medicalresearch.com: medical research exclusive interviews february 17 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]

February 17 2015

For Informational Purposes Only: Not for Specific Medical Advice.

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Two Frequent Genetic Variants Lower Risk for Heart AttackMedicalResearch.com Interview with: Wolfgang Sadee, Dr.rer.nat.

Felts Mercer Professor of Medicine and Chair, Pharmacology Directorand Elizabeth S Barrie, PhD Center for Pharmacogenomics

The Ohio State University Columbus OH

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

• Dr. Sadee and Dr. Barrie: We have determined that two frequent genetic variants can interact in a way that lowers the carrier’s risk for a heart attack. These genetic variants are single nucleotide polymorphisms (SNPs) – single base changes in the DNA sequence – of the dopamine-beta hydroxylase gene (DBH), which converts dopamine to norepinephrine. Both act as hormones in the periphery and as neurotransmitters vital to the brain’s activity central nervous system. Numerous studies had tested genetic variants in DBH for effects on brain functions. In contrast to expectations, however, our work demonstrates that our two genetic variants lower DBH activity primarily in the periphery, in tissues with sympathetic innervation mediated by norepinephrine, such as the heart, lung, and liver. As a result, we searched for genetic influence on risk of various diseases of the cardiovascular system and the lung, metabolic disorders, and more. Each of the two DBH variants alone was associated with a number of disease states; however, when considering both variants in combination, a strong protective effect on the risk for heart attacks was discovered in several clinical trials. Such combined effects arising from interactions between two genetic variants may be more common than currently realized, possibly providing a path towards effective biomarker panels for personalized medicine.

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

http://medicalresearch.com/genetic-research/two-frequent-genetic-variants-lower-risk-for-heart-attack/11553/

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





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

• Dr. Sadee and Dr. Barrie: The sympathetic tone of peripheral organs is critical to well being and disease risk. The hormone norepinephrine can over-stimulate the heart when it circulates in the bloodstream or is released within the heart. The DBH variants lower DBH expression in turn norepinephrine production in target organs. Testing for the presence of both genetic variants can indicate reduced activity of DBH and reduced norepinephrine (sympathetic tone) in multiple organs. Beta-blockers are mainstream medications for treatment of heart failure, and beta-agonists for treatment of asthma, for example. Patients carrying the DBH SNPs conveying reduced sympathetic activity may be less likely to benefit from beta blockers, but could be more responsive to beta-agonists.



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






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

• Dr. Sadee and Dr. Barrie: Norepinephrine has a pervasive impact on the body on all levels. Because the DBH SNPs robustly influence the local production and release of norepinephrine in sympathetically innervated organs, we anticipate a spectrum of potential effects on disorders and therapies. With the knowledge of how the two DBH SNPs exert their effect, we can exploit the vast databases consisting of clinical studies with genomic information available (genome-wide association studies) to determine where and how the genetic effect alters disease risk or treatment outcomes. Preliminary evidence suggests, that reduced DBH expression could have metabolic effects and represent a risk factor for asthma because lungs need norepinephrine to open constricted airways. The finding that both DBH SNPs combined afford protection against heart attacks further signals the relevance of sympathetic tone and therapeutic options. Prospective trials need to address how this information can be exploited for individualized therapies and disease prevention.

• Citaiton:

• Barrie ES, Weinshenker D, Verma A, Pendergrass SA, Lange LA, Ritchie MD, Wilson JG, Kuivaniemi H, Tromp G, Carey DJ, Gerhard GS, Brilliant MH, Hebbring SJ, Cubells JF, Pinsonneault JK, Norman GJ, Sadee W. Regulatory Polymorphisms in Human DBH Affect Peripheral Gene Expression and Sympathetic Activity. Circ.Res. 115: 1017-1025 (2014). PMID: 25326128



http://medicalresearch.com/heart-disease/beta_blockers_reduce_mortality_in_heart_failure_and_preserved_ejection_fraction/8957/

http://circres.ahajournals.org/content/early/2014/10/17/CIRCRESAHA.116.304398.abstract



Phase 3 Study of Oral Proteasome Inhibitor For Relapsed or Refractory Multiple MyelomaMedicalResearch.com Interview with:

Dr. Dixie-Lee Esseltine MD, FRCPCVice President, Oncology Clinical Research

Takeda.

• MedicalResearch: What is Ixazomib?

• Dr. Dixie-Lee Esseltine: Ixazomib is an investigational, oral, once-weekly proteasome inhibitor (PI) that is being investigated in multiple Phase 3 trials in multiple myeloma (MM) and systemic light-chain (AL) amyloidosis. It is the first oral proteasome inhibitor to enter Phase 3 clinical trials.

• Proteasome inhibition is a mechanism underpinning an established standard of care in the treatment of multiple myeloma. However, the current biweekly parenteral administration of proteasome inhibitors may pose challenges to patients. The ability to demonstrate that an oral, once-weekly PI can extend PFS would be a remarkably important finding in the effort to address these challenges. Early studies suggest ixazomib, has activity in MM patients, both as a single agent in relapsed patients and in combination in frontline patients.

• Ixazomib was granted orphan drug designation in multiple myeloma in both the U.S. and Europe in 2011, and for AL amyloidosis in both the U.S. and Europe in 2012. It was granted Breakthrough Therapy Designation for AL amyloidosis in the U.S. in 2014.


http://medicalresearch.com/cancer-_-oncology/phase-3-study-oral-proteasome-inhibitor-relapsed-refractory-multiple-myeloma/11548/





Takeda.

• MedicalResearch: What is the design for this study?

• Dr. Dixie-Lee Esseltine: The TOURMALINE MM-1 study (C16010) is a phase 3, randomized, double-blind study comparing ixazomib plus lenalidomide and dexamethasone versus placebo plus lenalidomide and dexamethasone in patients with relapsed and/or refractory multiple myeloma. Patients were randomized to receive ixazomib 4.0mg days 1,8 and 15 or placebo with lenalidomide 25mg days 1-21 and dexamethasone 40mg days 1,8,15 and 22. Treatment was given every 28 days until disease progression or unacceptable toxicity. Evaluation was based on the International Myeloma Working Group (IMWG) Uniform Response Criteria.

• MedicalResearch: What were the primary and secondary endpoints?

• Dr. Dixie-Lee Esseltine: The primary endpoint was progression free survival (PFS). Key secondary endpoints included overall survival (OS) and OS in high risk patients with del (17) cytogenetics. Additional secondary endpoints included overall response rate (ORR), CR+VGPR response rate, duration of response (DOR), time to progression (TTP), safety, pain response rate, change in global health status, OS and progression free survival in high risk populations, PK data and association between response or resistance to ixazomib treatment and proteasome and NFKB-related genes.







Takeda.


• Dr. Dixie-Lee Esseltine: Proteasome inhibition is a mechanism underpinning an established standard of care in the treatment of multiple myeloma; however, the current biweekly parenteral administration of proteasome inhibitors may pose challenges to patients. The ability to demonstrate that an oral, once-weekly Proteasome inhibition can extend progression free survival is a potentially important finding in the effort to address these challenges.





Recommendations To Restrict Dietary Fat Not Supported By Clinical TrialsMedicalResearch.com Interview with:

James J. DiNicolantonio, PharmDAssociate Editor BMJ Open Heart Cardiovascular Research Scientist

Saint Luke’s Mid America Heart Institute

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

Response: There were 6 randomized controlled dietary trials performed before the government dietary fat recommendations were released. When we performed a systematic review and meta-analysis of the available trials at this time, there was no significant difference in all-cause mortality or cardiovascular heart disease mortality. In essence, there was no support from randomized controlled trials at the time to support a reduction in fat and saturated fat (and there still isn’t from recent meta-analysis including newer trials).

• The reductions in mean serum cholesterol levels were significantly higher in the intervention groups but this did not result in significant differences in cardiovascular heart disease or all-cause mortality.

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

• Response: Recommendations to restrict saturated fat or total fat in the diet that began back in the late 1970s and early 1980s were not supported by the randomized clinical trials at the time, and in fact are still not supported by the randomized control trial evidence in the current-day.


http://medicalresearch.com/heart-disease/recommendations-to-restirct-dietary-fat-not-supported-by-clinical-trials/11468/



Recommendations To Restrict Dietary Fat Not Supported By Clinical TrialsMedicalResearch.com Interview with:

James J. DiNicolantonio, PharmDAssociate Editor BMJ Open Heart Cardiovascular Research Scientist

Saint Luke’s Mid America Heart Institute

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

• Response: Future research should target added sugars, which are likely dietary culprit involved in early mortality and cardiovascular heart disease mortality.

• Citation:

• Original research article: Evidence from randomised controlled trials did not support the introduction of dietary fat guidelines in 1977 and 1983: a systematic review and meta-analysis

• Zoë Harcombe, Julien S Baker, Stephen Mark Cooper, Bruce Davies, Nicholas Sculthorpe, James J DiNicolantonio, Fergal Grace

• Open Heart 2015;2:1 e000196 doi:10.1136/openhrt-2014-000196

• Webpage: http://www.saintlukeshealthsystem.org/dinicolantonio

• Research: https://www.researchgate.net/profile/James_Dinicolantonio

• Twitter: https://twitter.com/jjdinicol



http://medicalresearch.com/diabetes/added-sugar-more-harmful-than-other-carbohydrates-for-promoting-diabetes/10914/

http://openheart.bmj.com/citmgr?gca=openhrt;2/1/e000196



http://www.saintlukeshealthsystem.org/dinicolantonio

https://www.researchgate.net/profile/James_Dinicolantonio

https://twitter.com/jjdinicol



Should Hospitals Adopt Dress Code For Physicians?MedicalResearch.com Interview with:

Christopher Michael Petrilli MDDivision of General Internal Medicine The Department of Medicine

University of Michigan, Ann Arbor, Michigan

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

Dr. Petrilli: Our team took note of the broad spectrum of physician attire that was worn in health care settings. We found a lack of specific guidance with regards to “appropriate” physician attire. Then we began to find anecdotal evidence that physician attire may be an important early determinant of patient confidence, trust and satisfaction. Studies have shown that patients are more compliant with their medications and treatment regimens when they perceive their doctors as being competent, supportive and respectful. Therefore, given the increasingly rushed patient–physician encounter, the ability to gain a patient’s trust and confidence are highly desirable. We hypothesized that if physician attire matched patients’ preferences and expectations, it would improve the overall patient experience.

• Our findings supported our hypothesis. In general, we found that people prefer their physicians dress on the formal side — and definitely not in casual wear. Doctors of either gender in suits, or a white coat, are more likely to inspire trust and confidence. But fashion takes a back seat when it comes to emergency, surgical or critical care, where data show clothes don’t matter as much — and patients may even prefer to see doctors in scrubs. In general, Europeans and Asians of any age, and Americans over age 50, trusted a formally dressed doctor more, while Americans in Generation X and Y tended to accept less-dressy physicians more willingly.


http://medicalresearch.com/author-interviews/should-hospitals-adopt-dress-code-for-physicians/11566/



Should Hospitals Adopt Dress Code For Physicians?MedicalResearch.com Interview with:

Christopher Michael Petrilli MDDivision of General Internal Medicine The Department of Medicine

University of Michigan, Ann Arbor, Michigan

• Medical Research: What should clinicians and patients take away from your report?• Dr. Petrilli: As physicians, we look for evidence based solutions in our clinical practice. Similarly, we

should employ the same ideals when we decide what clothes to wear when seeing patients. 90% of the studies we reviewed showed that patients have a preference for more formal attire or no preference for their physician’s attire. Therefore, given this low risk, high reward proposition, we recommend that health care systems adopt a dress code that directs physicians to wear formal attire.


• Dr. Petrilli: Currently, our team is preparing to launch our own multi-center, international study. We will survey patients in outpatient general medicine and specialty clinic waiting rooms, and inpatient medical units. Hospitals in three countries have signed on to participate to date, making it the largest study of its kind. Using a standardized protocol and survey across multiple regions, we will be able to more effectively quantify how patients’ views of physicians change based on what they’re wearing, and where they’re providing care. It will also evaluate how attire might affect patients’ trust in what their doctor says or recommends.

• Citation:• Understanding the role of physician attire on patient perceptions: a systematic review of the

literature– targeting attire to improve likelihood of rapport (TAILOR) investigators• Christopher Michael Petrilli, Megan Mack, Jennifer Janowitz Petrilli, Andy Hickner, Sanjay Saint,

Vineet Chopra• BMJ Open 2015;5:1 e006578 doi:10.1136/bmjopen-2014-006578



http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312788/





Profilin1 Study Advances Understanding of Breast Cancer MetastasesMedicalResearch.com Interview with:

Alejandra Valenzuela-Iglesias Ph.D. candidateDepartment of Molecular Biology

University of Sonora Hermosillo, Sonora


• Response: Breast cancer is one of the leading causes of cancer death in women all around the world. In recent years, there has been great interest in creating new therapies that will help to prevent or stop metastasis, but the therapies developed up until today are not completely effective. Metastasis is the main cause of death for a cancer patient because it implies that tumor cells have detached from the primary tumor and have colonized in one or more vital organs or tissues in the organism. For this to occur, the invasive tumor cells form actin-driven membrane protrusions called invadopodia. These protrusions possess proteolytic activity to degrade the basal membrane and extracellular matrix, which facilitates metastatic cancer cells to enter the bloodstream and spread to distant organs in the body. It has been shown that any dysregulation in the actin cytoskeleton leads to impaired invadopodia formation.

• Profilin1, an actin and phosphoinositide binding protein, is downregulated in several adenocarcinomas.

• Our study was a collaboration between Albert Einstein College of Medicine, University of Pittsburgh, and University of Sonora, lead by Dr. Jose Javier Bravo-Cordero and published in the European Journal of Cell Biology. We showed for the first time the role of profilin1 in invadopodiaformation and function in human breast cancer cells MDA-MB-231. By using cell imaging techniques we unveiled the dynamic of the profilin1-depleted cells, finding that profilin1 can act as a negative regulator of breast cancer cell invasion, acting as a break in invadopodia turnover, by modulating the molecules involved in invadopodia maturation. The removal of profilin1 expression accelerates invadopodia maturation rate, explaining the invasive phenotype previously reported for this type of cells.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/profilin1-study-advances-understanding-of-breast-cancer-metastases/11561/

http://medicalresearch.com/cancer-_-oncology/new-breast-cancer-strategies-presented-at-conference/100/



Profilin1 Study Advances Understanding of Breast Cancer MetastasesMedicalResearch.com Interview with:

Alejandra Valenzuela-Iglesias Ph.D. candidateDepartment of Molecular Biology

University of Sonora Hermosillo, Sonora


• Response: Invadopodia are key subcellular structures during dissemination of metastasis that help tumor cells to escape from the primary tumor and reach the blood vessels to travel to distant organs. Our findings help to understand invadopodia regulation and could be used to develop new therapies to prevent invadopodia formation and therefore cancer metastasis.


