also higher risk for bleeding. Despite a growing population of older patients with indications for triple therapy, these patients have been underrepresented in clinical trials and are therefore understudied.

We found that relative to DAPT, patients on triple therapy had a similar risk of 2-year major adverse cardiac events but a significantly increased risk of bleeding requiring hospitalization, including greater risk of intracranial hemorrhage.


http://medicalresearch.com/heart-disease/triple-anticoagulation-therapy-raises-bleeding-risk-in-elderly-patients-with-afib-and-heart-attack/16422/

http://medicalresearch.com/heart-disease/acute-coronary-syndrome-genotyping-guided-antiplatelet-therapy-stent-surgery/3918/







• Dr. Hess: These data suggest that the risk-benefit ratio of triple therapy in older patients with myocardial infarction and Atrial Fibrillation should be carefully considered, as we found a significant increase in bleeding associated with triple therapy use without any associated reduction in MACE.



http://medicalresearch.com/author-interviews/oral-anticoagulation-medications-have-led-to-more-patients-treated-for-atrial-fibrillation/15994/







• Dr. Hess: Our results need to be confirmed with prospective studies focused on older patients with Atrial Fibrillation and MI; a number of ongoing randomized clinical trials may help to provide insight.

• Citation:

• Hess CN, Peterson ED, Peng S, et al. Use and Outcomes of Triple Therapy Among Older Patients With Acute Myocardial Infarction and Atrial Fibrillation. J Am Coll Cardiol. 2015;66(6):616-627. doi:10.1016/j.jacc.2015.05.062.



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

http://content.onlinejacc.org/article.aspx?articleID=2422306



Blood Biomarker Can Identify Patients At Risk of Continued Symptoms After Traumatic Brain InjuryMedicalResearch.com Interview with:

Frederick Korley MD Ph.DJohns Hopkins University School of Medicine

Emergency MedicineBaltimore, Maryland

Medical Research: What is the background for this study?

Dr. Korley: Each year, millions of Americans are evaluated in emergency departments for traumatic brain injuries. Currently the only test available for diagnosing traumatic brain injury is a brain CT scan. Brain CT scans accurately identify bleeding in the brain from trauma. However, they are unable to identify damage to brain cells. Approximately 90% of patients with traumatic brain injury have no bleeding in the brain and therefore have unremarkable brain CT scans. However, these patients typically have damaged brain cells and they continue to suffer headaches, dizziness, attention and memory deficits, sleep problems among others for months after their injury and can’t figure out why. Therefore new tests are needed to identify traumatic brain injury patients with damaged brain cells and especially those who are likely to have persistent traumatic brain injury-related symptoms for months after injury.


Blood Biomarker Can Identify Patients At Risk of Continued Symptoms After Traumatic Brain Injury Posted on August 9, 2015 Frederick Korley MD Ph.D Johns Hopkins University School of Medicine Emergency Medicine Baltimore, MarylandMedicalResearch.com Interview with: Frederick Korley MD Ph.D Johns Hopkins University School of Medicine Emergency Medicine Baltimore, Maryland

http://medicalresearch.com/author-interviews/compliance-with-guidelines-not-linked-to-outcomes-in-traumatic-brain-injury/16020/






• Medical Research: What are the main findings?

Dr. Korley: Our study determined that the blood levels of a protein called brain derived neurotrophic factor (BDNF) can help predict whether a patient will continue to have symptoms related to traumatic brain injury at six 6 months after injury, even if they had an unremarkable brain CT scan.


• Dr. Korley: There are exciting times ahead in the field of traumatic brain injury research. Although there are currently no FDA approved blood test for diagnosing traumatic brain injury, we are getting closer to having blood tests that can help us diagnose traumatic brain injury more accurately. Blood tests for BDNF will hopefully transform our ability to care for traumatic brain injury patients especially those who have an unremarkable brain CT scan.



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







• Dr. Korley: Additional studies need to be conducted at different medical centers to validate our findings. Furthermore, studies are needed to determine whether strategies that increase BDNF expression (such as early exercise and diet therapy) can help improve patient outcomes in traumatic brain injury.

• Citation:

• J Neurotrauma. 2015 Jul 10. [Epub ahead of print]

• Circulating Brain Derived Neurotrophic Factor (BDNF) Has Diagnostic and Prognostic Value in Traumatic Brain Injury.

• Korley FK1,2, Diaz-Arrastia R3, Wu AH4, Yue JK5, Manley GT M D Ph D6, Sair HI7, Van Eyk J8, Everett AD9, Okonkwo DO10, Valadka A11, Gordon WA12, Maas A13,14, Mukherjee P15, Yuh EL16, Lingsma H17,18, Puccio AM19, Schnyer DM20.



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

http://www.ncbi.nlm.nih.gov/pubmed/26159676





PCI Stenting All Lesions At Time of STEMI Reduces Reinfarction and MortalityMedicalResearch.com Interview with:

Henning Kelbæk, MDDepartment of Cardiology

Roskilde Hospital Roskilde, Denmark


Dr. Kelbæk: The background to conduct the DANAMI 3-Primulti trial is the uncertainty of which strategy is most favourable to the patient with ST-segment elevation myocardial infarction: to treat the culprit (resposible for the acute infarction) lesion only or to treat all visible lesions (complete revascularisation)

• The main findings of the PRIMULTI trial are that patients with ST-segment elevation myocardial infarction and multivessel disease, benefit from supplementary complete revascularisation of lesions in non-infarct related arteries when the second procedure is done during the index admission guided by measurement of the fractional flow reserve. This strategy results in a significant reduction in the combination of all-cause mortality, nonfatal reinfarction, and ischaemia-driven revascularisation.


http://medicalresearch.com/heart-disease/pci-stenting-all-lesions-at-time-of-stemi-reduces-reinfarction-and-mortality/16443/

http://medicalresearch.com/heart-disease/long-term-effects-of-ischemic-post-conditioning-with-pci-for-stemi/12362/







• Dr. Kelbæk: The take home message is that PCI of all lesions is safe when performed within the index admission. However, the effect of this staged strategy is driven entirely by the need for repeat revascularisation.



http://medicalresearch.com/heart-disease/no-difference-in-pci-stent-surgery-mortality-performed-withwithout-surgical-support/15787/







• Dr. Kelbæk: Several remaining questions have to be answered:

• Will complete revascularisation turn out to reduce mortality and/or the occurrence of reinfarction in a sufficiently powered (larger) trial ?

• Should only non-culprit lesions with prognostic significance be selected for treatment (in addition to the culprit lesion), and if so which lesions should be selected ? Is measurement of the fractional flow reserve necessary ?

• Should complete revascularisation be performed immediately, 2 days later or remote from the acute ST-segment elevation myocardial infarction ?

• Citation:

• Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel disease (DANAMI-3—PRIMULTI): an open-label, randomised controlled trial

• Thomas Engstrøm, MD Dr Henning Kelbæk, MD et al for the DANAMI-3—PRIMULTI Investigators

• The Lancet: Published Online: 04 August 2015DOI: http://dx.doi.org/10.1016/S0140-6736(15)60648-1



http://dx.doi.org/10.1016/S0140-6736(15)60648-1



Perfectionism Leads To Faster BurnoutMedicalResearch.com Interview with:

Andrew P. Hill, Ph.D, CPsychol, FBASES, FHEAAssociate Professor and Head of Taught Postgraduate Programmes

Faculty of Health and Life SciencesYork St John University York UK


• Dr. Hill: Our research examines the effects of perfectionism in a wide range of contexts and for a number of outcomes. We are particularly interested in the perfectionism-burnout relationship. Perfectionism is a characteristic that is more common than you might think, everyone seems to know someone who is a perfectionist. Burnout is the result of stress and, anecdotally, people seem to be finding modern life more stressful.

• The main finding was that perfectionistic concerns, a core feature of perfectionism that reflects doubts and fears relating to the consequences of failure, was positively related to burnout in the workplace, sport, and education. This relationship was stronger in the workplace.


http://medicalresearch.com/author-interviews/perfectionism-leads-to-faster-burnout/16437/







• Dr. Hill: In an imperfect world, being a perfectionist is stressful and if perfectionists aren’t able to develop strategies to deal with stress, it is likely to have a detrimental effect on health. Perfectionists require particular attention in terms of stress related health problems.









• Dr. Hill: We need more longitudinal research so to examine the perfectionism-burnout relationship over time (i.e., weeks, months, and years). We also need intervention studies aimed at reducing perfectionism fueled burnout.

• Citation:

• Andrew P. Hill, Thomas Curran. Multidimensional Perfectionism and Burnout: A Meta-Analysis. Personality and Social Psychology Review, July 2015 DOI: 10.1177/1088868315596286



http://dx.doi.org/10.1177/1088868315596286



Iodine Supplementation During Pregnancy Would Increase Childhood IQs, Reduce CostsMedicalResearch.com Interview with: Prof. Kate Jolly

Professor of Public Health and Primary CarePublic Health Building

School of Health & Population SciencesUniversity of Birmingham

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

Response: The UK is amongst 32 countries worldwide with evidence of iodine deficiency. Severe iodine deficiency during pregnancy is associated with a lower intelligence quotient (IQ) and developmental abnormalities in the children; these are reversible by iodine supplementation during pregnancy. However, the effects of mild or moderate iodine deficiency during pregnancy are less clear as there are no high quality trials of supplementation that have reported the outcome of child IQ. However, in two studies in the UK and Australia, nine year old children of women who had a urinary iodine concentration suggestive of mild iodine deficiency during their pregnancy exhibited reduced educational outcomes and decreased IQ scores compared to children of iodine replete mothers.