• Response: In the present day, we are in a very exciting moment for cancer research, because there has been a great number of investigations revealing how the invasive machinery of metastasis works and the molecules that are involved. We encourage continued unveiling of the invadopodia machinery with hopes that in the near future an effective anti-metastasis therapy can be created.

• Citation:

• Profilin1 regulates invadopodium maturation in human breast cancer cells

• Valenzuela-Iglesias A1, Sharma VP2, Beaty BT3, Ding Z4, Gutierrez-Millan LE5, Roy P6, Condeelis JS7, Bravo-Cordero JJ8.

• Eur J Cell Biol. 2015 Feb;94(2):78-89. doi: 10.1016/j.ejcb.2014.12.002. Epub 2014 Dec 31.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/study-attacks-breast-cancer-metastases-with-seizure-medicationstases-with-seizure-medication/11118/

http://www.ncbi.nlm.nih.gov/pubmed/25613364






Study Examines Malpractice Risk Of Mohs Surgery For Skin CancerMedicalResearch.com Interview with:

Omar A. Ibrahimi, M.D., Ph.DConnecticut Skin Institute Founding Medical Director

Stamford, CT 06905


• Dr. Ibrahimi: The delivery of healthcare in a efficient and cost effective fashion is one of the largest themes in medicine today. Malpractice lawsuits have steadily increased with the cost of healthcare delivery. Mohs surgery involves the surgical removal, the tissue analysis and the reconstruction of a skin cancer all in a single visit that bundles multiple procedures in a cost effective manner that is proposed to be the gold standard for treating certain skin cancers.

• Information regarding malpractice involving Mohs surgery is lacking. The only previous study that has been done was a survey of Mohs surgeons looking at how many had been involved in lawsuits and the reasons for being involved. Our study examined a legal database to identify all the lawsuits involving Mohs surgery and skin cancer. We were surprised to find that the majority of lawsuits involved non-Mohs surgeons as the primary defendant, mostly due to a delay of or failure in diagnosis, cosmetic outcome issues, lack of informed consent, and a delay of or failure in referral to a Mohs surgeon.


http://medicalresearch.com/author-interviews/study-examines-malpractice-risk-of-mohs-surgery-for-skin-cancer/11492/

http://medicalresearch.com/author-interviews/deaths-from-skin-diseases-differ-between-developed-and-developing-countries/8053/



Study Examines Malpractice Risk Of Mohs Surgery For Skin CancerMedicalResearch.com Interview with:

Omar A. Ibrahimi, M.D., Ph.DConnecticut Skin Institute Founding Medical Director

Stamford, CT 06905


• Dr. Ibrahimi: Skin cancer is the most common cancer in the United States. Clinicians of all types, Dermatologists, Primary Care Physicians/Internists and Plastic Surgeons would benefit from coordinating care with Mohs surgeons to optimize the treatment of skin cancer. The American Academy of Dermatology has developed appropriate use criteria (AUC) for Mohssurgery that can help guide when Mohs surgery is an appropriate treatment option for a particular skin cancer. Patients should always have a discussion with their physician regarding what their treatment options are and the varying risks, benefits and side effects.


• Dr. Ibrahimi: One of the benefits of Mohs surgery is that it offers the highest cure rate and has the potential to be extremely cost efficient due to bundling of the surgical removal and pathology. Larger studies looking at cost-effectiveness and quality of life scores for patients following Mohs surgery versus other treatment modalities would help further define the role of Mohs surgery in the treatment of skin cancers.

• Citation: Upcoming JAMA

• D’Souza LS, Jalian H, Jalian C, et al. Medical Professional Liability Claims for MohsMicrographic Surgery From 1989 to 2011. JAMA Dermatol. Published online February 04, 2015. doi:10.1001/jamadermatol.2014.4495





Tyrosine Kinase Inhibitor Effective in Advanced Refractory Thyroid CancerMedicalResearch.com Interview with:

Dr. Martin S. Schlumberger MDDepartment of Nuclear Medicine and Endocrine Oncology Centre de Référence Tumeurs Réfractaires de la Thyroïde

Institut Gustave Roussy and University Paris-SudVillejuif, France


Dr. Schlumberger: Patients with advanced refractory thyroid cancer is rare (4-5 patients/million population) but portends a poor prognosis with a median overall survival of 3-5 years from the diagnosis of metastases.

• Before the availability of kinase inhibitors there was no effective treatment, and for this reason placebo was used as control in SELECT trial. This trial showed an improvement of PFS lenvatinib vs placebo (hazard ratio: 0.21; 99% CI: 0.14–0.31, P<0.001; median PFS: 18.3 vs 3.6 months, respectively) and objective response rate of 65% with some complete responses. Time to response was short (2 months).

• Similar benefits were observed in naive patients and in patients who had been treated with another tyrosine kinase inhibitor, demonstrating the absence of cross resistance.

• Toxicity was significant and could be controlled with dose reduction and symptomatic treatment.


• Dr. Schlumberger: This is a major progress over previously available treatment modalities.


http://medicalresearch.com/cancer-_-oncology/tyrosine-kinase-inhibitor-effective-in-advance-refractory-thyroid-cancer/11499/



Tyrosine Kinase Inhibitor Effective in Advanced Refractory Thyroid CancerMedicalResearch.com Interview with:

Dr. Martin S. Schlumberger MDDepartment of Nuclear Medicine and Endocrine Oncology Centre de Référence Tumeurs Réfractaires de la Thyroïde

Institut Gustave Roussy and University Paris-SudVillejuif, France


• Dr. Schlumberger:1. Search for predictive biomarkers of efficacy.

• 2. Other treatment modalities.

• Citation:

• Lenvatinib versus Placebo in Radioiodine-Refractory Thyroid Cancer

• Martin Schlumberger, M.D., Makoto Tahara, M.D., Ph.D., Lori J. Wirth, M.D., Bruce Robinson, M.D., Marcia S. Brose, M.D., Ph.D., Rossella Elisei, M.D., Mouhammed Amir Habra, M.D., Kate Newbold, M.D., Manisha H. Shah, M.D., Ana O. Hoff, M.D., Andrew G. Gianoukakis, M.D., Naomi Kiyota, M.D., Ph.D., Matthew H. Taylor, M.D., Sung-Bae Kim, M.D., Ph.D., Monika K. Krzyzanowska, M.D., M.P.H., Corina E. Dutcus, M.D., Begoña de las Heras, M.D., Junming Zhu, Ph.D., and Steven I. Sherman, M.D.

• N Engl J Med 2015; 372:621-630



http://www.nejm.org/media/doi/full/10.1056/NEJMoa1406470

http://www.nejm.org/media/doi/full/10.1056/NEJMoa1406470



Order of Mutations Affects Disease Pattern in Chronic Blood DisordersMedicalResearch.com Interview with: David G. Kent, Ph.D

From the Cambridge Institute for Medical Research and Wellcome Trust–Medical Research Council Stem Cell Institute University of Cambridge


Dr. Kent: Cancers are the result of the sequential acquisition of errors in the genetic code. Most studies have focused on the sum of these mutations (e.g., A+B+C = cancer) but no study in patients has asked the question of whether or not the order of genetic mutations impacts the disease (e.g., does A to AB equal B to BA). We studied patients with chronic blood disorders (known as myeloproliferative neoplasms, or MPNs) that are precursors to cancer to access the earliest stages of tumour development and studied whether or not the order of mutation acquisition impacted disease. We studied patients with mutations in two genes (JAK2 and TET2) and showed that the order of acquisition of these mutations impacted timing of clinical presentation, disease subtype, frequency of thrombotic events, and differed in their response to targeted therapy in the lab.


• Dr. Kent: Two main findings for clinicians to take away are firstly that the order of mutation acquisition can impact disease pathogenesis and patients with known mutations may have distinct diseases depending on which mutation came first and secondly for those treating myeloproliferative neoplasms, patients that a JAK2-first disease is significantly different to a TET2-first disease and the order of acquisition has clinical implications for timing of presentation and thrombotic risk.


http://medicalresearch.com/cancer-_-oncology/leukemia/order-of-mutations-affects-disease-pattern-in-chronic-blood-disorders/11465/



Order of Mutations Affects Disease Pattern in Chronic Blood DisordersMedicalResearch.com Interview with: David G. Kent, Ph.D

From the Cambridge Institute for Medical Research and Wellcome Trust–Medical Research Council Stem Cell Institute University of Cambridge


• Dr. Kent: The order of acquisition of mutations should be studied in other cancers to determine if similar clinical stratification could be applied. Order of mutation should be considered in clinical trial design as well.

• Secondly we need to understand the molecular mechanism by which a first mutation can change the cell such that the second mutation does not have the same effect that it would normally have if it came first.

• Citation:Effect of Mutation Order on Myeloproliferative Neoplasms

• Christina A. Ortmann, M.D., David G. Kent, Ph.D., Jyoti Nangalia, M.B.Chir., F.R.C.Path., Yvonne Silber, M.Sc., David C. Wedge, Ph.D., Jacob Grinfeld, M.B., Ch.B., F.R.C.Path., E. Joanna Baxter, Ph.D., Charles E. Massie, Ph.D., Elli Papaemmanuil, Ph.D., Suraj Menon, Ph.D., Anna L. Godfrey, F.R.C.Path., Ph.D., Danai Dimitropoulou, B.Sc., Paola Guglielmelli, M.D., Ph.D., Beatriz Bellosillo, Ph.D., Carles Besses, M.D., Ph.D., Konstanze Döhner, M.D., Claire N. Harrison, D.M., F.R.C.Path., George S. Vassiliou, F.R.C.Path., Ph.D., Alessandro Vannucchi, M.D., Peter J. Campbell, M.B., Ch.B., Ph.D., and Anthony R. Green, F.R.C.Path., F.Med.Sci.

• N Engl J Med 2015; 372:601-612February 12, 2015



http://www.nejm.org/doi/full/10.1056/NEJMoa1412098?query=featured_home






HIV+ Donors Might Add To Available Kidney Donor PoolMedicalResearch.com Interview with:

Elmi Muller, M.B., Ch.B., M.Med.University of Cape Town–Surgery

Groote Schuur Hospital Observatory Cape TownCape Town, South Africa

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

Dr. Muller: South Africa currently offers dialysis and transplantation as a treatment option for patients with End Stage Renal Disease (ESRD). However, dialysis is not freely available to everyone, but severely limited and only available to a selected group of patients. This means that patients get assessed when they present with ESRD and they only get accepted onto a dialysis programme if they fulfill certain criteria. These criteria are criteria to assess the patient’s medical fitness in general as well as social criteria to assess whether the patient will be compliant with follow-up. In most state hospitals, patients will only be accepted onto a dialysis program if they are also fit to receive a transplant in the long run. The idea is that dialysis programs should naturally feed into transplant programs. Therefore a patient who is not a suitable transplant candidate will normally be turned down for dialysis.

• In 2008, when the HIV positive-to-positive program started, patients with ESRD and HIV would be turned down for dialysis. The reason was that they were seen as unfit for transplantation and therefore not suitable dialysis patients. This meant that anybody with HIV and ESRD was doomed to die. This situation remained unchallenged for a number of years, especially as the rollout of antiretroviral therapy was quite slow in the state sector.

• Because of very high HIV rates in the country, more and more HIV positive brain-dead donors presented to the Groote Schuur Hospital Transplant team. These donors were mostly braindeadpeople who were worked up for organ donation (after consent was obtained from the family) and who then turned out to be HIV positive. In 2008 it made sense to try and marry this supply of donors with the group of HIV positive patients without any treatment options in the country.


http://medicalresearch.com/infections/hiv/hiv-donors-might-add-to-available-kidney-donor-pool/11443/

http://hemodialysis.com

http://medicalresearch.com/author-interviews/hiv-remains-threat-to-urban-heterosexuals/10507/






Medical Research: What are the main findings?

Dr. Muller: In the study report on 27 patients who received kidneys form HIV positive donors over the last five years. Five patients died after transplant. The reasons for death were myocardial infarction, lung squamous cell cancer, pancreatitis with a duodenal perforation, disseminated Aspergillosis and Klebsiella Pneumonia sepsis. Two patients lost their grafts in the first week after transplantation: one with venous thrombosis of the graft and one with acute severe rejection within one week after transplantation. A third patient lost her graft with chronic vascular rejection and fibrosis of the graft 2 years after her transplant. The risk of rejection in this patient population group is higher than expected in HIV negative patients. In the Cape Town study rejection took place on 8 occasions in 5 of the patients, which gives an acute rejection rate of 18%. This happened despite induction therapy with Thymogloglobuline. A dysregulated immune response might be the reason for high rejection rates despite potent immunosuppression and similar high rejection episodes were reported in the NIH study using HIV negative donors for HIV positive recipients. (11)


• Dr. Muller: Using HIV positive donors might resolve some of the problems we are experiencing in getting enough donors for our patients wit ESRD. In the USA the HOPE act was accepted in 2014 and this might now also impact on the use of HIV positive donors elsewhere in the world.



http://medicalresearch.com/author-interviews/kidney_transplant_rejection_decreased_by_new_drug_regimen/6694/






• Medical Research: What recommendations do you have for future research as a result of this study?• Response: Concerns about a second viral strain remain a problem. In the literature the outcomes and

reports of HIV positive patients with superinfections are difficult to interpret as there are a lot of methodological difficulties which often yield conflicting results. (4,5) When a patient with low viral load gets exposed to a second viral strain, a superinfecting strain may be detectable for only a short period of time. Viral fitness and the ability of a viral strain to replicate effectively in a given environment, may play a role to determine whether the two different strains will eventually become undetectable in standard resistance tests or whether outgrowth of a different virus from the baseline or whether a novel recombinant virus will become detectable. We are currently investigating this question at UCT.

• Furthermore, in South Africa we have a unique situation in view of the fact that we have low antiretroviral therapy resistance rates. Most patients who failed second-line ART in South Africa, have wild-type virus and resistance rates remain less than 5% in our HIV population. So in our setting the issues transplanting HIV positive patients are mostly that they have very high rejection rates, that they need powerful and expensive immunosuppression as these patients have a dysregulated immunosystem rather than a suppressed one. They also have a high infection risk as opportunistic infections are more common in immunosuppressed and HIV positive patients and in Africa opportunistic infection remain a major reason why transplant patients might run into trouble. All these things needs to be followed up and investigated in more detail in the future.