• Recent research from the UK suggests that the country has become mildly iodine deficient. Many countries address their iodine deficiency by programmes of adding iodine to salt and some recommend that pregnant women take iodine supplements. Neither of these occur in the UK, although some commonly used pregnancy supplements already include iodine.


http://medicalresearch.com/author-interviews/iodine-supplementation-during-pregnancy-would-increase-childhood-iqs-reduce-costs/16361/






Edgbaston Birmingham• Controversy about the need for supplementation in pregnancy, the ethics of undertaking a

trial in which women would be randomly allocated to have iodine supplements, or not, and the high cost of following-up and assessing large numbers of children makes a trial unlikely.


Response: We used an economic model of best available evidence and used assumptions that did not favour iodine supplementation. We found that if all women took iodine supplements for 3 months prior to pregnancy, during their pregnancy and until they ceased breastfeeding, there would be an average increase in each child’s IQ by 1·22 points. This would save the NHS £199 and society £4476 per pregnant woman respectively.








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

• Response: Current available evidence suggests that a policy of iodine supplementation during pregnancy would be a cost-effective strategy for the UK health service.








Edgbaston Birmingham• Medical Research: What recommendations do you have for future research as a result of

this study?

• Response: The only way to conclusively find out the benefits of iodine supplementation in pregnancy on children’s development would be to undertake a trial in which half the mothers received iodine supplements and half did not.

• Citation:

• Costs and benefits of iodine supplementation for pregnant women in a mildly to moderately iodine-deficient population: a modelling analysis Published online: August 9, 2015 Mark Monahan, Kristien Boelaert, Kate Jolly, Shiao Chan, Pelham Barton, Tracy E Roberts The Lancet Diabetes & Endocrinology



http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00212-0/abstract






Most Clinical Performance Measures Neglect Overuse ParametersMedicalResearch.com Interview with: Erika Newton MD, MPH Department of Emergency Medicine

Brenda Sirovich RN, MPHDivision of Trauma Surgery, Department of Surgery Stony Brook University Medical Center

Stony Brook, New York

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

Response: Clinical performance measures – quality indicators used to evaluate and motivate health care providers’ performance – play a central role right now in efforts to improve quality in U.S. health care. But their potential to influence care on a wide scale has some worried about unintended effects.

• In particular, there’s been growing concern that if performance measures focus disproportionately on underuse of care – that is, measuring whether enough care is being provided – they risk leading to unexpected consequences. Specifically, if incentives tend to reward clinicians for doing more without attention to whether they do too much –this could inadvertently contribute to the problem of excessive care, or overuse.


http://medicalresearch.com/author-interviews/most-clinical-performance-measures-neglect-overuse-parameters/16459/







Response: We thought it was important to look at what that balance is – between measures of underuse and measures of overuse – in outpatient practice. We looked at 16 major national collections of performance measures and essentially counted measures targeting underuse (‘Did the clinician do enough?’) versus overuse (‘Did the clinician do too much?’).

• We found that over 90 percent of 521 outpatient measures targeted underuse, while a mere 7 percent of outpatient measures addressed overuse – in fact nearly half of the collections contained no overuse measures at all.









• Response: We think there are two issues here.

• The first relates to the performance measures themselves. Many are based on evidence, and many clinicians may view them as unassailable. But with unbalanced efforts to increase utilization, it is almost certain that measures are not applied solely to individuals for whom they’re appropriate (everyone’s heard an example like the patient with terminal lung cancer who gets sent for a mammogram) and may be applied too often (a diabetic blood test, ‘hemoglobin A1c’ at every monthly visit would be too often).

• We recommend that clinicians consider the possible downsides. That’s hard to do every visit of every day – instead we believe clinicians should think about getting involved in designing policies within their practice or health system. Most clinicians are well familiar with some hazards of performance measurement. Werner and Asch provide a nice summary of the issues (Ann Fam Med.2007;5(2):159-163).








The bigger issue relates to the effect of cultivating a “more is better” culture in medicine. We believe patients and clinicians can play an important role in helping to address this – by trying to remain aware of the tendency. We think that the best thing that could happen here is an honest dialogue in the office about, for example, diagnostic testing. Many diagnostic tests may represent discretionary interventions – we would hope that patients could feel comfortable asking their provider, “Could you say more about that test; is there a reasonable alternative?” –and that providers would feel comfortable with those discussions, and with involving patients in discretionary decisions.








• Medical Research: What are the implications of your report for policy makers?

• Response: Our findings point to a need for policymakers to actively monitor for any aggregate effects of performance measurement. In addition, we believe there would be value in developing and implementing a prospective underuse/overuse taxonomy, to ensure greater balance within performance measure collections – or even within individual measures.









• Response: An important future direction would be to investigate the actual effects of clinical performance measurement (e.g. using measure sets which differ with respect to the balance of underuse : overuse targets) on provider behavior and healthcare utilization.

• Citation:

• Newton EH, Zazzera EA, Van Moorsel G, Sirovich BE. Undermeasuring Overuse—An Examination of National Clinical Performance Measures. JAMA Intern Med. Published online August 10, 2015. doi:10.1001/jamainternmed.2015.4025.



http://archinte.jamanetwork.com/article.aspx?articleid=2426427



Methadone For IV Drug Addiction Reduces HIV InfectionsMedicalResearch.com Interview with:

Dr. Keith Ahamad, a clinician scientist at the BC Centre for Excellence in HIV/AIDS and a Family Doctor trained and certified in Addiction Medicine.

•

• MedicalResearch: What is the background for this study?

• Dr. Ahamad: Previous methadone research has mostly been done in restrictive settings, such as the USA, where methadone can only be dispensed through restrictive methadone programs and cannot be prescribed through primary care physician’s offices. Since a systematic review in 2012, randomised controlled trials have compared methadone treatment provided at restrictive specialty clinics with primary care clinics, which have shown the benefits of primary care models of methadone delivery on heroin treatment outcomes, but not on HIV incidence.


http://medicalresearch.com/addiction/methadone-for-iv-drug-addiction-reduces-hiv-infections/16461/





• MedicalResearch: What are the main findings?

• Dr. Ahamad: After adjusting for factors commonly associated with HIV, methadone remained independently associated in protecting against HIV in this group of injection drug users. Those study participants who were not prescribed methadone at baseline were almost four times more likely to contract HIV during study follow up.







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

• Dr. Ahamad: Methadone is an effective medication in treating opioid addiction. Through international randomized control trials, we already know that when prescribed though primary care offices, access to this life-saving medication is increased, effective, and increases patient satisfaction. Now, through our study, we have evidence that when delivered in this manner, it also decreases the spread of HIV.



http://medicalresearch.com/infections/hiv/identifying-risky-behaviors-the-key-to-hiv-prevention/396/





• MedicalResearch: How can this study help to inform health policy decisions?

• Dr. Ahamad: Injection drug users remain a highly marginalized population at very high risk of contracting and spreading HIV. Traditionally, this group has been difficult to engage, in particular around treating those injecting opioids, as evidence-based treatment like methadone maintenance is often not readily available. Recently, we have seen an HIV outbreak in Southeastern Indiana that is caused by the injection of opioids. And in countries like Russia, methadone remains illegal. Methadone needs to be readily available as a treatment to help stop these outbreaks.



http://medicalresearch.com/author-interviews/white-opioid-users-increasingly-hooked-on-heroin/13833/





• MedicalResearch: Why is methadone management therapy so controversial?

• Dr. Ahamad: Often, addiction is not treated as a medical disease despite significant scientific evidence to support this. Methadone is a medication that many feel is replacing one “addiction” with another rather than a medical treatment no different than insulin to treat diabetes. Methadone has been proven to reduce and eliminate many of the consequences of opioid addiction. As such, methadone must be viewed as a treatment for opioid addiction rather than a substitution.



http://medicalresearch.com/addiction/heroin-addiction-most-often-preceded-by-opioid-abuse/15733/





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

• Dr. Ahamad:Future research needs to focus on continuing to find innovative ways to increase access to this essential medication. Access is of particular concern in rural areas where primary care resources are limited and often physicians are not trained sufficiently to diagnose and treat substance use disorders with medications like methadone.

• Citation:

• Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study

• Keith Ahamad, MD Kanna Hayashi, PhD Paul Nguyen, PhD Sabina Dobrer Prof Thomas Kerr, PhD Christian G Schütz, MD Prof Julio S Montaner, MD Prof Evan Wood, MD

• Published Online: 06 August 2015

• DOI: http://dx.doi.org/10.1016/S2352-3018(15)00129-0



http://dx.doi.org/10.1016/S2352-3018(15)00129-0



Serum Phosphorus Level May Be a Biomarker For AnemiaMedicalResearch.com Interview with:

Lac Tran, MDDivision of Nephrology and Hypertension

Kaiser Permanente Los Angeles Medical CenterLos Angeles, CA


• Dr. Tran: Abnormal serum phosphorus levels have been associated with adverse cardiovascular outcomes and progression to renal failure. Given phosphorus’s important biological roles in cellular replication and bone mineral metabolism, we sought to investigate the association between phosphorus levels and anemia in normal kidney function and early chronic kidney disease.

• Our study is a population-based study among a large racially/ethnically diverse population within the Kaiser Permanente Southern California health system.Among 155, 974 individuals, 4.1% had moderate anemia and 12.9% had mild anemia. We found that phosphorus levels greater than 3.5 mg/dL and less than 2.0 mg/dL showed a greater likelihood for moderate anemia. Every 0.5 mg/dL phosphorus level increase demonstrated a 16% greater likelihood for moderate anemia. The highest phosphorus tertileof our population had a 26% greater likelihood for anemia compared to the middle tertile. We also found that female sex, Asian race, diabetes, low albumin, and low iron saturation were risk factors for anemia.


http://medicalresearch.com/author-interviews/thank-you-dr-for-your-interview-which-is-now-published-here-on-medicalresearch-com-if-you-would-like-to-add-a-photoheadshot-to-your-interview-please-forward-it-to-me-and-i-will-gladly-upload-for/16474/







• Dr. Tran: Phosphorus may be a biomarker for anemia and play a role in hematopoiesis. Theoretically, lowering the phosphorus level in individuals with serum phosphorus > 4.0 mg/dL may prevent anemia in our population with normal kidney function and early CKD.









• Dr. Tran: Our study is a cross-sectional analysis, and therefore, a causal association cannot be made between phosphorus and anemia. Future research should elucidate the mechanism of phosphorus in hematopoiesis, and the roles that parathyroid hormone, vitamin D, fibroblast-growth factor-23, and klotho may play. Information on nutritional supplements and dietary phosphorus intake would be helpful in evaluating their effects on serum phosphorus levels.

• Citation:

• Serum phosphorus and association with anemia among a large diverse population with and without chronic kidney disease.

• Tran L, Batech M, Rhee CM, Streja E, Kalantar-Zadeh K, Jacobsen SJ, Sim JJ.

• Nephrol Dial Transplant. 2015 Aug 8. pii: gfv297. [Epub ahead of print]

• PMID: 26254460









Shorter Radiation Course For Early Breast Cancer Results In Better Quality of LifeMedicalResearch.com Interview with:

Simona F. Shaitelman, MD, EdMAssistant Professor

Department of Radiation Oncology University of Texas MD Anderson Cancer CenterHouston, TX 77030


Dr. Shaitelman: Our study compared two different radiation therapy regimens for women with early stage breast cancer and examined the acute and short term toxicities associated with these two different treatments. The treatments compared a shorter versus a longer course of whole breast irradiation, both delivered with a tumor bed boost. Although prior published data supported giving a shorter course regimen, this was being used only in about one third of appropriate women in the United States, in part because of concerns regarding toxicities, restricted tumor enrollment in the earlier studies, as well as the earlier lack of incorporation of a tumor bed boost (which is standard and known to decrease the risk of tumor recurrence).


http://medicalresearch.com/cancer-_-oncology/breast-cancer/shorter-radiation-course-for-early-breast-cancer-results-in-better-quality-of-life/16380/

http://medicalresearch.com/cancer-_-oncology/breast-cancer/hypofractionated-whole-breast-irradiation-early-stage-breast-cancer/9663/






Medical Research: What are the main findings?

Dr. Shaitelman: A total of 287 patients were enrolled, age 40 years and older, with stage 0-II breast cancer. 76% of patients in the study were overweight or obese (in comparison with previous studies that had excluded patients with a larger body mass index). We found that during radiation treatment, women with the shorter course regimen had less breast pain, dermatitis, hyperpigmentation, and fatigue. At six months, by both physician assessment and patient report, patients treated with the shorter regimen had less fatigue. Patients treated with the shorter course regimen also reported having a better ability to care for the needs of their family compared to those patients treated with the longer course regimen.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/some-breast-cancer-patients-have-excellent-results-with-partial-breast-radiation/15388/







• Dr. Shaitelman: We believe that for women with early stage breast cancer, the shorter course regimen should be the starting point for discussions about whole breast radiation. As breast cancer outcomes continue to improve, focusing on how our treatments impact patients’ quality of life in both the short and long-term will be increasingly important.

• Citation:

• Shaitelman SF, Schlembach PJ, Arzu I, et al. Acute and Short-term Toxic Effects of Conventionally Fractionated vs Hypofractionated Whole-Breast Irradiation: A Randomized Clinical Trial. JAMA Oncol. Published online August 06, 2015. doi:10.1001/jamaoncol.2015.2666.



http://oncology.jamanetwork.com/article.aspx?articleid=2422117



Coordinated Approach Could Decrease Infections and Deaths From Antibiotic Resistant BacteriaMedicalResearch.com Interview with:

Rachel Slayton PhDNational Center for Emerging and Zoonotic Infectious Diseases

CDC


Dr. Slayton: Antibiotic-resistant bacteria cause more than 2 million illnesses and at least 23,000 deaths each year in the US. Additionally, Clostridium difficile caused close to half a million illnesses in 2011, and an estimated 15,000 deaths a year are attributable to C. difficileinfections. Antibiotic resistance is a regional problem with inter-facility spread through movement of patients who are colonized or infected with these organisms.

• In our first analysis we projected the national incidence of infections and deaths from Carbapenem-resistant Enterobacteriaceae (CRE), Clostridium difficile, invasive methicillin-resistant Staphylococcus aureus (MRSA), and multidrug-resistant Pseudomonas aeruginosa. With immediate implementation of national interventions combining infection control and antibiotic stewardship and, assuming similar effectiveness to that reported in other countries, an estimated 619,000 health care–associated infections and 37,000 deaths could be averted over 5 years.


http://medicalresearch.com/medication-research/antibiotic-resistance/coordinated-approach-could-decrease-infections-and-deaths-from-antibiotic-resistant-bacteria/16472/





CDC

Using CRE as an exemplar, we also estimated the effect of a coordinated approach in a network for the preventing the spread of antibiotic-resistance organisms among healthcare facilities that share patients. Our Carbapenem-resistant Enterobacteriaceae modeling was done in collaboration with Johns Hopkins Bloomberg School of Public Health, the University of Utah, and University of California Irvine School of Medicine. Both models clearly show that we could see fewer antibiotic-resistant infections if health care facilities and public health officials work together as a team. For example, five years after Carbapenem-resistant Enterobacteriaceaeenters an area with 10 facilities that share patients, baseline activity alone resulted a prevalence of healthcare-associated CRE infection or colonization of 12.2% with 2,141 patients acquiring CRE. With independent facility-augmented efforts, we estimated that there would be an 8.6% prevalence with 1,590 patients acquiring Carbapenem-resistant Enterobacteriaceae. With a coordinated augmented approach, we estimated that there would be a 2.1% prevalence with 406 patients acquiring CRE. Using a 102-facility model of Orange County, California, we estimated that over 15 years countywide 19,271 patient acquisitions could be prevented with the coordinated augmented approach compared with independent-facility efforts.



http://medicalresearch.com/infections/antibiotic_resistant_bacteria_increase_in_se_us_community_hospitals/6498/





CDC


• Dr. Slayton: Clinicians should be aware of antibiotic resistance patterns in their facility and area to protect their patients. They should prescribe antibiotics correctly, ordering cultures then starting the right drug promptly at the right dose for the right duration. Clinicians should ask patients if they have recently received care in another facility. Finally, clinicians should follow hand hygiene and other infection control measures with every patient.

• Patients and their families can ask their healthcare providers what they and the facility are doing to protect you from an antibiotic-resistant or C. difficile infection. Additionally, patients can tell their doctors if they have recently been in another healthcare facility, including hospitals and nursing homes. Importantly, patients should insist that every healthcare provider wash their hands before touching you.



http://medicalresearch.com/infections/c-difficile/non-toxic-spores-may-prevent-c-difficile-infection/13844/





CDC


• Dr. Slayton: For some of the questions we ask, like the ones we address in this study, we cannot get the answers we need through traditional epidemiologic study techniques. To do so is often impossible or not feasible- would take many years, have enormous expense, even if attempted would likely have so many complexities and weaknesses that the results may be impossible interpret. In such cases, we have choices–we can take no action, we can take action based on opinions or guesses, or we can use modeling as a tool to generate additional information that is valuable in guiding our actions. Continuing to use mathematical modeling as a complementary tool to traditional epidemiologic studies will enhance future research studies and public health decision making.

• Citation:

• MMWR: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities — United States

• Weekly August 7, 2015 / 64(30);826-831



http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a4.htm?s_cid=mmmm6430a4_w

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6430a4.htm?s_cid=mmmm6430a4_w



Why Does Georgia Have the Lowest Rate of Kidney Transplantation?MedicalResearch.com Interview with: Rachel Patzer, PhD, MPH

Director of Health Services Research, Emory Transplant CenterAssistant Professor

Department of Surgery Division of TransplantationEmory University School of Medicine


Dr. Patzer: There are two main treatments for patients with end stage kidney disease: dialysis or kidney transplantation. Kidney transplantation offers the best survival and quality of life compared to dialysis. However, there is a limited supply of organs in the U.S., so not all patients with end stage organ failure get a kidney transplant. Certain regions of the country have lower access to kidney transplantation than other regions. The Southeastern United States (GA, NC, and SC) has the lowest rates of kidney transplantation in the nation, and Georgia (GA) is the state that ranks at the very bottom.