• Citation:• HIV-Positive–to–HIV-Positive Kidney Transplantation — Results at 3 to 5 Years• Elmi Muller, M.B., Ch.B., M.Med., Zunaid Barday, M.B., Ch.B., Marc Mendelson, M.D., Ph.D., and Delawir

Kahn, M.B., Ch.B., Ch.M.• N Engl J Med 2015; 372:613-620

February 12, 2015 DOI: 10.1056/NEJMoa1408896



http://medicalresearch.com/infections/hiv/best-manage-co-infection-tb-hiv/5480/






Childhood Drowning: Very Poor Outcomes For Resuscitation Lasting More Than 30 MinutesMedicalResearch.com Interview with:

Joke Kieboom, paediatric intensivistBeatrix Children’s Hospital Medical Center Groningen

University of Groningen The Netherlands


Response: The aim of the study was to evaluate the outcome of drowned children with cardiac arrest and hypothermia, and to determine distinct criteria for termination of cardiopulmonary resuscitation in drowned children with hypothermia and absence of spontaneous circulation.

• From 1993 to 2012 in the Netherlands, 160 children presented with cardiac arrest and hypothermia after drowning. In 98 (61%) of these children resuscitation was performed for more than 30 minutes, of whom none had good outcome: 87 (89%) died and 11 (11%) survived for with severe disability or in a vegetative state (at one year after the drowning incident).


• Response: Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. The findings of this study question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia.


http://medicalresearch.com/pediatrics/childhood-drowning-very-poor-outcomes-for-resuscitation-lasting-more-than-thirty-minutes/11503/



Childhood Drowning: Very Poor Outcomes For Resuscitation Lasting More Than 30 MinutesMedicalResearch.com Interview with:

Joke Kieboom, paediatric intensivistBeatrix Children’s Hospital Medical Center Groningen

University of Groningen The Netherlands


• Response: Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. The findings of this study question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia.


• Response: This study does not provide data for children who drowned in exceptional circumstances, for example drowning in icy water in winter or inside a motor vehicle. Further research on the value of resuscitation beyond 30 minutes in children who drowned in exceptional circumstances is recommended.

• Citation:

• Extremely poor outcome after resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia: Dutch nationwide retrospective cohort study

• BMJ 2015;350:h418 doi: 10.1136/bmj.h418



http://www.bmj.com/content/350/bmj.h418




Low Vitamin D in Childhood Linked To Early AtherosclerosisMedicalResearch.com Interview with:

Markus Juonala, MD, PhDUniversity of Turku Finland


Response: Earlier studies suggest that low vitamin D levels may be associated with cardiovascular disease. We wanted to study whether low childhood vitamin levels predict carotid intima-media thickness, a marker of early atherosclerosis, in adulthood. We observed that those children with vitamin D in lowest quartile had increased risk for high carotid intima-media thickness.


• Response: Our study is only observational and does not provide answers for causality. However, it seems that awareness of vitamin D levels may be needed in childhood.


• Response: It is essential to have more data from intervention studies concerning the effects of vitamin D supplementation on arterial health.

• Citation:

• Markus Juonala, Atte Voipio, Katja Pahkala, Jorma S. A. Viikari, Vera Mikkilä, Mika Kähönen, Nina Hutri-Kähönen, Antti Jula, David Burgner, Matthew A. Sabin, Jukka Marniemi, Britt-Marie Loo, Tomi Laitinen, Eero Jokinen, Leena Taittonen, Costan G. Magnussen, Olli T. Raitakari. Childhood 25-OH Vitamin D Levels and Carotid Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study. The Journal of Clinical Endocrinology & Metabolism, 2015; jc.2014-3944 DOI: 10.1210/jc.2014-3944


http://medicalresearch.com/vitamin-d/low-vitamin-d-childhood-linked-early-atherosclerosis/11599/

http://medicalresearch.com/genetic-research/genetics-common-bacteria-affect-atherosclerosis-heart-disease/10513/

http://medicalresearch.com/vitamin-d/vitamin-d-levels-lower-children-drink-non-cows-milk/8462/

http://www.sciencedaily.com/releases/2015/02/150210141736.htm


http://medicalresearch.com/vitamin-d/low-vitamin-d-childhood-linked-early-atherosclerosis/11599/

Multidrug Resistant Bacteria Found Commonly In Oncology Intensive CareMedicalResearch.com Interview with:

Dr. Cornejo-JuárezDepartment of Infectious Disease, Instituto Nacional de Cancerología

Tlalpan Mexico

• MedicalResearch: What is the background for this study?

• Dr. Cornejo: Critically ill patients in the intensive care unit are at major risk of hospital-acquired infections. Immunosuppressed patients have a higher risk related with continuous exposure to the hospital setting, mucositis and disruption of skin integrity, presence of indwelling catheters and abnormal immune system because of primary malignancy or chemotherapy. Our aimed was to investigate prevalence and outcome of hospital-acquired infections in an oncology ICU.

• MedicalResearch: What are the main findings?

• Dr. Cornejo: We found that hospital-acquired infections are a major problem in the ICU. Hospital-acquired infections are related with higher mortality. Multidrug resistant bacteria are frequently involved in these infections, and are associated with increased mortality.

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

• Dr. Cornejo: Prevalence of hospital-acquired infections at this oncologic ICU is high as well as Multidrug resistant bacteria isolates; both factors are associated with a higher mortality. Antimicrobial stewardship, including focused and rigorous interventions by multidisciplinary team should help to limit the problem and improve the outcomes.


• Dr. Cornejo: This study was retrospective, so in the future we will carry out a prospective research, it could let to control some confounding variables, and expand the sample. Additionally we implemented and reinforced some strategies; the impact will be measured in a near future.

• Citation:• The impact of hospital-acquired infections with multidrug-resistant bacteria in an oncology intensive care unit• P. Cornejo-Juárez D. Vilar-Compte C. Pérez-Jiménez, S.A. Ñamendys-Silva

S. Sandoval-Hernández P. Volkow-FernándezInternational Journal of Infectious DiseasesVolume 31, February 2015, Pages 31–34


http://medicalresearch.com/cancer-_-oncology/multidrug-resistant-bacteria-found-commonly-in-oncology-intensive-care/11602/

http://www.sciencedirect.com/science/article/pii/S1201971214017408





http://medicalresearch.com/cancer-_-oncology/multidrug-resistant-bacteria-found-commonly-in-oncology-intensive-care/11602/

Patients With Mental Disorders Have Increased Risk of DeathMedicalResearch.com Interview with:

Elizabeth Walker, PhD, MPH, MATFIRST Postdoctoral Fellow Center for Behavioral Health Policy Studies

Rollins School of Public Health, Emory University

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

Response: Mental disorders are a major cause of disability globally and are associated with premature mortality. Quantifying and understanding excess mortality among people with mental disorders can inform approaches for reducing this burden. The purpose of this study was to systematically review the literature in order to estimate individual- and population-level mortality rates associated with mental disorders. We conducted a comprehensive systematic review and meta-analysis, which included 203 studies from 29 countries.

• Medical Research: What are the main findings?

Response: We estimated that 8 million deaths worldwide per year are attributable to mental disorders. People with mental disorders have over 2 times the risk of mortality compared to the general population or people without mental disorders. This translates to a median of 10 years of life lost. In total, 67.3% of people with mental disorders died from natural causes, 17.5% from unnatural causes, and the remainder from unknown causes.


http://medicalresearch.com/mental-health-research/patients-mental-disorders-increased-risk-death/11510/

http://medicalresearch.com/mental-health-research/mental-health-disorders-and-risk-of-shortened-lifespan/1644/

http://medicalresearch.com/mental-health-research/systemic_inflammation_linked_to_depression_and_psychotic_disorders/6949/



Patients With Mental Disorders Have Increased Risk of DeathMedicalResearch.com Interview with:

Elizabeth Walker, PhD, MPH, MATFIRST Postdoctoral Fellow Center for Behavioral Health Policy Studies

Rollins School of Public Health, Emory University


• Response: In order to reduce the burden of mental disorders at both an individual and population level, there must be a focus on both less prevalent but more severe diagnoses, such as psychoses, and more common mental disorders, such as depression and anxiety. Efforts to address premature mortality must include several approaches, including prevention and care of chronic medical conditions and suicide prevention.


• Response: Future research should examine the factors that contribute to excess mortality among people with mental disorders at a population level. It is important to consider the magnitude of such factors as socioeconomic status, health behaviors, comorbid medical and mental conditions, and access and quality of treatment.

• Citation:

• Walker E, McGee RE, Druss BG. Mortality in Mental Disorders and Global Disease Burden Implications: A Systematic Review and Meta-analysis . JAMA Psychiatry. Published online February 11, 2015. doi:10.1001/jamapsychiatry.2014.2502.



http://medicalresearch.com/mental-health-research/depression/linked-to-functional-decline-in-heart-disease-patients/10383/

http://archpsyc.jamanetwork.com/article.aspx?articleid=2110027



Stent-Thrombectomy May Be New Standard of Care for Ischemic StrokeMedicalResearch.com Interview with:

Dr Bruce Campbell MBBS(Hons), BMedSc, PhD, FRACPConsultant Neurologist, Head of Hyperacute Stroke

Department of Neurology Royal Melbourne Hospital


• Dr. Campbell: EXTEND-IA was a randomised trial comparing standard thrombolysis with tPAplus endovascular stent-thrombectomy versus tPA alone in ischemic stroke patients selected for the presence of major vessel occlusion and salvageable brain tissue using CT perfusion imaging. It was designed in 2011 at a time when there was uncertainty about the effectiveness of endovascular therapy which deepened in 2013 with the publication of 3 neutral trials. The recent publication of the Dutch MR-CLEAN study showing improved outcomes with stent-thrombectomy was a major advance and prompted a data safety and monitoring committee review of the EXTEND-IA data leading to early termination of the trial for efficacy.

• The key findings from EXTEND-IA were that the addition of stent-thrombectomy to tPA led to a dramatic increase in restoration of blood flow to the brain from 34% to 89%. This translated to markedly improved outcomes at 3 months with 71% of stent-thrombectomy patients compared with 40% of tPA-only patients regaining independence. The 3 trials released today were remarkably consistent in their outcomes and this provides a solid evidence base to recommend stent-thrombectomy as the new standard of care for patients with large vessel ischemic stroke.

• Patients who were treated with stent-thrombectomy in EXTEND-IA had more than double the rate of reperfusion (restoration of blood flow to the brain) compared to the standard tPApatients and this translated to a 31% absolute increase in the proportion of patients living independently at 3 months.


http://medicalresearch.com/stroke/stent-thrombetomy-may-be-new-standard-of-care-for-ischemic-stroke/11281/

http://medicalresearch.com/stroke/stroke-tpa-used-frequently-teaching-hospitals-esp-elderly/2668/







• Dr. Campbell: Putting the results of recent trials together, there is clear evidence that stent-thrombectomy improves outcomes for patients with large vessel ischemic stroke.

• In many countries, including Australia, there are a limited number of centers that can provide stent-thrombectomy and limited neurointerventionists trained to perform the procedure. Currently many patients have to be transferred between hospitals and rural patients rarely have access within a suitable timeframe.

• Given the strong evidence for improved outcome, systems of care need to be re-designed and adequately resourced to implement the findings of this research. Whilst stent-thrombectomy may only be suitable for ~10% of all stroke patients, these are the group most likely to suffer long term disability and death and so the potential societal benefit is highly significant. Initial analysis of treatment costs suggests that stent-thrombectomy is highly cost effective.









• Dr. Campbell: The key differences between recent studies revolve around the method of patient selection using brain imaging. These methods have led to positive trials but we cannot exclude some benefit of stent-thrombectomy in patients excluded from the trials and this requires further research. EXTEND-IA used CT perfusion which we find very useful in guiding our decision-making. The fully automated RAPID software (Stanford University) provided fast, standardised and easy to interpret images that determined eligibility for the study and proved robust across centers with a wide range of imaging experience.

• Citation:

• Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection

• Bruce C.V. Campbell, M.D., Peter J. Mitchell, M.D., Timothy J. Kleinig, M.D., Helen M. Dewey, M.D., Leonid Churilov, Ph.D., Nawaf Yassi, M.D., Bernard Yan, M.D., Richard J. Dowling, M.D., Mark W. Parsons, M.D., Thomas J. Oxley, M.D., Teddy Y. Wu, M.D., Mark Brooks, M.D., Marion A. Simpson, M.D., Ferdinand Miteff, M.D., Christopher R. Levi, M.D., Martin Krause, M.D., Timothy J. Harrington, M.D., Kenneth C. Faulder, M.D., Brendan S. Steinfort, M.D., Miriam Priglinger, M.D., Timothy Ang, M.D., Rebecca Scroop, M.D., P. Alan Barber, M.D., Ben McGuinness, M.D., Tissa Wijeratne, M.D., Thanh G. Phan, M.D., Winston Chong, M.D., Ronil V. Chandra, M.D., Christopher F. Bladin, M.D., Monica Badve, M.D., Henry Rice, M.D., Laetitia de Villiers, M.D., Henry Ma, M.D., Patricia M. Desmond, M.D., Geoffrey A. Donnan, M.D., and Stephen M. Davis, M.D. for the EXTEND-IA Investigators

• February 11, 2015DOI: 10.1056/NEJMoa1414792








Shared Medical Decision Making Improves Cancer Patient SatisfactionMedicalResearch.com Interview with:

Kenneth L. Kehl, MDDivision of Cancer Medicine, MD Anderson Cancer Center

Houston, Texas


Response: Prior studies have demonstrated that most patients with cancer wish to participate in their treatment decisions. We studied a cohort of patients with lung or colorectal cancer and assessed whether patient involvement in decision-making was associated with perceived quality of care or ratings of physician communication. We found that patients who described a more shared decision-making process gave higher ratings of their care quality and physician communication. This effect was independent of patients’ stated preferences regarding involvement in decision-making.


• Response: Clinicians may wish to consider the possibility that encouraging patient participation in medical decision-making is associated with higher patient satisfaction with the decision-making process, even among patients who state preferences that physicians control their medical decisions.


http://medicalresearch.com/cancer-_-oncology/shared-decision-making-improves-cancer-patients-satisfaction/11563/

http://medicalresearch.com/author-interviews/contraception-decision-making-womens-priorities/5800/

http://medicalresearch.com/author-interviews/patient_satisfaction_and_quality_of_care_may_not_be_directly_associated/7052/



Shared Medical Decision Making Improves Cancer Patient SatisfactionMedicalResearch.com Interview with:

Kenneth L. Kehl, MDDivision of Cancer Medicine, MD Anderson Cancer Center

Houston, Texas


• Response: Further research should include assessment of the impact of shared decision-making in other cancer types, and of interventions designed to promote patient involvement in medical decisions.