• Our research team and collaborators from the Southeastern Kidney Transplant Coalition sought to examine some of the reasons for why Georgia had the lowest rates of kidney transplantation in the nation. The transplant centers in our Coalition collaborated to share data on patient referrals from dialysis facilities, where the majority of end stage renal disease patients receive treatment, to transplant centers in Georgia. Referral from a dialysis facility to a transplant center is required for patients to undergo the extensive medical evaluation that is required for a patient to either be placed on the national deceased donor waiting list, or to receive a living donor kidney transplant (e.g. from a friend or family member).


http://medicalresearch.com/author-interviews/why-does-georgia-have-the-lowest-rate-of-kidney-transplantation/16483/






• There were several major findings:

• 1) That overall, referral of patients from a dialysis facility to a kidney transplant center is low (only about 28% of patients with kidney failure are referred to a transplant center within a year of starting dialysis).

• 2) There was much variation in referral for transplantation across dialysis facilities in GA, where some facilities referred no patients within a year, and others referred up to 75% of their patient population.









• Dr. Patzer: Physicians in dialysis facilities are required to discuss transplantation as a treatment option with all of their patients with end stage kidney disease within the first few months of starting treatment. However, there are no standard guidelines for what this conversation should entail. Clinicians should explain the benefits of transplantation to their patients, and work with the patients to remove any potential barriers that the patient may face. Be an advocate for your patients! We recommend that if there is any uncertainty into whether the patient is eligible for a transplant, they should be referred for transplant so that the transplant center can do a detailed medical evaluation to make that determination.

• For patients, it is important to be your own advocate. You can ask your doctor, nurse, or social worker questions about what is involved in the kidney transplant process. You can also self-refer to a transplant center.









• Dr. Patzer: This study was conducted in Georgia only, due to the availability of referral data. There are no national sources of referral data, so it is unknown whether these findings are generalizable to the rest of the United States. Our future research involves collecting more data on referral patterns for dialysis facilities outside of just Georgia. We also have ongoing work to intervene on the dialysis facilities in our region with the lowest rates of referral. We are providing educational materials and support for dialysis facility leadership, staff, and patients to try and improve referral for kidney transplantation for patients.

• Citation:

• Patzer RE, Plantinga LC, Paul S, et al. Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia. JAMA. 2015;314(6):582-594. doi:10.1001/jama.2015.8897.



http://jama.jamanetwork.com/article.aspx?articleid=2425745



New cancer marker may be key to tailored chemotherapy treatment in hard to treat breast cancer – Cancer vaccine target?MedicalResearch.com Interview with: Dr Stephen Chan DM, FRCR, FRCP

Consultant Oncologist Breast and Gynaecological CancersNottingham University Hospitals Trust

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

• Dr. Chan: Worldwide each year 1.68 million women are diagnosed with breast cancer and more than half a million die from the disease. Of these new cases around 12% will be classified as triple negative breast cancer (TNBC), meaning that tumour cells from these patients do not show any of the three established clinical markers that can be treated with targeted therapies. These drugs are used in addition to standard chemotherapy to improve the chance of a good treatment response, leading to prolonged disease free survival. Without these additional treatment options triple negative patients are forced to depend entirely on chemotherapy to treat their cancer.

• Traditionally the sensitivity of a cancer to different types of chemotherapy has been categorised is based on a tumours tissue of origin and stage. There is currently no predictive marker of response that would allow chemotherapy treatment to be tailored to individual patients. With this information a clinician can predict which patients would benefit most from a particular chemotherapy and switch any who would do poorly to an alternative. The result would be a shift to increased treatment efficacy, while avoiding toxicity from ineffective treatment, which would in turn also reduce the cost to the health service. This need is particularly acute in triple negative breast cancer cases where chemotherapy is the cornerstone of treatment.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/new-cancer-marker-may-be-key-to-tailored-chemotherapy-treatment-in-hard-to-treat-breast-cancer-cancer-vaccine-target/16489/

http://medicalresearch.com/cancer-_-oncology/breast-cancer/novel-compound-may-shut-pancreatic-triple-negative-breast-cancer-cells/10939/





In collaboration with researchers based at Nottingham Trent University our group has been successful in finding new markers, which can predict how a patient will respond to chemotherapy treatment. One of these is HAGE (DDX43), a DEAD box RNA helicase. We have found that high HAGE expression predicts good respond to one of the main first line chemotherapy drugs, called anthracycline (Tarek MA Abdel-Fatah et al, April 2014). Our recent work (Tarek MA Abdel-Fatah, 2015) has shown that the predictive value is strong in triple negative breast cancer cases.



http://www.nature.com/bjc/journal/v110/n10/abs/bjc2014168a.html

http://clincancerres.aacrjournals.org/content/early/2015/08/01/1078-0432.CCR-15-0610.abstract





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

• Dr. Chan: Because patients with TNBC are so reliant on chemotherapy to cure their cancer, it is important to choose the one that will be the most effective. Our results have shown that HAGE may be a good test for tailoring these patients chemotherapy, so that those who will respond well to anthracycline receive it and those who will not, go on to receive an alternative that may give them a better chance of a good response.



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





• MedicalResearch: What are the possibilities for future research as a result of this study?

• Dr. Chan: In the future a test kit for HAGE could be used to help guide clinical decision making for these patients. However it is likely that such a kit would include several markers in combination, to provide a complete profile of all the chemotherapy options. We have several other markers, awaiting publication, which could be combined in this way. Our long term goal for this research would be the development of a testing kit, as well as conducting a clinical trial to establish its clinical utility.

• Going beyond testing for HAGE we have found that it can provoke an immune response, and that high expression is associated with the presence of tumour infiltrating lymphocytes. This indicates that HAGE may provide a potential target for a future cancer vaccine, and work is already under way to test this hypothesis.







• Citations:

• HAGE in triple negative breast cancer (TNBC) is a novel prognostic, predictive and actionable biomarker: A Transcriptomic and protein expression analysis

• Authors: Dr. Tarek MA Abdel-Fatah, Dr. Stephanie E McArdle, Ms. Devika Agarwal, Mr. Paul M Moseley, Dr. Andrew R Green, Prof. Graham R Ball, Prof. A. Graham Pockley, Prof. Ian O Ellis, Prof. Robert C Rees, Prof. Stephen YT Chan

• Journal: Clinical Cancer Research Impact Factor: 8.722

• Published as Online First before final proofs on 3rd August 2015

• Link: http://clincancerres.aacrjournals.org/content/early/2015/08/01/1078-0432.CCR-15-0610.abstract

• Original clinical paper in British Journal of Cancer, published online on 22nd April 2014

• Title: HAGE (DDX43) is a biomarker for poor prognosis and a predictor of chemotherapy response in breast cancer

• Authors: Tarek M.A. Abdel-Fatah, Stéphanie E.B. McArdle, Catherine Johnson, Paul M. Moseley, Graham R. Ball, A. Graham Pockley, Ian O. Ellis, Robert C. Rees, Stephen Y.T. Chan

• Link: http://www.nature.com/bjc/journal/v110/n10/abs/bjc2014168a.html



http://clincancerres.aacrjournals.org/content/early/2015/08/01/1078-0432.CCR-15-0610.abstract

http://www.nature.com/bjc/journal/v110/n10/abs/bjc2014168a.html



CT Scan IV Contrast Not Linked With AKI or Emergent Dialysis, Even In Patients With Impaired Kidney FunctionMedicalResearch.com Interview with:

Jennifer S. McDonald Ph.DAssistant Professor

Department of RadiologyMayo Clinic

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

Dr. McDonald: Our research group is interested in studying contrast-induced nephropathy (CIN), which is the development of acute kidney injury following administration of iodinated contrast material. Iodinated contrast material is frequently administered during CT examinations. Recent publications, including those by our group, suggest that the incidence of contrast-induced nephropathy has been overestimated by prior, uncontrolled studies. The purpose of our study was to better evaluate the incidence and severity of CIN in patients with diminished renal function (eGFR < 60 ml/min/1.73m2). In the current article, we performed a controlled retrospective study comparing patients who received a contrast-enhanced CT scan at our institution to patients who received an unenhanced CT scan. We used propensity score analysis that incorporated numerous variables to match contrast recipients and control patients with similar clinical characteristics. After performing this analysis, we found that the rate of AKI, emergent dialysis, and short-term mortality was similar between contrast recipients and control patients.


http://medicalresearch.com/radiology/ct-scan-iv-contrast-not-linked-with-aki-or-emergent-dialysis-even-in-patients-with-impaired-kidney-function/16499/

http://medicalresearch.com/author-interviews/team_approach_improved_patient_safety_from_cath_lab_procedure/6650/







• Dr. McDonald: Our study found that intravenous contrast material administration was not associated with an increased risk of acute kidney injury, emergent dialysis, and short-term mortality, even in patients with a pre-scan eGFR < 30 ml/min/1.73m2. These findings provide additional evidence that the risk of CIN is extremely low in the vast majority of patients who receive a CT scan. Our findings promote a more liberalized use of contrast material in patients where diagnostically indicated. This would mean better use of contrast material and faster, more accurate diagnoses for patients.



http://medicalresearch.com/allergies/ppi_one_of_risk_factors_for_hypersensitivity_reaction_to_contast_media/7428/







• Dr. McDonald: While our study was extensive, it was retrospective in nature. Prospective studies are needed to better evaluate the true incidence and severity of contrast-induced nephropathy. Ideally, randomized controlled trials should be performed where patients are randomized to contrast administration. We hope that the findings of our retrospective studies will help pave the way for these randomized trials.

• Citation:

• Risk of Acute Kidney Injury, Dialysis, and Mortality in Patients With Chronic Kidney Disease After Intravenous Contrast Material Exposure

• McDonald JS1, McDonald RJ2, Lieske JC3, Carter RE4, Katzberg RW5, Williamson EE2, Kallmes DE

• Mayo Clin Proc. 2015 Aug;90(8):1046-53. doi: 10.1016/j.mayocp.2015.05.016.



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

http://www.ncbi.nlm.nih.gov/pubmed/?term=Risk+of+Acute+Kidney+Injury,+Dialysis,+and+Mortality+in+Patients+With+Chronic+Kidney+Disease+After+Intravenous+Contrast+Material+Exposure





Lung Cancer Diagnosis and Staging Takes Too Long In Real World SettingsMedicalResearch.com Interview with:

Raymond Osarogiagbon MD, FACPThoracic Oncology Research Group

Baptist Cancer CenterMemphis, Tennessee


• Dr. Osarogiagbon: Lung cancer care is complicated, but can be broken down into 5 steps: x-ray detection, biopsy, x-ray tests of cancer spread (the ‘stage’), biopsy of suspicious areas where cancer may have spread, and treatment.

• Looking only at patients who had surgery for a suspected lung cancer, we worked backwards to see how their care went through the key steps and how long it took.

• We found that patients often skip some of the crucial steps. For example, 22% did not have a staging PET/CT scan, 88% did not have an invasive staging test. Only 10% had the recommended combination of 3 staging tests leading up to surgery: a CT scan, PET/CT scan, and invasive staging test.

• It took a month and a half to more than 6 months for the middle half of patients to go from first abnormal x-ray sign of possible lung cancer to surgery.


http://medicalresearch.com/cancer-_-oncology/lung-cancer-diagnosis-and-staging-takes-too-long-in-real-world-settings/16504/







• Dr. Osarogiagbon: It takes too long for patients who may have lung cancer to get to final treatment (in this case, surgery) and too many patients skip vital steps needed to decide the best possible treatment. This leads to surgery in advanced cases where other treatment might have been more appropriate. We are also concerned that the reverse problem is probably also happening, where patients who might benefit from surgery do not get it.

• Patients should ask lots of questions: ‘How long will it take to figure out what’s the best treatment for me?’, ‘what’s the stage of my cancer?’, ‘how do you know?’, ‘how do you know this is the best treatment for me?’









• Dr. Osarogiagbon: We have only looked at patients with the best possible outcomes: they received surgery. We don’t yet know how many patients who may have benefited from surgery missed the opportunity because of delays or misinterpretation of their test results. The current report came from an ongoing research project to test the value of changing the care delivery system to center lung cancer patients in the midst of key specialist doctors early in each patient’s care journey. We’re trying to test if this method increases the rate at which patients get the right care at the right time, and whether that improves patients’ care experience and survival.

• More research is needed into the barriers to successful implementation of effective multidisciplinary care programs at all types of lung cancer care delivery environments (tertiary and community care centers). Otherwise recent, current and future advances in lung cancer treatment will not translate into meaningful change at the broad population level.

• Citation:

• Preoperative Evaluation of Lung Cancer in a Community Health Care Setting

• Nicholas Faris, M. Div. Xinhua Yu, MD, PhD Srishti Sareen, MBBS Raymond S. Signore, RNFA Laura M. McHugh, RN Kristina Roark, RN Edward T. Robbins, MD Raymond U. Osarogiagbon, MBBS

• Accepted: March 6, 2015; Published Online: June 11, 2015

• DOI: http://dx.doi.org/10.1016/j.athoracsur.2015.03.008



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

http://www.annalsthoracicsurgery.org/article/S0003-4975(15)00371-9/abstract



http://dx.doi.org/10.1016/j.athoracsur.2015.03.008



Long Term Hypoxic Events Linked To Adverse Outcomes In Very Preterm InfantsPosted on August 11, 2015

Prof. Dr. med. Christian F. Poets Neonatologie, Univ.-Klinikum Tübingen Tübingen GermanyMedicalResearch.com Interview with:Prof. Dr. med. Christian F. Poets

Neonatologie, Univ.-Klinikum TübingenTübingen Germany


Prof. Poets: Episodes of intermittent hypoxemia (lack of oxygen) and bradycardia (slow heart rate) are common in very preterm infants and often a subject of considerable concern. However, up to now there has been a lack of knowledge as to how often or how long such episodes may occur without increasing an infant’s risk for impaired development or even death.

In this study, we utilized long-term recordings (lasting 8-12 weeks) of oxygen saturation and heart rate obtained as part of the Canadian Oxygen Trial (COT), a large study performed in extremely immature infants and comparing a higher with a lower oxygen saturation target range (85-89 vs. 91-95% oxygen saturation measured by pulse oximetry). For this secondary analysis, we wanted to test the hypotheses that spending a high proportion of time at an oxygen saturation below 80% or a pulse rate <80 beats per minute increases the risk of the following adverse outcomes:


http://medicalresearch.com/pediatrics/16469long-term-hypoxic-events-linked-to-adverse-outcomes-in-very-preterm-infants/16469/






Death after reaching a post-menstrual age of 36 weeks (i.e. 4 weeks before their due date) or disability, determined at 18-22 months corrected age and defined as motor impairment, cognitive or language delay, severe hearing loss, or bilateral blindness;

Motor impairment (determined at 18-22 months corrected age);

Cognitive or language delay (determined at 18-22 months corrected age);

Severe retinopathy of prematurity.









Prof. Poets: Analyzable recordings and outcome data were available for 1019 infants, of which the least affected 10% spent 0.4%, and the most affected infants 13.5% of the time at an oxygen saturation <80%. We found that the risk to develop all of the adverse outcomes mentioned above increased with the percentage of time spent at an oxygen saturation below 80%, but this was true only for hypoxemic events lasting for at least 1 minute. Episodes with a low heart rate (in the absence of concomitant hypoxemia) were not associated with an increased risk of an adverse outcome. Interestingly, hypoxemic events occurring in infants originally randomized to the higher oxygen group in the original COT study were associated with a stronger increase in the risk of death or disability than such episodes occurring infants randomized to the lower oxygen saturation target range.








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

Prof. Poets: There is good news and bad news in these data:

The good news is that it is reassuring that only the (comparatively rare) events lasting for 1 minute or more were associated with an adverse outcome, and that episodes with a slow heart rate added very little to this risk.

The bad news is that prolonged episodes with a low oxygen saturation (<80%) are clearly of concern, as they may affect long-term development, at least if our findings are confirmed in future studies.








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

Prof. Poets: If our findings are confirmed in future studies, increased efforts to prevent or treat (shorten) such episodes are needed. This may involve a closer look at interventions that are yet only insufficiently tested, such as higher caffeine doses, doxapram administration, or specific ventilator strategies.

Citation:

Association Between Intermittent Hypoxemia or Bradycardia and Late Death or Disability in Extremely Preterm Infants

Christian F. Poets MD, Robin S. Roberts MSc, Barbara Schmidt MD, MSc, Robin K. Whyte MB, Elizabeth V. Asztalos MD, MSc, David Bader MD, Aida Bairam MD, PhD, Diane Moddemann MD, Abraham Peliowski MD, Yacov Rabi MD, Alfonso Solimano MD, Harvey Nelson MSc





Traditional Treatments For Central Retinal Artery Occlusion May Be Worse Than No TreatmentPosted on August 11, 2015

MedicalResearch.com Interview with:Matthew Schrag MD

Department of Neurology Yale UniversityNew Haven, Connecticut


Dr. Schrag: Central retinal artery occlusion (CRAO) is a relatively rare disorder that is caused by interruption of blood flow to the retina, usually by a clot or some other embolus. Despite around 150 years of research, no compelling treatment has been found for this disease. Treatment with fibrinolytics has been used experimentally for a long time and some of the results have been encouraging. The point of the current study was to aggregate all of this observational data and compare how patients withCentral retinal artery occlusion do when treated with fibrinolyticsversus when they are treated with other approaches or not treated at all.