• Citation:

• Kehl KL, Landrum M, Arora NK, et al. Association of Actual and Preferred Decision Roles With Patient-Reported Quality of Care: Shared Decision Making in Cancer Care. JAMA Oncol. Published online February 12, 2015. doi:10.1001/jamaoncol.2014.112.



http://oncology.jamanetwork.com/article.aspx?articleid=2108850



Tyrosine May Help Predict Increased Risk of Diabetes in South AsiansMedicalResearch.com Interview with:

Dr. Therese TillinResearch Fellow, Cardiometabolic Phenotyping Group

Institute of Cardiovascular Science Faculty of Pop Health Sciences


Dr. Tillin: The global burden of type 2 diabetes is rising rapidly and people of South Asian origins (from the Indian subcontinent) remain at much higher risk of developing diabetes than people of European origin. Why is this? Although it is thought that increased levels of obesity around the waist level, diet, physical activity levels and genetic factors contribute, no study to date has been able to tease out fully the underlying causes for the added risk in South Asian people. However, it is likely that complex metabolic disturbances may play an important role.

• We have been studying a British cohort of people of European and South Asian origin for nearly 20 years and have used nuclear magnetic resonance spectroscopy to build a profile of amino acids in blood samples that were collected at the start of the study between 1988 and 1991. We found that higher levels of some amino acids, in particular tyrosine, were already present in non-diabetic South Asian individuals back then. Some of these amino acids, again especially tyrosine, more strongly predicted later development of type 2 diabetes in the South Asian people than in the Europeans in our study, even after adjustment for other risk factors such as obesity and insulin resistance. A given increase (one standard deviation) in tyrosine increased risk of developing diabetes by just 10% in Europeans, while in South Asians the increase in risk was 47%.


http://medicalresearch.com/diabetes/tyrosine-my-help-predict-increased-risk-of-diabets-in-south-asians/11519/

http://medicalresearch.com/diabetes/study-confirms-increased-risk-earlier-onset-diabetes-south-east-asians/7658/







• Dr. Tillin: This study has fitted another piece of the jigsaw of complicated underlying reasons as to why South Asians are at such high risk of developing type 2 diabetes compared with European origin populations. This is the first study that has looked at the links between amino acid levels (the building blocks of proteins) and the future development of diabetes in people of both European and South Asian origins living in one geographical area. Disturbances of amino acid are likely to occur in the liver, kidneys, muscle and adipose tissues. We don’t pretend to have all the answers, but believe that our findings suggest that amino acid disturbances ( particularly tyrosine) may be a focus for future research, paving the way for better prevention and potentially for targeted treatments in South Asian individuals.



http://medicalresearch.com/diabetes/rapidly-digested-dietary-carbohydrates-may-promote-development-diabetes/9161/







• Dr. Tillin: In our population-based study we were unable to perform the detailed study of metabolism that is needed to understand why some amino acid levels were higher in South Asiansand why they were more strongly linked to the development of diabetes in South Asians. Future studies in South Asians and comparable Europeans could examine in each ethnic group the role of different tissues such as liver, kidneys, adipose and muscle, in metabolic pathways which involve amino acids and their associations with impaired insulin sensitivity.

• Some studies have suggested that in Europeans, altered amino acid metabolism is linked with poorer sensitivity to the effects of insulin before the development of diabetes. South Asian people tend to have less lean muscle tissue and more liver fat as well as larger and more poorly functioning adipose tissue cells and it is possible that increased turnover of protein may result from increased obesity in the abdomen and lower level of lean muscle in these individuals.

• Citation:

• Diabetes risk and amino acid profiles: cross-sectionaland prospective analyses of ethnicity, amino acids and diabetesin a South Asian and European cohort from the SABRE (Southall And Brent REvisited) Study)

• T Tillin, AD Hughes, Q Wang, P Würtz, M Ala-Korpela, N Sattar, NG Forouhi, IF Godsland, S Eastwood, PM McKeigue, N Chaturvedi



http://medicalresearch.com/diabetes/insulin-resistance-and-cardiorespiratory-fitness-ethnic-differences/1036/



Patients with Tourette Syndrome Likely To Have Additional Psychiatric SymptomsMedicalResearch.com Interview with:

Carol MathewsProfessor, Psychiatry

UCSF School of Medicine


• Dr. Mathews: The background for this study is that, as a part of ongoing genetic studies of Tourette Syndrome, the Tourette Syndrome Association International Genetics Collaborative (TSAICG) has collected a wealth of information about commonly co-occurring psychiatric disorders in individuals with Tourette Syndrome and their families, providing us with an opportunity to explore questions about Tourette Syndrome that are relevant to individuals with Tourette Syndrome, their families, and their treating clinicians.

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

• Dr. Mathews: Individuals who present to clinics for evaluation and/or treatment of Tourette Syndrome are very likely to have additional psychiatric symptoms, including not only symptoms of obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD), but also mood, anxiety, and disruptive behavior disorders. These disorders start early in life, sometimes as early as age 4, in individuals with TS. None of the psychiatric conditions studied, except OCD and ADHD, had a direct genetic relationship to TS. Instead, they were related to OCD or ADHD. This suggests that individuals with OCD or ADHD, or those who have family members with these disorders, should be especially carefully screened for additional psychiatric symptoms.

• Clinicians should begin to screen early for psychiatric symptoms in individuals with TS, particularly if they have ADHD or OCD or a family history of these conditions.


http://medicalresearch.com/mental-health-research/patients-tourette-syndrome-likely-additional-psychiatric-symptoms/11550/



Patients with Tourette Syndrome Likely To Have Additional Psychiatric SymptomsMedicalResearch.com Interview with:

Carol MathewsProfessor, Psychiatry

UCSF School of Medicine


• Dr. Mathews: Additional research needs to be done to further explore our preliminary finding that psychotic symptoms and substance abuse are not elevated in individuals with TS. The genetic causes and the genetic relationships of these disorders to each other are a major focus of our ongoing work.

• Citation:

• Hirschtritt ME, Lee PC, Pauls DL, et al. Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiatry. Published online February 11, 2015. doi:10.1001/jamapsychiatry.2014.2650.



http://archpsyc.jamanetwork.com/article.aspx?articleid=2110028



New Classification System For Low-dose CT Screening For Lung CancerMedicalResearch.com Interview with:

Paul F. Pinsky, PhD MPHActing Chief Early Detection Research Group

National Cancer Institute Bethesda, MD, 20892


Response: The National Lung Screening Trial (NLST) reported, in 2011, a 20% reduction in lung cancer mortality with low-dose CT screening. However, there was a high false positive rate, around 25% in the first two screening rounds, and somewhat lower in the final round. In order to reduce the high false positive rate, and also to standardize the reported system for low-dose CT screening, analogous to the use of BIRADS for mammography screening, the American College of Radiology (ACR) developed the Lung-RADS classification system. It was released in May, 2014. Although it was developed based on published summary data from several studies, including the NLST, it was never applied to a large group of screened subjects on an individual basis. Therefore, we retrospectively applied Lung-RADS to previously collected, detailed screening data from the National Lung Screening Trial .

• The major findings were that the false positive rate decreased very substantially using Lung-RADS instead of the original National Lung Screening Trial criteria. At the baseline screen, it decreased by 50% and at subsequent screens it decreased by 75%. There was also, however, a modest decrease in the sensitivity rate, from 93% to 85% at baseline and from 93% to 79% at subsequent screens.


http://medicalresearch.com/cancer-_-oncology/lung-cancer/new-classification-system-for-low-dose-ct-screening-for-lung-cancer/11439/

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



New Classification System For Low-dose CT Screening For Lung CancerMedicalResearch.com Interview with:

Paul F. Pinsky, PhD MPHActing Chief Early Detection Research Group

National Cancer Institute Bethesda, MD, 20892

• Medical Research: What should clinicians and patients take away from your report?• Response: For clinicians and patients, the take-away is that with low-dose CT screening using Lung-

RADS, the false positive rate would be expected to be substantially lower than that seen in the National Lung Screening Trial . This is important because of several factors, including anxiety associated with a false positive test, the possibility of invasive procedures, with risk of complications, following a (false) positive screen, and cost and resource utilization issues. Also, the sensitivity of the test may be modestly lower, meaning more cancers may be missed. The effect of missing these extra cancers on the life-saving benefit of low-dose CT is unknown, though it would be expected to also be modest.


• Response: For the future, it is critical to have ongoing monitoring of large groups of persons undergoing low-dose CT screening, optimally using registries, to see if, when used prospectively in actual clinical practice, Lung-RADS can achieve the same low false positive rates seen in this study, where Lung-RADS was applied retrospectiively. Also, it will be important to see if the sensitivity rates observed in the current study are also observed in clinical practice.

• Citation:• Performance of Lung-RADS in the National Lung Screening Trial: A Retrospective Assessment

ONLINE FIRST• Paul F. Pinsky, PhD; David S. Gierada, MD; William Black, MD; Reginald Munden, MD; Hrudaya Nath,

MD; Denise Aberle, MD; and Ella Kazerooni, MD• Ann Intern Med. Published online 10 February 2015 doi:10.7326/M14-2086• Email *



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

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

http://annals.org/article.aspx?articleid=2109176





Patient Demands Not A Significant Driver Of Health Care CostsMedicalResearch.com Interview with:

Ezekiel Jonathan Emanuel MD PhD Department of Medical Ethics and Health PolicyPerelman School of Medicine and Department of Health Care Management

The Wharton School University of Pennsylvania Philadelphia, PA


• Dr. Emanuel: The genesis for this study is twofold.

• One, the first referenced article, by John Tilbert1 discussed how physicians explain US health care costs. In this study, physicians felt patients, insurance companies, drug companies, government regulations and malpractice lawyers…all were more to blame than doctors themselves for the high cost of US health care.

• Secondly, I give lots of presentations to doctors who offer two explanations for escalating health care costs: fear of malpractice litigation, and demanding patients, who request extensive testing and drugs. We decided to see whether the impression doctors frequently held of patients’ demands driving up health care costs, had been previously investigated. We could find no article to substantiate this belief. In addition, demanding patients were not common in my medical experience.

• In our study we included 5050 patient encounters. We asked the clinician coming out of the encounter, did the patient make a demand or request? (By asking immediately after the doctor left the examination room, there was little risk of inaccurate recall of the specifics of visit). In 8.7% there was a patient request and of these, over 70% were deemed clinically appropriate as determined by the physician (i.e. a request for pain medication, palliative care or imaging to address a new symptom or finding). In only 1% of all encounters (50/5050) was a clinically inappropriate request made as determined by the doctor, and the doctors hardly filled any of these inappropriate requests (total of 7 of 5050 encounters).

• We concluded that it is pretty rare for patients to make demands or requests, at least in this oncology setting, and even less common for the demands to be complied with by the doctor. Therefore it seems unlikely to us that health care costs are significantly driven by inappropriate patient requests. It is possible that there are more or different patient demands in other health care settings but we were very surprised to find no difference in patient requests based on patient-income, i.e. wealthier, more educated patients made no more demands than patients of lesser means.


http://medicalresearch.com/cancer-_-oncology/patient-demands-not-a-significant-driver-of-health-care-costs/11621/







• Dr. Emanuel: Clinicians should take away that while patient demand events are rare, they loom large in the doctor’s memory, and may be negatively emotionally charged. Doctors may perceive requests by patients for more or different medications or specific testing as a vote of no confidence in the doctor’s care or management. The requests may also result in more demands on the doctor’s time and, as our data suggests, imply a less good relationship with patient. Those doctor-patients relationships that are not going well may be accompanied by more demands by the patient or family. The physician may also disproportionately remember less than ideal relationships.

• For patients, the message should be ‘we’re really not to blame here for escalating health care costs’!









• Dr. Emanuel: I think we need further studies to address the impact of patient requests on health care costs but set in three different environments:

• Not in Philadelphia. Our study was based in three different Philadelphia locations. There may be regional differences in doctor-patient interactions.

• Not in oncology practices but studied perhaps in primary care or another common specialty i.e. cardiology.

• Not in exclusively outpatient venues. An inpatient or ICU setting would be ideal, although my guess is that intensive care or surgical patients are less likely to make specific demands of their physicians than in an outpatient setting.

• Reference:

• 1: Tilburt JC, Wynia MK, Sheeler RD, et al. Views of US physicians about controlling health care costs. JAMA 2013; 210(4); 380-388

• Citation:

• Gogineni K, Shuman KL, Chinn D, Gabler NB, Emanuel EJ. Patient Demands and Requests for Cancer Tests and Treatments. JAMA Oncol. Published online February 12, 2015. doi:10.1001/jamaoncol.2014.197.



http://oncology.jamanetwork.com/article.aspx?articleid=2108852



Productivity of US Hospitals Surprisingly GoodMedicalResearch.com Interview with:

John Romley Ph.DEconomist at the Leonard D. Schaeffer Center for Health Policy and Economics

Research Assistant Professor Sol Price School of Public PolicyUniversity of Southern California, Los Angeles.


• Dr. Romley: The need for better value in US health care is widely recognized. Existing evidence suggests that improvement in the productivity of American hospitals—that is, the output that hospitals produce from inputs such as labor and capital—has lagged behind that of other industries. However, previous studies have not adequately addressed quality of care or severity of patient illness. Our study, by contrast, adjusts for trends in the severity of patients’ conditions and health outcomes. We studied productivity growth among US hospitals in treating Medicare patients with heart attack, heart failure, and pneumonia during 2002–11. We found that the rates of annual productivity growth were 0.78 percent for heart attack, 0.62 percent for heart failure, and 1.90 percent for pneumonia.

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

• Dr. Romley: These findings suggest that productivity growth in US health care could be better than is sometimes believed, and may help alleviate concerns about Medicare payment policy under the Affordable Care Act.


• Dr. Romley: It is unknown, and worth knowing, whether similar productivity gains are being achieved in sectors such as skilled nursing care, or through new delivery and payment models such as accountable care organizations. Understanding the drivers of productivity trends is also important.

• Citation:

• US Hospitals Experienced Substantial Productivity Growth During 2002–11Romley JA, Goldman DP, Sood NHealth Aff (Millwood). 2015 Feb 11. pii: 10.1377/hlthaff.2014.0587


http://medicalresearch.com/author-interviews/productivity-of-us-hospitals-surprisingly-good/11635/

http://www.ncbi.nlm.nih.gov/pubmed/25673334?dopt=Abstract

http://www.ncbi.nlm.nih.gov/pubmed/25673334?dopt=Abstract


http://medicalresearch.com/author-interviews/productivity-of-us-hospitals-surprisingly-good/11635/

Cerebral Palsy Sometimes Due To Genetics, Not Birth TraumaMedicalResearch.com Interview with:

Prof. Jozef GeczNH&MRC Senior Principal Research Fellow

Professor of Human Genetics


Prof. Gecz: Cerebral palsy is the most frequent movement disorder of children for many years considered to be due to brain injury. Given that cerebral palsy incidence has not changed dramatically over many years while medical care is constantly improving, we look for other causes and specifically genetic mutation. By investigating 183 children with cerebral palsy and for many also one or both of their parents we find that for at least 14% of these we can find plausible explanation in genetic mutation being involved in the causation of their cerebral palsy. Importantly, we find that 10% of these mutations are de novo, which means that these mutations are not present in the parents (specifically in their blood as that is the tissue source we tested). 4% of mutations were inherited from unaffected mothers to affected sons. Previous estimates suggested 2% genetic contribution to Cerebral palsy. We now know that it is at least 14% and likely more.