The biggest surprise in the data was the poor performance of conventional treatments at less than half the recovery rate of patients who were simply left alone. The literature on treating central retinal artery occlusion with ocular massage, hemodilution or anterior chamber paracentesis has never been particularly compelling, but these treatments were thought to be harmless and are often practiced in the acute management of central retinal artery occlusion. This new analysis strongly suggests that these interventions may be harmful. While this data is not perfect (it is retrospective, non-randomized, acquired over long periods of time, etc), for me it raises enough doubt that I think ocular massage, anterior chamber paracentesis and hemodilution should be abandoned as treatments for acute CRAO.


http://medicalresearch.com/neurological-disorders/traditional-treatments-for-central-retinal-artery-occlusion-may-be-worse-than-no-treatment/16513/







Dr. Schrag: The data is encouraging regarding the effectiveness of tPA for CRAO — but only early on. This is not strong enough data to make a compelling recommendation that patients with CRAO should receive tPA. However, many centers do treat CRAO off-label with tPA and for those centers I would recommend only treating within the first 4.5 hours.









Dr. Schrag: This type of analysis tries to maximize the power of observational data. Rare diseases like CRAO are hard to study in randomized controlled trials which give us the best quality data. Maximizing the usefulness of retrospective and observational data can help to ensure the best possible clinical design and I hope will improve the odds of having a successful trial.

Citation:

Schrag M, Youn T, Schindler J, Kirshner H, Greer D. Intravenous Fibrinolytic Therapy in Central Retinal Artery Occlusion: A Patient-Level Meta-analysis. JAMA Neurol.Published online August 10, 2015. doi:10.1001/jamaneurol.2015.1578.





Without Insurance Data, Hospitals Don’t Know Their True Readmission RateMedicalResearch.com Interview with:

Alisa Khan, MDPediatric hospitalist and health services research fellow

Boston Children’s Hospital


Dr. Khan: Patients can be readmitted to the same hospital they were discharged from or to a different hospital. In adults, readmissions to different hospitals make up about 20% of all readmissions. We don’t know a lot about how often different-hospital readmissions happen in children.

Insurance companies know hospitals’ true readmission rates (which include when a hospital’s patients are readmitted to the same hospital and when they are readmitted to a different hospital). However, hospitals don’t know their true readmission rates since they don’t have access to the full information that insurance companies have.

If hospitals don’t know their true rates, they may think they are doing better at preventing readmissions than they really (for instance, if all their discharged patients are simply being readmitted to a different hospital). Hospitals may also draw incorrect conclusions when they compare themselves to one another (like through benchmarking), and may not be able to predict whether they will be subject to penalties by insurers for having excessively high readmission rates.


http://medicalresearch.com/pediatrics/without-insurance-data-hospitals-dont-know-their-true-readmission-rate/16523/







Dr. Khan: We found that about 1 in 7 pediatric readmissions in New York over a 5-year period were to a different hospital than the hospital the patient was discharged from. The percentage of different-hospital readmissions varied by hospital and patient characteristics. Patients who were admitted to non-children’s hospitals, lower-volume hospitals, or urban hospitals had a higher chance of being readmitted to a different hospital, as did patients who were younger, white, privately insured, or who had certain chronic conditions (like mental health, neurologic, and circulatory conditions).

We also found a lot of variability in how much individual hospitals would underestimate their true readmission rates if they only used this incomplete same-hospital readmission info. Some hospitals would underestimate their true readmission rates by only 0.6 relative percentage points while others would underestimate them by 68 points.









Dr. Khan: Hospitals can’t accurately predict or judge their real readmission rates if they don’t have access to the full information that insurance companies have, including information about readmissions to different hospitals. It would be helpful for hospitals to have access to this information. This would allow them to better gauge the success of their quality improvement efforts, prioritize areas of improvement, compare themselves to other hospitals, and anticipate penalties by insurers.









Dr. Khan: Future areas of research include looking at whether these patterns hold true in other states, learning more about the reasons that parents and patients say they go to different hospitals, and studying ways to reduce readmissions to different hospitals.

Citation:

JAMA Pediatr. 2015 Aug 3. doi: 10.1001/jamapediatrics.2015.1129. [Epub ahead of print]

Same-Hospital Readmission Rates as a Measure of Pediatric Quality of Care.

Khan A1, Nakamura MM2, Zaslavsky AM3, Jang J4, Berry JG1, Feng JY5, Schuster MA1.





Southern Diet May Raise Risk of Coronary Artery DiseaseJames M. Shikany, DrPH Professor of Medicine Division of Preventive Medicine University of Alabama at Birmingham Birmingham, AL

MedicalResearch.com Interview with: James M. Shikany, DrPH Professor of MedicineDivision of Preventive Medicine

University of Alabama at BirminghamBirmingham, AL


Dr. Shikany: There is a growing interest in the field of nutritional epidemiology in relating overall dietary practices to various disease endpoints. For example, the assessment of dietary patterns in a population may be more meaningful than concentrating on isolated nutrients or foods because they more closely reflect how people eat in the real world. Previously, we looked at how the degree to which one adhered to 5 dietary patterns identified in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study was associated with the risk of stroke. In the current study, we investigated how the degree to which one adhered to these dietary patterns was related to the risk of incident acute coronary heart disease.


http://medicalresearch.com/heart-disease/southern-diet-may-raise-risk-of-coronary-artery-disease/16332/






The main finding was that a Southern dietary pattern (characterized by added fats, fried foods, eggs and egg dishes, organ meats, processed meats, and sugar-sweetened beverages) was associated with a significantly greater hazard of incident acute coronary heart disease in REGARDS participants. The association persisted following adjustment for sociodemographics, lifestyle factors, and energy intake. Specifically, following multivariable adjustment, participants in the highest quartile of consumption of the Southern pattern experienced a 56% greater hazard of incident coronary heart disease compared with those in the lowest quartile of consumption of this pattern. Another pattern we observed – the Plant-based pattern – characterized by vegetables, fruits, beans, yogurt, poultry, and fish was not associated with an increased risk of coronary heart disease.









Dr. Shikany: It should be acknowledged that this was an observational study, not a clinical trial. However, it was a large study in a well-characterized cohort using rigorous methods. It also included regional and sociodemographic diversity (including a large proportion of African American participants). The major take-away message is that a person’s overall pattern of eating may be related to the risk of coronary heart disease. Specifically, based on our results, it would be prudent to advise those who report usually consuming a Southern-type dietary pattern to move away from this pattern by recommending such things as eating fewer fried foods and processed and organ meats and drinking fewer sugar-sweetened beverages. Guiding patients to consume more of the Plant-based dietary pattern may be advisable because of its lack of an association with risk of coronary heart disease in this study. There are no known risks associated with these recommendations, and they may favorably influence the risk of incident coronary heart disease.









Dr. Shikany: As with most research, these findings need to be replicated in different populations.

Citation:

Southern Dietary Pattern is Associated with Hazard of Acute Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) StudyJames M. Shikany, Monika M. Safford, P.K. Newby, Raegan W. Durant, Todd M. Brown, and Suzanne E. Judd





Dementia Patients on Cholinesterase Inhibitors Risk Substantial Weight Loss

MedicalResearch.com Interview with:Meera Sheffrin MD Geriatrics Fellow

Division of Geriatrics | Department of MedicineSan Francisco VA Medical Center

University of California, San Francisco


Dr. Sheffrin: The main drug treatments for dementia are a class of medications called cholinesterase inhibitors. They have only modest effects on cognition and function in most patients, but since they are one of the few available treatments for dementia and thus very commonly prescribed. However,they are known to cause GI side effects (nausea, vomiting, diarrhea, and anorexia) in many patients when first started. It is plausible they could also caustweight loss, espeically considering they cause nausea and anorexia. However, the data on weight loss from randomized controlled trials is very limited and inconclusive, so we did a very large observational study in a real-world of the VA national healthcare system who were newly started on these medications, to see if they were associated with weight loss.


http://medicalresearch.com/weight-research/dementia-patients-on-cholinesterase-inhibitors-risk-substantial-weight-loss/16575/







• We found that patient with dementia started on cholinesterase inhibitors had a substantially higher risk of clinically significant weight loss over a 12-month period compared to matched controls.

• 1,188 patients started on cholinesterase inhibitors were matched to 2,189 similar patients who were started on other new chronic medications. The primary outcome was time to a 10-pound weight loss over a 12-month period, as this represents a degree of loss that would be clinically meaningful – not only noticed by a clinician but would perhaps prompt further action in considering the causes of the weight loss and medical work-up.

• We found that starting cholinesterase inhibitors was associated with a 24% greater risk of developing weight loss. Overall, 29% of patients started on cholinesterase inhibitors experienced a weight loss of 10 pounds or more, compared with 23% of the control group. This corresponds to a number needed to harm of 21 over 1 year; meaning only 21 patients need to be treated with a cholinesterase inhibitor over the course of a year for one patient to experience a 10 pound weight loss.










• Dr. Sheffrin: Patients with dementia started on cholinesterase inhibitors had a substantially higher risk of experiencing a clinically significant weight loss. The decision to prescribe a cholinesterase inhibitor is a complex one- clinicians and should take into account the modest benefits and possible harms, including weight loss, that are associated with these medications.










• Dr. Sheffrin: Further research should be done to determine if they are particular groups of patients (women, frail patients) who are more likely to experience the adverse effect of weight loss after starting cholinesterase inhibitors.