• Prof. Gecz: Cerebral palsy is at least to some extent genetic and not due to perinatal trauma. Some cerebral palsies can now be diagnosed and as such recurrence risk for other pregnancies mitigated. Accurate diagnosis is a start for better care, short and long term and provides explanations as to what went wrong.


http://medicalresearch.com/genetic-research/cerebral-palsy-sometimes-due-to-genetics-not-birth-trauma/11628/

http://medicalresearch.com/general-medicine/does_magnesium_help_prevent_cerebral_palsy/7544/



Cerebral Palsy Sometimes Due To Genetics, Not Birth TraumaMedicalResearch.com Interview with:

Prof. Jozef GeczNH&MRC Senior Principal Research Fellow

Professor of Human Genetics


• Prof. Gecz: We and international cerebral palsy research community need to extend these studies to larger cohorts of patients to refine the extent of genetic contribution to CP. For those genetic cases of cerebral palsy we will need to understand the role of the genes involved and how and if and when the problem can be fixed. For those cerebral palsy cases where we do not find genetic mutation we need to look harder for other explanations so we can minimise the risk of cerebral palsy.

• Citation:

• Whole-exome sequencing points to considerable genetic heterogeneity of cerebral palsy

• G McMichael, M N Bainbridge, E Haan, M Corbett, A Gardner, S Thompson, B W M van Bon, C L van Eyk, J Broadbent, C Reynolds, M E O’Callaghan, L S Nguyen, D L Adelson, R Russo, S Jhangiani, H Doddapaneni, D M Muzny, R A Gibbs, J Gecz and A H MacLennan

• Molecular Psychiatry , (10 February 2015) | doi:10.1038/mp.2014.189



http://www.nature.com/mp/journal/vaop/ncurrent/full/mp2014189a.html#http:/www.nature.com/mp/journal/vaop/ncurrent/full/mp2014189a.html





Education Remains Strong Predictor of LongevityMedicalResearch.com Interview with:

Robert M. KaplanOffice of Behavioral and Social Sciences Research National Institutes of Health

Bethesda, MD 20892


• Response: Years of formal education is one of the strongest correlates of life expectancy. The purpose of this study was to examine the relationship between educational attainment and life expectancy with adjustments for other social, behavioral, and biological factors. Using data from a large cohort of nearly 30,000 adults, we found that education was a very strong predictor of survival and that biological and behavioral factors only partially explained the relationship.

•


• Response: Factors external to health care have powerful effects on health outcome. The crude relationship between education and life expectancy is very strong in comparison to other risk factors. For example, the crude relationship between elevated versus normal LDLcholesterol is about 0.67 quality-adjusted years of life. In contrast, several studies suggest that the crude relationship between having a college degree versus less than a high school education is about 10 quality-adjusted life years.


http://medicalresearch.com/medical-research-centers/nih/education-remains-strong-predictor-longevity/11597/

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



Education Remains Strong Predictor of LongevityMedicalResearch.com Interview with:

Robert M. KaplanOffice of Behavioral and Social Sciences Research National Institutes of Health

Bethesda, MD 20892


• Response: The results of this study are consistent with several previous publications. Education is an interesting leverage point because it is potentially mutable. Unlike some other social determinants of health, education can be boosted. But, we need new research demonstrating the causal relationship between investments in education and health outcome. Collaborations between education researchers, who are actively doing intervention studies, and public health investigators, may be fruitful.

• Citation:

• Educational Attainment and Longevity: Results from the REGARDS US National Cohort Study of Blacks and Whites

• Preventive Medicine

• Volume 68, November 2014, Pages 5–10 Robert M. Kaplan








Science Can Help You With Your On-line DatingMedicalResearch.com Interview with:

Professor Khalid KhanWomen’s Health Research Unit

Multi-disciplinary Evidence Synthesis Hub The Blizard Institute

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

Prof. Khan: My co-author talked me into helping him with his online dating and so we embarked on this project. We were fascinated to see if there was any scientific evidence which could help people in their online pursuit of love – and to our surprise there was lots of attraction and persuasion research. There were 86 published studies on attraction and persuasion which met our criteria, and these covered literature in psychology, sociology, and computer behavioural and neurocognitive sciences. Their design features included randomisation in 28 studies, cohort follow-up in 13 studies, cross-sectional evaluation in 37 studies, qualitative analysis in 5 studies and systematic review in 3 studies. We found that Success in converting initial online contact to a first date is not a complex formula. It relates to simple factors such as a fluent headline, truthfulness of profile, and reciprocity in communication. Just like when you meet someone in real life, simple actions such as showing interest in the other person (commenting on something in their profile rather than just talking about yourself) goes a long way.


http://medicalresearch.com/author-interviews/science-can-help-line-dating/11595/



Science Can Help You With Your On-line DatingMedicalResearch.com Interview with:

Professor Khalid KhanWomen’s Health Research Unit

Multi-disciplinary Evidence Synthesis Hub The Blizard Institute


• Prof. Khan: The scientific basis of effective online data will hopefully improve success in matching people together. Those who have not been finding success with their online dating profile should go through these findings and see if they can use any of the advice to improve the image they’re portraying of themselves online, whilst of course taking the advice about remaining truthful, humorous and playful.


• Prof. Khan: Future research should focus on long term outcomes beyond converting online contact into the first date.

• Citation:

• Khalid S Khan, Sameer Chaudhry. An evidence-based approach to an ancient pursuit: systematic review on converting online contact into a first date. Evid Based Med, 12 February 2015 DOI: 10.1136/ebmed-2014-110101



http://dx.doi.org/10.1136/ebmed-2014-110101



Meth Even More Toxic To Adolescent Than Adult BrainMedicalResearch.com Interview with:

Kyoon Lyoo, M.D., Ph.DEwha W. UniversitySeoul, South Korea


• Dr. Lyoo: Recent studies increasingly suggested that the developing brain shows unique characteristics of neuroplasticity to environmental stimuli. Still, it remains unclear whether the adolescent brain would undergo adaptive or dysfunctional changes when exposed to highly neurotoxic substances including methamphetamine. However, despite an increasing prevalence of methamphetamine use in this population, human studies have not yet found clear answers to these questions regarding the effects of methamphetamine exposure on the adolescent brain.

• This study reports novel in vivo findings in adolescent methamphetamine users, and thus provides a new perspective regarding adolescent-specific brain correlates of methamphetamine-induced neurotoxicity. Using cortical thickness and diffusion tensor image analyses, we found greater and more widespread gray and white matter alterations, particularly affecting the frontostriatal system, in adolescent methamphetamine users compared with adult users. Our findings highlight that the adolescent brain, which undergoes active myelination and maturation, is much more vulnerable to methamphetamine-induced neurotoxicity than the adult brain. This may help explain why adolescent-onset methamphetamine users show more severe and chronic clinical course than adult-onset users.


http://medicalresearch.com/addiction/meth-even-toxic-adolescent-adult-brain/11647/

http://medicalresearch.com/addiction/methamphetamine-research-aims-to-disrupt-drug-associated-memories/1748/



Meth Even More Toxic To Adolescent Than Adult BrainMedicalResearch.com Interview with:

Kyoon Lyoo, M.D., Ph.DEwha W. UniversitySeoul, South Korea

• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Lyoo: The current study shows that the magnitude of the detrimental effects of

methamphetamine on the brain was far greater in adolescence than in adulthood. This poses even greater problems since the top-down control over risky and addictive behavior is less mature in adolescence than in adulthood when the brain reaches its full maturity. Through this neurobiological evidence, clinicians and adolescents should be more aware of how dangerous stimulant use can be even at a low dose.


• Dr. Lyoo: We believe that the future longitudinal follow-up studies on adolescent drug users will provide a new insight on whether prolonged abstinence may reverse the drug-induced neurotoxic effects on the adolescent brain.

• Moreover, based on the finding that the methamphetamine use-related deficits in the frontostriatalsystem and executive function were particularly evident in adolescent users, the future studies will be necessary to examine potential efficacy of the therapeutic strategies targeting these neural markers.

• Citation:• I K Lyoo, S Yoon, T S Kim, S M Lim, Y Choi, J E Kim, J Hwang, H S Jeong, H B Cho, Y A Chung, P F

Renshaw. Predisposition to and effects of methamphetamine use on the adolescent brain. Molecular Psychiatry, 2015; DOI: 10.1038/mp.2014.191MedicalResearch.com Interview with:, & Kyoon Lyoo, M.D., Ph.D (2015). Meth Even More Toxic To Adolescent Than Adult Brain MedicalResearch.com



http://medicalresearch.com/addiction/methamphetamine_users_do_brain_function_differences_predispose_to_risky_behavior/5409/

http://dx.doi.org/10.1038/mp.2014.191



Binge Drinking Linked To Risky Sexual Behavior in MSMMedicalResearch.com Interview with:

Kristen Hess ORISE FellowDivision of HIV/AIDS Prevention,

National Center for HIV, Viral Hepatitis, STD and TB PreventionCenters for Disease Control and Prevention Atlanta, GA


• Response: Men who have sex with men (MSM) of all races continue to be the risk group most severely affected by HIV in the United States. CDC’s most recent HIV incidence data show that the number of new infections among MSM increased 12 percent between 2008 and 2010, with an even steeper increase among the youngest MSM. These data clearly show the urgent need to better understand the factors that affect their risk and to develop effective prevention interventions.

• One specific factor is excessive alcohol use, which is responsible for 88,000 deaths in this nation each year, and cost the U.S. about $224 billion in 2006. Binge drinking (consuming ≥5 drinks for men on an occasion; ≥4 drinks for women) is the most common form of excessive alcohol consumption. The association between excessive alcohol consumption, including binge drinking, and risky sexual behaviors among MSM has had mixed results in the literature with some studies finding an association and others not. One limitation of previous work is that the definition of excessive alcohol consumption varies between studies, so results are not easily compared between studies and populations.

• Our study examines the relationship between binge drinking and sexual risk behaviors among MSM who are current drinkers and who were either HIV-negative or unaware of their HIV status.


http://medicalresearch.com/infections/hiv/binge-drinking-linked-to-risky-sexual-behavior-in-msm/11660/







• Response: We assessed the prevalence of binge drinking, using a standard definition, among a sample of MSM recruited from 20 cities across the U.S. We also examined the association between binge drinking and several risky sexual behaviors.

• The findings show that 6 in 10 MSM reported binge drinking. Those who binge drank, in comparison to non-binge drinkers, were more likely to engage in risky sexual behaviors such as sex with an HIV-positive or unknown status partner and exchange sex for money or drugs at last sex, as well as more likely to have concurrent partners and more condomless sex partners in the past year.

• We also found that the likelihood of risky sexual behaviors went up with increased frequency of binge drinking. In fact, MSM who reported 10 or more binge-drinking episodes in the past month were more likely to report risky behaviors. This is a critical point, especially given that, among those who binged, 22 percent reported 10 or more binge drinking episodes in the past month.



http://medicalresearch.com/author-interviews/msm-may-need-greater-hpv-vaccine-protection/10181/







• Response: The high prevalence of binge drinking among MSM and its association with risky behaviors suggests that it is important for clinicians to screen for excessive alcohol use. CDC recommends that clinicians screen patients for excessive alcohol use as this may affect sexual risk behavior, liver or renal health, or medication adherence, which may affect decisions about the appropriateness of prescribing pre-exposure prophylaxis (PrEP) medication.

• HIV prevention programs could also incorporate the risks of excessive drinking into prevention messages. Evidence-based strategies for reducing excessive alcohol use, including binge drinking, may be important to help reduce risky sexual behavior among MSM and facilitate the use of other effective interventions.



http://medicalresearch.com/author-interviews/cdc-recommends-routine-annual-hiv-testing-sexually-active-msm/6533/







• Response: In the future, event-level studies would help to clarify the association between binge drinking and risky behaviors. It would also be helpful to have a similar analysis among HIV-positive MSM to add to our understanding of the impact of binge drinking on HIV transmission.

• Citation:

• Binge drinking and risky sexual behavior among HIV-negative and unknown HIV status men who have sex with men, 20 US cities

• Kristen L. Hess , ,Pollyanna R. Chavez ,Dafna Kanny ,Elizabeth DiNenno,Amy Lansky ,Gabriela Paz-Bailey ,for the NHBS Study Group

• Drug and Alcohol Dependence Volume 147, 1 February 2015, Pages 46–52



http://medicalresearch.com/author-interviews/hiv-remains-threat-to-urban-heterosexuals/10507/






Endovascular Therapy Improves Outcomes In Acute Ischemic StrokeMedicalResearch.com Interview with:

Michael D Hill, MD MSc FRCPC Calgary Stroke ProgramProfessor, Dept Clinical Neurosciences Hotchkiss Brain Institute

University of Calgary, Cumming School of Medicine Calgary, Canada


Dr. Hill: ESCAPE examine endovascular therapy for major acute ischemic stroke.

• The study found that among acute stroke patients with proximal occlusions (blocked ICA or MCA), good collaterals and fast endovascular treatment, there was a substantial reduction in morbidity (24% absolute reduction) and in mortality (a 9% absolute and 50% relative reduction in death).


• Dr. Hill: The finding are a major and compelling validation of endovascular treatment of major ischemic stroke. In combination with results from other studies – MRCLEAN, SWIFT-prime, EXTEND-IA, we believe that the standard of care for major acute ischemic stroke has been definitively changed.


http://medicalresearch.com/author-interviews/endovascular-therapy-improves-outcomes-in-acute-ischemic-stroke/11663/



Endovascular Therapy Improves Outcomes In Acute Ischemic StrokeMedicalResearch.com Interview with:

Michael D Hill, MD MSc FRCPC Calgary Stroke ProgramProfessor, Dept Clinical Neurosciences Hotchkiss Brain Institute

University of Calgary, Cumming School of Medicine Calgary, Canada

• Medical Research: What recommendations do you have for future research as a result of this study?• Dr. Hill: We must remember that there were still 47% of patients who did not have an independent functional outcome and 10% who died. This

means that there is still lots of work to do to improve outcomes in those patents.• A key thing to do next is to work hard on how to implement this therapy. It takes tremendous teamwork, fast workflow, attention to imaging plus

good technique and use of novel technology to make this work and work well.• The key messages from ESCAPE are:• Select patients with imaging – measure the physiology – www.aspectsinstroke.com

• Good scan (exclude the large core patients), proximal artery occlusion, moderate-good collaterals on mCTA• Act very fast on that information

– Picture-to-puncture (First slice CT groin puncture) < 60 minutes– Picture-to-perfusion (First slice CT reperfusion) < 90 minutes

• Achieve reperfusion – TICI 2b/3• Work as a team!• NNT = 3 if you do this.• Citation:• Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times

(ESCAPE) Bruce C.V. Campbell, M.D., Peter J. Mitchell, M.D., Timothy J. Kleinig, M.D., Helen M. Dewey, M.D., Leonid Churilov, Ph.D., Nawaf Yassi, M.D., Bernard Yan, M.D., Richard J. Dowling, M.D., Mark W. Parsons, M.D., Thomas J. Oxley, M.D., Teddy Y. Wu, M.D., Mark Brooks, M.D., Marion A. Simpson, M.D., Ferdinand Miteff, M.D., Christopher R. Levi, M.D., Martin Krause, M.D., Timothy J. Harrington, M.D., Kenneth C. Faulder, M.D., Brendan S. Steinfort, M.D., Miriam Priglinger, M.D., Timothy Ang, M.D., Rebecca Scroop, M.D., P. Alan Barber, M.D., Ben McGuinness, M.D., Tissa Wijeratne, M.D., Thanh G. Phan, M.D., Winston Chong, M.D., Ronil V. Chandra, M.D., Christopher F. Bladin, M.D., Monica Badve, M.D., Henry Rice, M.D., Laetitia de Villiers, M.D., Henry Ma, M.D., Patricia M. Desmond, M.D., Geoffrey A. Donnan, M.D., and Stephen M. Davis, M.D. for the EXTEND-IA Investigators

• February 11, 2015DOI: 10.1056/NEJMoa1414792



http://www.aspectsinstroke.com

http://www.nejm.org/doi/full/10.1056/NEJMoa1414792





Sodium Reduction Not Linked To Higher Fasting Glucose ConcentrationsMedicalResearch.com Interview with:Sheena M. Patel, MPH, ORISE, Fellow

Division for Heart Disease and Stroke PreventionCDC


• Dr. Patel: Although significant evidence reveals reduced sodium intake lowers blood pressure, some studies report that sodium reduction could have a negative impact on insulin resistance and glucose tolerance. As a result, we conducted a comprehensive meta-analysis of intervention studies to examine the effect of sodium reduction on glucose tolerance and provide direction for future research.

• Overall, our research found sodium reduction did not lead to higher average fasting glucose concentrations, a measure of insulin resistance. This suggests that the current recommendations to reduce sodium intake are unlikely to cause harm related to hyperglycemia or insulin resistance. It’s important to note that, in some cases, sodium reduction was associated with higher average insulin concentrations. However, this finding varied significantly across studies, suggesting caution in interpreting this result.

• To determine these findings, we reviewed previously published randomized and non-randomized prospective intervention trials. In randomized trials, people have an equal chance of being in each group examined. The data was pulled from five databases with research spanning from January 1950 to August 2014 and included 38 trials.


http://medicalresearch.com/diabetes/sodium-reduction-not-linked-higher-fasting-glucose-concentrations/11669/

http://medicalresearch.com/heart-disease/much-salt-intake-recommended-patients-heart-disease/10200/






• Dr. Patel: This study is meaningful because it suggests short-term large reductions in sodium intake might not affect fasting glucose concentrations, a measure of insulin resistance. These findings can help clinicians, patients and public health representatives focus efforts as needed.

• Due to the overwhelming evidence in favor of reducing sodium intake, CDC continues to support sodium reduction as an achievable and effective public health strategy to lower blood pressure and improve heart health nationwide.



http://medicalresearch.com/heart-disease/reduced_sodium_intake_may_improve_heart_failure_prognosis/9251/






• Dr. Patel: This meta-analysis revealed no evidence that, in trials with a short intervention and large reductions in sodium, circulating glucose concentrations differed between groups. Further research could more rigorously examine the impact of sodium reduction on glucose tolerance, including ensuring that participants are randomly assigned to interventions, test longer intervention durations, incorporate sodium intake levels relevant to population reduction initiatives, and examine the longer-term measures of glucose tolerance, e.g., glycated hemoglobin.

• Citation:

• Dietary Sodium Reduction Does Not Affect Circulating Glucose Concentrations in Fasting Children or Adults: Findings from a Systematic Review and Meta-Analysis

• Sheena M Patel, Paul Cobb, Sharon Saydah, Xuanping Zhang, Janet M de Jesus, and Mary E Cogswell

• Nutr. 2015 jn.114.195982; first published online January 21, 2015. doi:10.3945/jn.114.195982



http://medicalresearch.com/author-interviews/brain-functions-may-be-affected-by-chronic-high-salt-intake/10907/

http://jn.nutrition.org/content/early/2015/01/21/jn.114.195982.short?rss=1





For Most Birth Defects Survival Poorer Among MinoritiesMedicalResearch.com Interview with:

Ying Wang, PhD, MPHData Management, Analysis & Research

Office of Primary Care and Health System Management New York State Department of Health


Dr. Wang: The purpose of the study was to examine the survival of children with one or more of 21 major birth defects in the United States. We used data from 12 population-based birth defects surveillance programs that participate in the National Birth Defects Prevention Network. The study included nearly 100,000 infants born with birth defects between 1997 and 2007.

• We found that children who were born with hypoplastic left heart syndrome (a severe congenital heart defect) had the lowest chance of survival across multiple ages (up to 28 days of life, 1 year, 2 years, and 8 years of life), compared to children with any other birth defects studied. We also found that the chances of survival up to 1 year of life was greater than 90% for babies born with spina bifida, cleft palate, cleft lip with or without cleft palate, pyloric stenosis, gastroschisis, or Down syndrome. For most birth defects, survival was poorer among non-Hispanic black mothers and Hispanic mothers compared to non-Hispanic white mothers.


• Dr. Wang: This study is one of the largest population-based studies of survival among children with birth defects in the United States. It provides important information for those involved (e.g., clinicians, policymakers, patients) in developing health policies and planning for services.


http://medicalresearch.com/author-interviews/for-most-birth-defects-survival-poorer-among-minorities/11674/

http://medicalresearch.com/genetic-research/folate-deficiency-may-affect-subsequent-generations-epigenetics/2168/

http://medicalresearch.com/author-interviews/more-women-of-reproductive-age-need-folic-acid-to-prevent-birth-defects/10677/



For Most Birth Defects Survival Poorer Among MinoritiesMedicalResearch.com Interview with:

Ying Wang, PhD, MPHData Management, Analysis & Research

Office of Primary Care and Health System Management New York State Department of Health


• Dr. Wang: Future studies should examine survival among those who needed surgery, those who had another condition requiring a hospital stay or other procedure, and those who had more severe or complex types of specific birth defects.

• Citation:

• Racial/Ethnic Differences in Survival of United States Children with Birth Defects: A Population-Based Study

• Wang, Ying et al.

• The Journal of Pediatrics on behalf of theNational Birth Defects The Journal of Pediatrics

• Available online 29 January 2015



http://medicalresearch.com/mental-health-research/depression/do_antidepressants_during_pregnancy_promote_cardiac_birth_defects/5899/







Antioxidants May Have Mixed Effect on AgingMedicalResearch.com Interview with: Dr. Jeremy Van Raamsdon PhD

Laboratory of Aging and Neurodk egenerative Disease (LAND),Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Michigan, Deptment of Translational Science and

Molecular Medicine, Department of Genetics


Dr. Van Raamsdonk : The free radical theory of aging is one of the most widely accepted theories of aging. This theory suggests that reactive oxygen species (ROS), which are also known as free radicals, cause a type of damage, called oxidative damage, that accumulates over time to cause the functional decline associated with aging. ROS have also been proposed to play a role in many diseases including neurodegenerative disorders such as Parkinson’s disease and Huntington’s disease.

• However, recent work has demonstrated that ROS are not necessarily detrimental. ROS perform functional roles in the body and thus it is possible to have too little ROS. We previously showed that increasing ROS by decreasing the levels of an antioxidant enzyme called superoxide dismutase (SOD) does not decrease lifespan even when all of the SOD genes are removed. We also showed that in some cases treatment with an antioxidant, such as Vitamin C, can lead to decreased lifespan. This finding is consistent with human clinical trials in which it has not been possible to show a beneficial effect of antioxidants on longevity.

• In this paper we further examine the relationship between ROS and aging. We use a simple genetic model organism, the worm Caenorhabditis elegans, which has been used extensively in aging research, to determine how location impacts the effect of ROS on lifespan. We used a genetic approach to increase the levels of ROS in different parts of a cell and found that location is crucial in determining the effect of ROS on lifespan. Mildly increasing the levels of ROS in the mitochondria increases lifespan, while increasing ROS in the cytoplasm has the opposite effect of decreasing lifespan.


http://medicalresearch.com/author-interviews/antioxidants-may-have-mixed-effect-on-aging/11676/

http://medicalresearch.com/author-interviews/vitamin-c-gene-activation-and-in-vitro-fertilzation/960/







• Dr. Van Raamsdonk: I think the take home message is that the relationship between ROS and aging is complex. ROS are neither good nor bad. While high levels of ROS can be toxic, ROS perform functional roles and thus it is also possible to have too little ROS. In addition to levels, the location of ROS in a cell is important in determining whether they will have a beneficial or detrimental effect. These findings have implications for taking antioxidants to reduce ROS. While antioxidants may be beneficial when ROS levels are too high, it is also possible that they will have a detrimental effect if ROS levels are optimal or low. In addition, this work suggests that it may be necessary to target antioxidants to specific locations in a cell to maximize their benefit and minimize the possibility of having a negative impact.



http://medicalresearch.com/diabetes/diabetes/2451/







• Dr. Van Raamsdonk : I think it will be important to continue to define the functional roles of ROS. By defining the mechanism by which elevated mitochondrial ROS increases lifespan, this knowledge may be used to promote healthy aging and longevity. In future studies, the levels and location of ROS must be considered. In this study we have focused on the relationship between ROS and aging. It would be interesting to extend these studies to examine the importance of the location of ROS in a cell in the context of disease.

• Citation:

• Mitochondrial and cytoplasmic ROS have opposing effects on lifespan

• Claire E. Schaar , Dylan J. Dues , Katie K. Spielbauer , Emily Machiela, Jason F. Cooper, Megan Senchuk, Siegfried Hekimi, M. Van Raamsdonk

• PLOS Genetics Published: February 11, 2015

• DOI: 10.1371/journal.pgen.1004972



http://medicalresearch.com/aging/unhealthy-aging-and-chronic-inflammation/1879/

http://journals.plos.org/plosgenetics/article?id=10.1371/journal.pgen.1004972






Gender Identity Is A Biologic ProcessMedicalResearch.com Interview with:

Joshua D. Safer MD, FACPDirector, Endocrinology Fellowship Training and Endocrinology Education

Boston University Medical Center


Dr. Safer: This is a review of the current medical literature in favor of the biologic nature of gender identity. The main barrier to medical care for transgender patients is lack of physicians with the knowledge and willingness to provide that care. A major concern of physicians is that this is a mental health issue, meaning that transgender hormone therapy and surgery may be too drastic a response to an individual who should be counseled instead. The review lays out the evidence to make it clear that a major component of gender identity is biologic even if we don’t have the exact details worked out. Therefore, counseling alone cannot address the disconnect between transgender individuals’ gender identity and their physical bodies.


• Dr. Safer: Once comfortable that gender identity is biologic, the next step is to logically address how to deal with someone who has a transgender identity. The data are quite strong that changing the physical appearance to match the gender identity is far and away the most successful approach.


http://medicalresearch.com/author-interviews/gender-identity-is-a-biologic-process/11684/



Gender Identity Is A Biologic ProcessMedicalResearch.com Interview with:

Joshua D. Safer MD, FACPDirector, Endocrinology Fellowship Training and Endocrinology Education

Boston University Medical Center


• Dr. Safer: There is much future research to be done. Even if it is becoming clearer that gender identity is a biologic process, the exact biology is far from understood. As well, much work needs to be done to determine the most effective and safest treatment regimens.

• Citation:

• Evidence Supporting the Biological Nature of Gender Identity.

• Saraswat A1, Weinand M2, Safer JD3.

• Endocr Pract. 2015 Feb 9:1-20. [Epub ahead of print]








Hand Dermatitis Increases In Health Care Workers Due To Hand Washing MeasuresMedicalResearch.com Interview with:

Dr Jill Stocks PhD, Research FellowCentre for Occupational and Environmental Health,

Centre for Epidemiology; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care

• MedicalResearch.com Interview with:Dr Jill Stocks PhD, Research FellowCentre for Occupational and Environmental Health,Centre for Epidemiology; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary CareInstitute of Population Health, University of Manchester, UK.


Dr. Stocks: Reducing healthcare-associated infections has been a priority in the UK over recent decades; and this has been reflected in interventions and guidelines focussing on improving hygiene procedures. During 2004 to 2008 the Cleanyourhands campaign promoted hand hygiene in all NHS trusts. There was anecdotal evidence from dermatologists and occupational physicians that irritant contact dermatitis was on the increase in healthcare workers, and that it was caused by hand hygiene. We investigated whether or not there was an increase in the incidence of irritant contact dermatitis in healthcare workers due to hand hygiene or other types of hygiene coinciding with the interventions and guidelines promoting hygiene. We used reports made by dermatologists to the Occupational and Health reporting network, a voluntary surveillance scheme collecting reports of work-related ill-health. Trends in incidence of irritant contact dermatitis due to hygiene in healthcare workers were compared with trends in control groups (irritant contact dermatitis in workers with other jobs) using a quasi-experimental (interrupted time series) design. We found a 4.5 fold increase in irritant contact dermatitis due to hand hygiene and hygiene in general in healthcare workers between 1996 and 2012. The results also suggested a steepening of the increase in incidence during the rollout period of the Cleanyourhands campaign but the limitations of the data made this less clear cut.


http://medicalresearch.com/author-interviews/hand-dermatitis-increases-in-health-care-workers-due-to-hand-washing-measures/11689/

http://www.population-health.manchester.ac.uk/epidemiology/COEH/research/thor/



Hand Dermatitis Increases In Health Care Workers Due To Hand Washing MeasuresMedicalResearch.com Interview with:

Dr Jill Stocks PhD, Research FellowCentre for Occupational and Environmental Health,

Centre for Epidemiology; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care

• Medical Research: What should clinicians and patients take away from your report?• Dr. Stocks: The benefit of good hand hygiene in controlling healthcare-associated infections is

indisputable, but this study shows that irritant contact dermatitis is a serious problem for some healthcare workers. All healthcare workers should carefully follow the latest evidence-based guidelines for hand hygiene regarding the use of hand rubs rather than soap and water where possible, the use of moisturisers and emollients, thorough drying of hands and the use of less irritating products. Infection control teams should provide advice to healthcare workers and patients based on these same guidelines. Decisions regarding which hand hygiene products to purchase should involve healthcare workers as well as infection control and prevention professionals, occupational disease professionals and administrative staff.