• Citation:

• Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System

• Meera Sheffrin MD Yinghui Miao MPH W. John Boscardin PhD1,2 and Michael A. Steinman MD1

• Article first published online: 3 AUG 2015

• DOI: 10.1111/jgs.13511 J Am Geriatr Soc 2015.



http://onlinelibrary.wiley.com/doi/10.1111/jgs.13511/abstract






Penn Developed Sarcoidosis Score Reliably Measures Disease ActivityMedicalResearch.com Interview with:

Misha A. Rosenbach, MDAssistant Professor of Dermatology at the Hospital of the University of Pennsylvania

Assistant Professor of Dermatology in Medicine


• Dr. Rosenbach: Sarcoidosis is an inflammatory disease of unknown etiology where genetically susceptible patients develop multi-organ granulomatous inflammation in response to an as-yet unidentified stimulus. Patients with sarcoidosis typically have granulomatous inflammation in their lungs, but the second most commonly affected organ is the skin; the eyes, lymph nodes, liver, heart, brain, and other organs can be affected as well. Patients with sarcoidosis can experience a few disease trajectories; some spontaneously recover, while others have persistent, active inflammation, whereas another group can experience inflammation which leads to scarring and fibrosis. It can be challenging to distinguish these cohorts of patients based on their lungs alone.

• The skin is much easier to evaluate, as it is right there on the surface, and can be examined by physicians without resorting to invasive tests or radiography. At Penn, we developed a novel cutaneous sarcoidosis assessment tool, called the Cutaneous Sarcoidosis Activity and Morphology Instrument (CSAMI), which is designed to accurately measure how inflamed skin sarcoid lesions are in a given patient, as well as describing which type of cutaneous lesion patients’ have. The CSAMI has in previously studies been shown to be reliable when used by dermatologists, with excellent inter-rater and intra-rater reproducibility.


http://medicalresearch.com/author-interviews/penn-developed-sarcoidosis-score-reliably-measures-disease-activity/16495/






In this study, we had a group of Pulmonologists, Rheumatologists, and Dermatologists (representing the groups of physicians who most commonly care for patients with sarcoidosis, especially if there is skin involvement) evaluate a group of patients with cutaneous sarcoidosis, using the CSAMI and another sarcoidosis activity instrument, the SASI, which has also previously been used to measure skin sarcoidosis activity in a number of settings. We were able to demonstrate that these cutaneous scoring tools are reliable and reproducible and able to accurately measure cutaneous sarcoidosis disease activity in a variety of patients with a range of skin disease severity. We also compared the physician scores to patients’ own evaluations of their disease, and showed that the CSAMI (physician impression of disease) correlated well with patients’ own perception of their disease activity and severity.



http://medicalresearch.com/author-interviews/ace-level-lowered-by-ace-inhibitors-can-falsely-rule-out-sarcoidosis/16347/







• Dr. Rosenbach: Taken together, these findings suggest that we have some useful tools available to measure cutaneous sarcoidosis activity. Ideally, this will help with clinical trials, as having accurate, reliable tools to measure disease activity is critical when conducting trials with a therapeutic intervention. It is essential that we can measure how patients’ disease changes in response to therapy, so that we can have a standard metric for evaluating sarcoidosis activity and comparing outcomes within a single trial, and between multiple trials. Development of clinical assessment tools is the first step towards accurately understanding how we can effect change in our patients’ sarcoidosis with our therapeutic interventions.

• Citation:

• Yeung H, Farber S, Birnbaum BK, et al. Reliability and Validity of Cutaneous Sarcoidosis Outcome Instruments Among Dermatologists, Pulmonologists, and Rheumatologists.JAMA Dermatol. Published online August 12, 2015. doi:10.1001/jamadermatol.2015.2008.



http://archderm.jamanetwork.com/article.aspx?articleid=2426397



C- Section May Raise Attention Deficit Risk in Neonates

MedicalResearch.com Interview with:Scott A. Adler, Ph.D. Associate Professor Coordinator

Developmental Science Graduate Program Dept. of Psychology & Centre for Vision ResearchVisual and Cognitive Development Project York University

Toronto, Ontario Canada Medical Research: What is the background for this study?

Dr. Adler: Experiences that we have early in life clearly have an impact on our brain development and behavior as we get older. Numerous studies have detailed these experiences, ranging from how we were fed as a baby to how many languages we hear to traumatic events. These experiences have been shown to influence formation, maintenance, and pruning of the networks of synaptic connections in our brain’s that impact all manner of thought and behavior. Yet, the impact of one of the earliest experiences, that of being born, on brain and psychological behavior has not before been explored. A recent study with rat pups has strongly suggested that the birth process has a definite impact on initial brain development. If that is the case, what happens if the infant’s birth is one in which she does not experience the natural birth process, such as occurs with caesarean section births?


http://medicalresearch.com/author-interviews/c-section-may-raise-attention-deficit-risk-in-neonates/16555/

http://medicalresearch.com/mental-health-research/autism/caesarean-section-linked-to-increased-autism/15231/






Toronto, Ontario Canada • Medical Research: What are the main findings?

Dr. Adler: There were two main findings from this study. We measured the speed and timing of infants’ saccadic eye movements, which are overt indicators of attention, relative to the onset of visual events on a computer monitor. Moving attention and eye movements can occur through two general classes of processes. The first is bottom-up mechanisms in which attention is moved reactively and automatically to the appearance or existence of unique and salient events in the world. In this case, where attention goes is essentially controlled by the events in the world.

• The second is top-down mechanisms in which we move attention voluntarily to what we determine to be relevant event in the world based on our own cognitive biases and goals.

• This study found that 3-month-old infants born by caesarean section were significantly slower to move attention and make eye movements in reaction to the occurrence of visual events on the basis of bottom-up mechanisms than were infants born vaginally. In contrast, there was difference between infants in moving attention and making eye movements in anticipation of the appearance of visual events on the basis of top-down mechanisms. Additionally, maternal age, which has been shown to be related to the occurrence of caesarean sections, was found not to be related to the current effects.



http://medicalresearch.com/allergies/pre-labor-c-section-affects-newborns-immune-system/15210/






Toronto, Ontario Canada • Medical Research: What should clinicians and patients take away from your report?

• Dr. Adler: First, I urge caution at taking too much away from this study as it is only one study, does not indicate any causal link but only a relation between caesarean section and attentional slowness, and it needs to be replicated. Further, there are many other factors, such method of feeding, fetal birth weight, use of epidurals (just to name a few), that could be influencing the current results. For clinicians, however, who are astutely aware of the rising rates of caesarean section births, the current finding should be added to their list of considerations when advising patients on the risks of caesarean section births. Clearly, emergency c-sections and c-sections for high risk pregnancies, such as with high birth weight babies and older mothers, the current result likely should not have much impact. However, for low-risk pregnancies and elective c-sections, which are the fastest growing category of c-sections, the current finding will add to the chorus of cautions concerning this category of c-sections. In fact, many medical associations in the U.S., Canada, and the U.K. have issued warning concerning the use of c-sections for low-risk pregnancies and in an elective manner. For patients, especially those with low-risk pregnancies and those considering an elective c-section, the information provided by this study could help influence their decision as to whether to have a c-section. They would know that perhaps the procedure is not completely innocuous and could potentially have an impact on their child’s brain and cognition.



http://medicalresearch.com/allergies/pre-labor-c-section-affects-newborns-immune-system/15210/






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

• Dr. Adler: Because this is just the first study detailing any brain or psychological impact of c-sections, there is a long list of studies that need to follow this one. Beyond looking at all the other variables that likely contribute to the result of this study, such as feeding method, type of pregnancy, administration of drugs during delivery, there are 3 important avenues to follow up. First, many developmental effects that show up in infancy dissipate as the child ages. So, does this attentional slowness in c-section delivered infants modulate as they get older. In other words, is this a temporary difference or does being delivered by c-section have a more permanent repercussions. Second, and this related to the first, many of issues with learning in academic settings have been linked to problems with allocating attention. This is true for ADD/ADHD, Autistic Spectrum Disorders, as well as many learning disabilities. Whether there is any relation between being born by c-section, and the potentially related attention issue, and these learning problems is completely unknown. In the future, we will need to investigate whether there is in fact a link, especially if being born by c-section is having influence on initial brain development. Finally, we were unable to separate out emergency c-sections from elective c-sections. In many emergency c-sections, the infant experiences partial labor, in which case they receive part of the birth experience — is that enough? Would experiencing part of the birth experience ameliorate the effect on attention and be sufficient for initializing the relevant brain development? Future research must answer this question in order for the effect uncovered in this study to have more medical usefulness.

• Citation:

• Differential attentional responding in caesarean versus vaginally delivered infants

• Scott A. Adler1 & Audrey M. B. Wong-Kee-YouAtten Percept PsychophysDOI 10.3758/s13414-015-0969-3



http://download.springer.com/static/pdf/321/art:10.3758/s13414-015-0969-3.pdf?originUrl=http://link.springer.com/article/10.3758/s13414-015-0969-3&token2=exp=1439381544~acl=/static/pdf/321/art:10.3758/s13414-015-0969-3.pdf?originUrl=http://link.springer.com/article/10.3758/s13414-015-0969-3*~hmac=32ad2885b866d07769347595e71c9712a59f858d318987c30677a6776b347fbb

http://download.springer.com/static/pdf/321/art:10.3758/s13414-015-0969-3.pdf?originUrl=http://link.springer.com/article/10.3758/s13414-015-0969-3&token2=exp=1439381544~acl=/static/pdf/321/art:10.3758/s13414-015-0969-3.pdf?originUrl=http://link.springer.com/article/10.3758/s13414-015-0969-3*~hmac=32ad2885b866d07769347595e71c9712a59f858d318987c30677a6776b347fbb



Liver Inflammation During Pregnancy Linked To Later Life Cancer, Cardiac and Autoimmune DiseaseMedicalResearch.com Interview with:

Prof. Hanns-Ulrich Marschall Professor of clinical hepatologyWallenberg Laboratory

Sahlgrenska Academy Göteborg, Sweden

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

Dr. Marschall: Intrahepatic cholestasis of pregnancy, or ICP, is the most common liver disease during pregnancy, affecting 1.5% of all pregnancies in Sweden. ICP is characterized by otherwise unexplained pruritus with elevated bile acids and/or transaminases in the late second and third trimester of pregnancy. It is well established that ICP is associated with risks for the unborn child, in particular preterm delivery, but also stillbirth.

• In contrast, for the mother, ICP has for a long time only been considered as an annoying but not serious condition that spontaneously resolves after delivery.


http://medicalresearch.com/hepatitis-liver-disease/liver-inflammation-during-pregnancy-linked-to-later-life-cancer-cardiac-and-autoimmune-disease/16564/






However, ICP obviously is not such a benign condition for the mother: We have recently shown that women with ICP have a 3- to 5-times increased risk of hepatobiliary diseases, such as hepatitis C, cirrhosis and gallstones. Here we extended our study to investigate the association between ICP and later cancer, diabetes mellitus and other autoimmune-mediated diseases, and cardiovascular diseases.









Dr. Marschall: Our study showed that women with ICP were at about 25% increased risk to be later diagnosed with immune-mediated diseases, in particular diabetes mellitus and Crohn’s disease but not ulcerative colitis. There was also a small increased risk of later cardiovascular disease, in particular if the woman with ICP also suffered from preeclampsia.

• Most important were the data on the risk of later malignancy: We found a 2.5-times higher risk for cancer in the biliary tree and even a 3.5-times increased risk of liver cancer. Even after adjusting for a diagnosis of hepatitis C, which is very strongly associated with liver cancer, more than 30-times, women with ICP were still at 2.5-times increased risk of later liver malignancy.









• Dr. Marschall: First of all, we again strongly advocate testing pregnant women with pruritus for hepatitis C, and of course, treatment if positive. Then we also strongly recommend a follow-up of liver function tests 6-12 weeks after delivery in all women with ICP, with and without persisting pruritus, and if liver enzymes are elevated, further evaluation by a hepatologist.









• Dr. Marschall: Future research should focus on the interaction between hepatitis C virus and elevated gestational hormones in late pregnancy. One might speculate on impaired uptake or excretion causing the ICP phenotype with pruritus and elevated bile acids.

• Citation:

• “Intrahepatic cholestasis of pregnancy and cancer, immune-mediated and cardiovascular diseases: A population-based cohort study,” by Elisabeth A. Wikström Shemer, OlofStephansson, Marcus Thuresson, Malin Thorsell, Jonas F. Ludvigsson, and Hanns-Ulrich Marschall. DOI: http://dx.doi.org/10.1016/j.jhep.2015.02.022. Published online in the Journal of Hepatology, in advance of Volume 63, Issue 2 (August 2015).



http://dx.doi.org/10.1016/j.jhep.2015.02.022



Fresh Donor Eggs Result In More Live Births Than FrozenMedicalResearch.com Interview with:

Vitaly A Kushnir MDThe Center for Human Reproduction

New York, NY 10021


Dr. Kushnir: In January 2013, the American Society for Reproductive Medicine declared the technique of oocyte cryopreservation no longer experimental, although they body did call for further study.

• Vitaly A. Kushnir, M.D., of the Center for Human Reproduction, and colleagues used 2013 data from 380 U.S fertility centers to compare live birth and cycle cancellation rates using either fresh or cryopreserved donor oocytes.

• The study found roughly 20 percent of donor cycles used cryopreserved oocytes and 80 percent fresh oocytes. Of those embryos transferred, 56 percent that started as fresh oocytes resulted in live births compared to just 47 percent of those that started as cryopreserved oocytes.


http://medicalresearch.com/author-interviews/fresh-donor-eggs-result-in-more-live-births-than-frozen/16386/





New York, NY 10021


• Dr. Kushnir: So called “egg-freezing” has recently become commonplace and more often used for delaying parenthood for social reasons. It is important clinicians and patients know the associated risks of cryopreservation. In this study, it appears using fresh donor eggs results in a better outcome than those that have been earlier collected, frozen, and thawed.

• Patients and clinicians need to evaluate their options carefully when making the decision between fresh and frozen donor eggs.







New York, NY 10021


• Dr. Kushnir: The reason for this statistically-important difference in live birth rates is still unclear and was not a focus of the study. As cryopreservation becomes more and more the norm the authors hope the cause is quickly identified and mitigating measures put into place.

• Citation:

• Kushnir VA, Barad DH, Albertini DF, Darmon SK, Gleicher N. Outcomes of Fresh and Cryopreserved Oocyte Donation. JAMA.2015;314(6):623-624. doi:10.1001/jama.2015.7556.



http://jama.jamanetwork.com/article.aspx?articleid=2425734



MedicalResearch.com IntervPanel Testing Identifies More Management-Changing Genes Than BRAC1/2 Alonewith: Leif W. Ellisen, M.D., Ph.D

Professor of Medicine, Harvard Medical School Program Director, Breast Medical OncologyCo-Leader, Breast Cancer Program MGH Research Scholar MGH Cancer Center

Boston, MA 02114


Dr. Ellisen: The traditional approach to genetic testing for women with suspected hereditary breast and/or ovarian cancer risk is to test for BRCA1 and BRCA2 alone. Recent studies have shown that testing with a multi-gene panel finds relevant risk gene mutations in substantially more women than does testing for BRCA1 and BRCA2 alone. However, one of the concerns about broader multi-gene testing has been that the results really wouldn’t change what you told women about their risk and management – either because the risk associated with the other genes may not be as high as for BRCA1/2, or because the clinical practice guidelines associated with some of the other genes are less specific.

•


http://medicalresearch.com/cancer-_-oncology/breast-cancer/panel-testing-identifies-more-management-changing-genes-than-brac12-alone/16561/





Boston, MA 02114

Our study sought to determine how often testing such women using a multi-gene panel would find mutations in genes other than BRCA1/2, and more importantly to ask whether finding those mutations would change how you would manage the patient and their family. We found that multi-gene panel testing finds relevant risk gene mutations in substantially more women (approximately 40% more) than does testing for BRCA1 and BRCA2 alone. Furthermore, in a case-by-case analysis we showed that finding mutations in these other genes is likely to change the clinical management that is considered or recommended for the majority of the mutation-positive women and their families. Notably, our analysis of the predicted management change is based not just on the gene mutation alone, but on how the gene appears to be behaving in that particular family.



http://medicalresearch.com/cancer-_-oncology/myriad-presents-data-on-expanded-cancer-genetics-and-chemotherapy-susceptibility-testing/14641/





Boston, MA 02114


• Dr. Ellisen: Multigene panel testing for patients with suspected hereditary breast and/or ovarian cancer identifies substantially more individuals with relevant cancer risk gene mutations than does BRCA1/2 testing alone. Identifying such mutations is likely to change management for the majority of these individuals and their families in the near term, and in the long term should lead to development of effective management guidelines and improved outcomes for at-risk individuals.

• It is important to note that multi-gene genetic testing is not appropriate for everyone, and is most useful where personal and family histories suggest hereditary cancer, which is not the case for most individuals with breast and ovarian cancer.



http://medicalresearch.com/cancer-_-oncology/cancer_risk_multiple_gene_testiing-can_benefit_selected_patients/4960/

http://medicalresearch.com/cancer-_-oncology/ovarian-cancer/two-gene-mutations-linked-to-deadly-ovarian-cancer/11127/





Boston, MA 02114


• Dr. Ellisen: The next step, which is a long-term project, is to show how and whether recommendations made based on this testing lead to earlier detection, cancer prevention, and improved survival. These future studies will also help us refine and modify the gene-based management recommendations over time. We have been testing for BRCA1/2 for over 15 years, and the outcome studies and modifications of management guidelines are still ongoing.

• Citation:

• Desmond A, Kurian AW, Gabree M, et al. Clinical Actionability of Multigene Panel Testing for Hereditary Breast and Ovarian Cancer Risk Assessment. JAMA Oncol.Published online August 13, 2015. doi:10.1001/jamaoncol.2015.2690.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast-cancer-risk-reduction-of-prophylactic-salpingo-oophorectomy-may-be-overestimated-for-some-brca1-carriers/14081/

http://oncology.jamanetwork.com/article.aspx?articleid=2425836

















































































Date post:	23-Jan-2018
Category:	Health & Medicine
Upload:	marie-benz
View:	441 times
Download:	5 times

MedicalResearch.com Top Medical Research Interview August 14 2015

Health & Medicine