• Dr. Stocks: Future evaluations of interventions promoting infection control through hygiene should also assess the impact on the worker’s skin. Further research to identify and promote products and practices to reduce the incidence of irritant contact dermatitis is needed. The question of whether workers with dermatitis remain colonised longer than those with healthy skin, and the risk of transmission to the patient, needs to be investigated.

• Citation:• The impact of national level interventions to improve hygiene on the incidence of irritant contact

dermatitis in healthcare workers: changes in incidence from 1996-2012 and interrupted times series analysis

• S J Stocks, R McNamee, S Turner, M Carder, R M Agius• Br J Dermatol. 2015 Feb 5. doi: 10.1111/bjd.13719. [Epub ahead of print]



http://medicalresearch.com/infections/hand-hygiene-global-strategy/2060/

http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf

http://medicalresearch.com/outcomes-safety/hand-hygiene-improvement-program-electronic-monitoring-and-compliance/776/






ISC 2015: Analysis of MR CLEAN Trial for Endovascular Therapy in Acute Ischemic StrokeMedicalResearch.com Interview with:

Dr. May Nour MD PhDNeurology Fellow

UCLA


Dr. Nour: In October of 2014, results from the MR CLEAN trial were the first to demonstrate better functional outcomes in stroke patients as a result of endovascular therapy. Among patients whose stroke was caused by clot blocking a large vessel responsible for delivering blood to the vital tissue of the brain, the use of endovascular therapy, primarily utilizing second-generation clot retrieval devices, showed improved outcomes in most cases evaluated in combination with medical therapy, when compared to medical therapy alone. Currently, the standard of care involves delivery of intravenous tissue plasminogen activator (IV tPA) within a short time window (up to 3-4.5 hrs) with the intention of dissolving, rather than physically removing the clot as in the case of endovascular retrieval.


• Dr. Nour: This analysis sought to capture the full magnitude of endovascular treatment effect in the MR CLEAN trial by calculating the number of patients needed to undergo endovascular therapy in order for there to be benefit or harm as a result of clot retrieval. The investigators found that endovascular therapy allows one additional patient to have fully restored neurologic function for every seven patients treated and one additional patient to have improved neurologic function for every 3-5 patients treated. It also showed that for every 100 patients treated with endovascular therapy, 14 more will have a nondisabled outcome and 22-29 will have a less disabled outcome, leading researchers to report the treatment effect as substantial in the MR CLEAN trial.


http://medicalresearch.com/stroke/isc-2015-analysis-mr-clean-trial-endovascular-therapy-acute-ischemic-stroke/11555/



ISC 2015: Analysis of MR CLEAN Trial for Endovascular Therapy in Acute Ischemic StrokeMedicalResearch.com Interview with:

Dr. May Nour MD PhDNeurology Fellow

UCLA


• Dr. Nour: The published results of the trial taken together with this analysis, which further defines the magnitude of improvement in patient outcomes, is likely to herald a much anticipated paradigm shift in the clinical treatment of stroke caused by large vessel occlusion. This serves as a platform for us to continue to assess and understand patient selection for endovascular therapy and to determine which patients will benefit the most from this treatment.

• Citation: International Stroke Conference 2015 abstract:

• Presented by May Nour, MD

• ISC 2015, Nashville, TN

• Number Needed to Treat to Benefit and Harm for Endovascular Therapy in Acute Ischemic Stroke: Joint Outcome Table Analysis of the MR CLEAN Trial



http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_471837.pdf



Elderly With Co-Morbidities Account For Most Readmissions for DiabeticsMedicalResearch.com Interview with:

Dr Syed M R GillaniDiabetes Centre, New Cross Hospital,

Wolverhampton, UK


• Dr. Gillani: NHS is facing the greatest challenge of its history in the form of A&E pressures and bed availabilities. Unplanned admissions are considered one of the key reasons. With an aging population, multiple co-morbidities and increasing pressures on social and primary care, we need to develop a proactive strategy to deal with this situation. It is a high priority agenda for the DOH. Initiatives such as “named GP for over 75” and “directly enhanced services to avoid unplanned admissions” have been rolled out by DOH in the last 2 years. In order to find an innovative way to assist in reduction of unplanned admissions, we decided to conduct an audit on all recurrent unplanned admissions with diabetes in the hospital over 12 months period. Its objective was to determine any unmet patient needs during an index admission to explore potential of changes in the service and to utilize available resources more effectively in an attempt to prevent next hospital admission for that patient.


• Dr. Gillani: People who are having ≥3 non elective admissions in the hospital are elderly, have multiple co-morbidities and varied reasons for admissions. Only a minority of these patients were admitted due to diabetes related issues and most of these admissions were avoidable. Concepts of “avoidability” and “justification” are used to determine whether admission was potentially preventable with a suitable, proactive prior intervention. Due to multi morbidity in these patients a holistic patient centric care is required that reflects the need of dialectologists to be as skilled general physicians to meet patients’ needs.


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

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

http://medicalresearch.com/diabetes/lowering-blood-pressure-reduces-complications-in-diabetes/11474/



Elderly With Co-Morbidities Account For Most Readmissions for DiabeticsMedicalResearch.com Interview with:

Dr Syed M R GillaniDiabetes Centre, New Cross Hospital,

Wolverhampton, UK

• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Gillani: For clinicians, there is a need to consider unmet needs of the patients at each discharge

and to promote and practice holistic rather than gluco-centric medicine. Communication with various agencies like primary and social care to help people cope better at home and to intervene at an early stage of the illness can help avoid unplanned admissions. This requires an integrated model of care delivery across NHS boundaries.

• For patients, it may be re-assuring to know that NHS is trying its best to provide better care and finding more effective way to improve patient experience during their time of illness.


• Dr. Gillani: We need to conduct a research trial to evaluate the impact of proactive intervention during an index admission of the patients who have recurrent non elective admissions. This will be a prospective study to address unmet patient needs and to design a methodology to do an early intervention in an appropriate setting across primary and specialist services in an attempt to prevent the next unplanned admissions. There is a lack of evidence base in this arena and we would encourage people to conduct more trials in this field of medicine.

• Citation:• Non elective re-admissions to an acute hospital in people with diabetes: Causes and the potential

for avoidance. The WICKED project• Syed M.R. Gillani Umaira Aziz,David Blundell Baldev M. Singh• Primary Care Diabetes• Available online 11 February 2015









Mental Stress Linked To Poor Heart Attack Recovery For WomenMedicalResearch.com Interview with:

Xiao Xu, PhD Assistant ProfessorHarlan M Krumholz MD, SM

Harold H. Hines, Jr. Professor of Medicine


Response: Prior research of heart attack has mostly examined older patients, while few studies have focused on younger patients. Although we know that younger women differ from men and older patients in heart attack etiology and mortality, there is limited data on non-mortality outcomes of younger women and factors influencing their recovery. Mental stress is a particularly relevant factor for younger women as prior research showed higher stress in women than in men and an inverse association between age and stress. Therefore, in this study, we compared women and men 18-55 years old with heart attack and examined gender difference in mental stress and its potential role in explaining the worse recovery in women.

• We addressed these questions using data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) project, which is the largest prospective observational study of young and middle-aged women and men with heart attack and has comprehensive information on patients’ clinical and psychosocial characteristics. Our findings showed significantly higher stress in women than in men. Moreover, mental stress is associated with worse recovery in multiple health outcomes 1 month after heart attack, such as angina-specific and overall quality of life. The greater stress in women may partially contribute to their worse recovery.


http://medicalresearch.com/heart-disease/mental-stress-linked-to-poor-heart-attack-recovery-for-women/11704/

http://medicalresearch.com/heart-disease/women_may_have_more_cardiac_ischemia_than_men_in_response_to_mental_stress/8250/







• Response: Clinicians need to be vigilant about patients’ status of psychological stress, especially among younger women patients. Incorporating screening tests and teaching patients appropriate coping skills could be beneficial. We also need to recognize that women and men are burdened by different stressors, and should take a gender-specific approach when helping patients manage psychological stress.

• From patients’ perspective, they need to be aware of the adverse impact of mental stress on heart attack recovery. Avoiding stressful situations and learning appropriate coping skills may help reduce stress and its adverse health impact.



http://medicalresearch.com/author-interviews/link-between-stress-and-fertility-examined/10841/







• Response: Our findings suggest many areas for further investigation. For example, the current study assessed patient outcomes at 1 month after heart attack. We need to determine whether similar relationship holds for longer term recovery. Moreover, although we found a strong association between mental stress and poor recovery, further research is needed to understand the underlying mechanisms of the sex-stress-recovery relationship. That information is crucial for designing the most appropriate interventions to improve patient outcome.

• Citation:

• Xu, H. Bao, K. Strait, J. A. Spertus, J. H. Lichtman, G. D’Onofrio, E. Spatz, E. M. Bucholz, M. Geda, N. P. Lorenze, H. Bueno, J. F. Beltrame, H. M. Krumholz. Sex Differences in Perceived Stress and Early Recovery in Young and Middle-Aged Patients with Acute Myocardial Infarction. Circulation, 2015; DOI: 10.1161/CIRCULATIONAHA.114.012826



http://medicalresearch.com/mental-health-research/depression/after_heart_attack_women_more_likely_to_develop_anxiety_and_depression/8536/

http://dx.doi.org/10.1161/CIRCULATIONAHA.114.012826



Mindfulness Training Improved Sleep Quality In Older AdultsMedicalResearch.com Interview with:

David S. Black, Ph.D., M.P.H.Associate Professor of Preventive Medicine

Keck School of Medicine of USC.

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

Dr. Black: Sleep disturbances pose a significant medical and public healthconcern for our nation’s aging population. An estimated 50% of peopleaged 55 years and older suffer from some form of sleep problem,including initiating and maintaining sleep. Older adults report thehighest prevalence of sleep problems compared to younger age groupswhen quantified by both self-report and biological assessment.

• Moderate sleep complaints in older adults are often associated withdeficits in daytime functioning, including elevated levels of fatigue,disturbed mood such as depressive symptoms and reduced quality oflife, and lead to the onset of clinical insomnia. Addressing moderatesleep complaints and sleep-related daytime dysfunction usingcommunity-accessible programs is a promising public health approach.Our main findings indicate that the mindfulness training program,which is available to the general community, resulted in improvementin sleep quality at post-intervention relative to a highly active andstandardized sleep hygiene education program. Effect size forimprovement in sleep quality was large (0.89) and of clinicalrelevance considering that effect sizes obtained from all types ofbehavioral interventions on self-reported sleep quality outcomesaverages 0.76 in older adults. Meta-analyses comparing treatmentmodalities indicate that the mean effect size for self-reported sleepimprovements resulting from pharmacotherapy (0.87) (i.e.,benzodiazepines, benzodiazepine receptor agonists) and behavioraltherapy (0.96) are of medium-to-large magnitude in mixed-age adultsamples with primary insomnia. Thus, our observed changes areconsistent with previous studies and are at the level of a minimallyimportant difference for insomnia severity. The mindfulness programalso yielded relative improvements on sleep-related daytimeimpairments of depression and fatigue symptoms that were ofmedium-to-large effect size.


http://medicalresearch.com/sleep-disorders/mindfulness-training-improved-sleep-quality-older-adults/11632/

http://medicalresearch.com/author-interviews/sleep_difficulties_linked_to_shrinking_brain/7445/

http://medicalresearch.com/pain-research/mindfulness-meditation-improve-anxiety-depression-pain/3293/







• Dr. Black: According to our findings, mindfulness meditation appears to have arole in addressing the prevalent burden of sleep problems in olderadults by remediating their moderate sleep complaints and deficits indaytime functioning with short-term effects sizes commensurate withthe status quo of clinical treatment approaches for sleep problems.Strengths of our study include it being the first RCT to examine theimpact of a MBI on sleep disturbances, and solely among older adults.Enrollment of older adults has high potential health impact as thispopulation reports the highest prevalence of sleep problems.









• Dr. Black: Findings from our study suggest that mindfulness meditation might beintroduced to older adults as a short-term solution to remediate theirmoderate sleep complaints, although research is needed to determinepossible longer-term effects on sleep. Given that standardizedmindfulness programs are readily delivered in many communities,dissemination efforts do not serve as a barrier in this instance, andthus older adults often have immediate access to these programs, whichare offered at relatively low cost. Pending future replication ofthese findings, structured mindfulness meditation training appears tohave at least some clinical utility to remediate moderate sleepproblems and sleep-related daytime impairments in older adults.

• Citation:

• Black DS, O’Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness Meditation and Improvement in Sleep Quality and Daytime Impairment Among Older Adults With Sleep Disturbances: A Randomized Clinical Trial. JAMA Intern Med. Published online February 16, 2015. doi:10.1001/jamainternmed.2014.8081.



http://medicalresearch.com/author-interviews/meditation-may-improve-creative-thinking-problem-solving/8662/



Short Follow-Up Intervals For Hypertension Reduces Adverse EventsMedicalResearch.com Interview with:

Dr. Alexander Turchin M.D.,M.S.Director of Informatics Research

Division of Endocrinology, Brigham and Women’s Hospital Boston, MA


Dr. Turchin: Hypertension is the most common risk factor for cardiovascular events. High blood pressure increases the risk for stroke, myocardial infarction, heart failure and kidney failure. Treatment of high blood pressure reduces these risks. However, our understanding of optimal treatment of hypertension is incomplete. In particular, there is little information to guide clinicians on how quickly they should achieve blood pressure control in their patients. There have been no clinical trials focusing on this question. Current guidelines are sparse and are based only on expert opinion.

• Our study analyzed treatment of nearly 90,000 patients in primary care practices in the U.K. between 1986 and 2010. We found that patients whose blood pressure medications were adjusted within 1.4 months after systolic blood pressure reached over 150 mm Hg and whose blood pressure was re-assessed within 2.7 months after their treatment was adjusted had the lowest risk for acute cardiovascular events and death from any cause.


• Dr. Turchin: Our main finding is that time is money in treatment of high blood pressure. Both treatment adjustments after patient is found to have an elevated blood pressure and re-assessment of the effect of treatment change have to be done in a timely fashion to optimize long-term patient outcomes.


http://medicalresearch.com/author-interviews/short-follow-up-intervals-for-hypertension-reduces-adverse-events/11720/

http://medicalresearch.com/diabetes/lowering-blood-pressure-reduces-complications-in-diabetes/11474/



Short Follow-Up Intervals For Hypertension Reduces Adverse EventsMedicalResearch.com Interview with:

Dr. Alexander Turchin M.D.,M.S.Director of Informatics Research

Division of Endocrinology, Brigham and Women’s Hospital Boston, MA


• Dr. Turchin: Our study was a retrospective / database analysis. Future studies should include an interventional clinical trial that would compare different strategies in treatment of high blood pressure to confirm the optimal time frame for therapy of hypertension. We also need studies that would focus on particularly vulnerable patients, such as individuals with diabetes mellitus, kidney disease, heart disease and older patients, to determine whether optimal treatment parameters are the same or different for them.

• Citation:

• Optimal systolic blood pressure target, time to intensification, and time to follow-up in treatment of hypertension: population based retrospective cohort study

• BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h158 (Published 05 February 2015) BMJ 2015;350:h158







How Much Does Specialized Melanoma Screening Cost?MedicalResearch.com Interview with:

Caroline Watts| PhD CandidateCancer Epidemiology and Services Research | Sydney School of Public Health

The University of Sydney

• MedicalResearch: What is the background for this study? What are the main findings?• Response: A clinic for people at high risk of melanoma was established at the Royal Prince Alfred

Hospital, Sydney in 2006 to look at the impact of surveillance regime which included regular full body skin examination supported by dermoscopy and total body photography at 6 monthly intervals. If a suspicious lesion was identified, the lesion was either removed or sequential digital dermoscopy was performed and the patient returned in 3 months for review. This study aimed to estimate the costs associated with surveillance in this type of specilaised clinic.

• The mean number of clinic visits per year was 2.7 (95% CI, 2.5-2.8) for surveillance and 3.8 (95% CI, 3.4-4.1) for patients requiring surgical excisions. The mean annual cost per patient to the health system was A $882 (95% CI, A $783-$982) (US $599 [95% CI, US $532-$665]) and mean annual societal cost per patient (excluding health system costs) was A $972 (95% CI, A $899-$1045) (US $660 [95% CI, US $611-$710). Diagnosis of melanoma or non-melanoma skin cancer and frequent excisions for benign lesions in a relatively small number of patients was responsible for skewed health system costs.

• MedicalResearch: What should clinicians and patients take away from your report?• Response: From a health system perspective, the costs of surveillance are driven by the labour

costs of the clinic staff and the number of follow-up extended-length surveillance consultations required by these patients. The cost from a societal perspective are similar to health system costs reflecting the amount of time patients are willing to give up to attend the clinic. High-risk patients in specilaised surveillance programs have been shown to have melanomas detected at an earlier stage compared with high-risk individuals not in a specilaised surveillance program. There is less morbidity and health care costs if melanoma is detected early.


http://medicalresearch.com/author-interviews/how-much-does-sepcialized-melanoma-screening-cost/11734/

http://medicalresearch.com/author-interviews/dermatologists-find-thinner-melanomas/6776/

http://medicalresearch.com/author-interviews/even_thin_melanomas_can_be_fatal/8407/



How Much Does Specialized Melanoma Screening Cost?MedicalResearch.com Interview with:

Caroline Watts| PhD CandidateCancer Epidemiology and Services Research | Sydney School of Public Health

The University of Sydney


• Response: Recommendations for future research include identifying which groups would benefit most from this specialized screening strategy and trialling this type of clinic in other practice settings to reduce the cost of surveillance. Results from this study will be used in an economic evaluation of the cost-effectiveness of this specialised model of care for individuals at high risk for melanoma compared with standard care in the community.

• Citation:

• Watts CG, Cust AE, Menzies SW, Coates E, Mann GJ, Morton RL. Specialized Surveillance for Individuals at High Risk for Melanoma: A Cost Analysis of a High-Risk Clinic. JAMA Dermatol. 2015;151(2):178-186. doi:10.1001/jamadermatol.2014.1952.



http://medicalresearch.com/author-interviews/melanoma/10616/

http://archderm.jamanetwork.com/article.aspx?articleid=1935477



MRSA Persistence Linked With Household Members and PetsMedicalResearch.com Interview with:

Valerie Cluzet, MDHospital of the University of Pennsylvania Division of Infectious Diseases

Philadelphia, PA 19104,


• Dr. Cluzet: MRSA is a major cause of skin and soft tissue infection (SSTI) in the community and we know that colonization is an important risk factor for subsequent infection. Past studies have calculated duration of colonization based on colonization at hospital admission or focused on populations not representative of the typical community-dwelling patient. We wanted to identify the factors associated with duration of colonization in a typical patient that clinicians would see (i.e. adults and children presenting to ambulatory setting with a MRSA SSTI), so that the findings would be generalizable and relevant to their practice. In addition, there has been an increasing focus on the role of the household in transmission of MRSA, so wanted to specifically examine that in a longitudinal, systematic way.

• There are a few major points that emerged from our study.

• 1) The first is that the duration of colonization after treatment for a methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) is relatively short, but there is a significant subset of patients (approximately 20%) who will have persistent colonization.

• 2) We also found that treatment of the MRSA SSTI with clindamycin was associated with shorter duration of colonization, an association we did not see with other MRSA-active agents.

• 3) Finally, this study highlights the potential role of MRSA colonization among household members as a contributing factor in duration of colonization in patients.


http://medicalresearch.com/author-interviews/mrsa-persistence-linked-with-household-members-and-pets/11731/

http://medicalresearch.com/author-interviews/mrsa_also_common_at_body_sites_other_than_nose/6960/







• Dr. Cluzet: These findings contribute to the growing knowledge that MRSA colonization among household members, household items and even pets are sources of MRSA transmission and may contribute to inability to clear MRSA colonization, increasing the risk for recurrent infections. A recent study showed that decolonization of the whole household led to fewer recurrent infections in children. The effect of total household decolonization needs to be studied in a broader population including adults as well as children in order to confirm these findings and recommend this strategy more broadly.

• Additionally, the reasons for association between treatment with clindamycin and more rapid clearance of colonization remain unclear, but it may argue for preferential use of clindamycin in those diagnosed with MRSA SSTI to shorten the duration of colonization.



http://medicalresearch.com/author-interviews/mrsa_strains_can_affect_humans_and_livestock/8779/







• Dr. Cluzet: I think the most important contribution of this study is the questions it raises for future research. We should examine the risk factors for recurrent colonization and those for recurrent infection in order to better identify those subjects and to implement strategies to decrease the burden of infection. Similarly, we would like to identify those factors that are associated with persistent colonization (i.e. the 20% of subjects that never cleared colonization), as these are potentially the patients at highest risk of recurrent infections and so we could focus efforts on this subgroup. Also, as I discussed earlier, we need to study the effect of total household decolonization on duration of colonization and recurrent infections in adults and children, as well as the reasons for clindamycin’s association with shorter duration of MRSA colonization and its role in decolonization protocols.

• Citation:

• Duration of Colonization and Determinants of Earlier Clearance of Colonization with Methicillin-Resistant Staphylococcus aureus

Valerie C. Cluzet,et al

• Clin Infect Dis. first published online February 3, 2015 doi:10.1093/cid/civ075



http://medicalresearch.com/pediatrics/mrsa-number-infections-still-increasing-children/1994/

http://cid.oxfordjournals.org/citmgr?gca=cid;civ075v1

http://cid.oxfordjournals.org/citmgr?gca=cid;civ075v1



Fusobacterium Pharyngitis May Be As Serious As Strep ThroatMedicalResearch.com Interview with:

Robert M Centor, MD, MACP Chair ACP Board of RegentsRegional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801

Professor, General Internal Medicine UAB Birmingham, AL 35294-3407


• Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis. This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess). The organism also causes around 80% of the Lemierre Syndrome. We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis. The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis.


Dr. Centor: In our college health population, Fusobacterium necrophorum caused more pharyngitis then did group A strep. Clinically, the patients with Fusobacterium necrophorumpharyngitis had the same signs and symptoms as the strep pharyngitis patients. This suggests that the previously develop Centor score identifies bacterial pharyngitis, and not just strep pharyngitis.


http://medicalresearch.com/infections/fusobacterium-pharyngitis-may-be-as-serious-as-strep-throat/11545/

http://en.wikipedia.org/wiki/Lemierre's_syndrome

http://www.mdcalc.com/modified-centor-score-for-strep-pharyngitis/



Fusobacterium Pharyngitis May Be As Serious As Strep ThroatMedicalResearch.com Interview with:

Robert M Centor, MD, MACP Chair ACP Board of RegentsRegional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801

Professor, General Internal Medicine UAB Birmingham, AL 35294-3407


• Dr. Centor: We believe that we should consider Fusobacterium pharyngitis as seriously as strep pharyngitis. Patients should understand that if they get no antibiotics that they should be aware of the following warning signs (or red flags) – worsening symptoms (routine pharyngitis should improve quickly, over 2-3 days), night sweats or rigors (these suggest bacteremia), or unilateral neck swelling. Given the sensitivities of strep and Fusobacterium, if the clinician plans to give empiric antibiotics, he/she should use penicillin (or a penicillin derivative) and not use a macrolide.


• Dr. Centor: We need a series of confirmatory studies. We need to develop a point-of-care test for Fusobacterium necrophorum.

• Citation:

• The Clinical Presentation of Fusobacterium-Positive and Streptococcal Positive Pharyngitis in a University Health Clinic

• Robert M. Centor, MD; T. Prescott Atkinson, MD, PhD; Amy E. Ratliff, MLS; Li Xiao, PhD; Donna M. Crabb, MT (ASCP); Carlos A. Estrada, MD, MS; Michael B. Faircloth, MD; Lisa Oestreich, DO; Jeremy Hatchett, MD; Walid Khalife, PhD; and Ken B. Waites, MD

• Ann Intern Med. 2015;162(4):241-247. doi:10.7326/M14-1305



http://annals.org/article.aspx?articleid=2118593http://





Physical Activity For Heart Health Doesn’t Have To Be A BurdenMedicalResearch.com Interview with:

Dr Miranda Armstrong M.Phil.Physical Activity Epidemiologist

Cancer Epidemiology Unit University of Oxford Oxford, UK


Dr. Armstrong: Physical activity has generally been associated with reduced risk of heart disease. However, there is limited evidence on the associations between the frequency and durations of various activities with stroke and blood clots, especially in middle-aged women.

• This is a very large study of 1.1 million middle-aged women, which confirms the benefits of moderate activity for reducing the risk of heart disease and stroke. Further to this, it shows that benefits may be more wide ranging than previously thought as the risk of blood clots was also lower in women reporting moderate activity when compared to inactive women. We found little evidence to suggest that activity more frequent than a few times per week provided further benefits in relation to these diseases.


• Dr. Armstrong: Becoming active to improve heart health does not have to be a burden for inactive middle-aged women. In our study, moderate levels of activity were associated with lower risks than inactivity, and more frequent activity did not reduce risks further. Activities may not necessarily need to be sports or exercise at the gym, because even everyday activities such as gardening and walking were associated with significantly lower risks in these women.


http://medicalresearch.com/exercise-fitness/physical-activity-for-heart-health-doesnt-have-to-be-a-burden/11585/

http://medicalresearch.com/exercise-fitness/increasing_physical_activity_in_a_population_required_changing_physical_environment/8734/

http://medicalresearch.com/exercise-fitness/primary-care-intervention-program-increased-physical-activity-in-women/11532/



Physical Activity For Heart Health Doesn’t Have To Be A BurdenMedicalResearch.com Interview with:

Dr Miranda Armstrong M.Phil.Physical Activity Epidemiologist

Cancer Epidemiology Unit University of Oxford Oxford, UK


• Dr. Armstrong: I lead a program of work on physical activity and health based in the Million Women Study, a large study of UK women coordinated from the University of Oxford. One of our next projects will be to investigate associations between physical activity levels and mortality from these diseases.

• Citation:

• Frequent Physical Activity May not Reduce Vascular Disease Risk as Much as Moderate Activity: Large Prospective Study of UK Women Miranda E.G. Armstrong, Jane Green, Gillian K. Reeves, Valerie Beral, and Benjamin J. Cairns

• Circulation. 2015;CIRCULATIONAHA.114.010296published online before print February 16 2015, doi:10.1161/CIRCULATIONAHA.114.0102



http://medicalresearch.com/exercise-fitness/physical-activity-critical-global-world-health/10802/



High Fat-Free Mass Linked To Lower Mortality In MenMedicalResearch.com Interview with:

Dr. med. Laurence Genton, FMH Médecine InterneMédecin adjointe agrégée, chargée de cours Nutrition Clinique

Hôpitaux universitaires de Genève Genève


Response: Several studies have shown that body mass index is linked to mortality through a U- or J-curve, i.e. that a low and maybe a high body mass index are related to a higher risk of mortality in elderly people. However, body mass index consists of fat mass and fat-free mass, and the former studies cannot differentiate the impact of these body compartments. However, this differentiation may be important to guide our public health care strategies. For instance, fat and fat-free mass can both be reduced by hypocaloric diet and endurance exercise, while fat-free mass can be increased with adequate calorie and protein intakes, resistance exercise and anabolic treatments. Thus, this study aimed at evaluating the impact of fat mass and fat-free mass on mortality.

• We found that body mass index and body composition did not predict mortality in older women. However, a high fat-free mass was associated with a lower risk of mortality in men, even when adjusting for body mass index.


• Response: In older people, a body mass index in the overweight or obese range is not a predictor of mortality. Thus, dieting in older overweight or obese people may not be beneficial. However, men should aim at having the highest muscle mass possible, as a high fat-free mass has been associated with lower mortality. This could be achieved by resistance exercises, adequate calorie and protein intakes and hormonal therapies.


http://medicalresearch.com/weight-research/high-fat-free-mass-linked-to-lower-mortality-in-men/11758/

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

http://medicalresearch.com/weight-research/healthy-obese-adults-tend-to-become-unhealthy-over-time/10349/



High Fat-Free Mass Linked To Lower Mortality In MenMedicalResearch.com Interview with:

Dr. med. Laurence Genton, FMH Médecine InterneMédecin adjointe agrégée, chargée de cours Nutrition Clinique

Hôpitaux universitaires de Genève Genève


• Response: Future research should focus on the impact of interventions improving fat-free mass on mortality, in older people, especially in older men. Furthermore, it would be interesting to evaluate the impact of fat-free mass on mortality, when adjusting for other components of physical fitness, as muscle strength and cardiorespiratory fitness. This would allow to determine which factor is the most important with regard to outcome.

• Citation:

• Body composition and all-cause mortality in subjects older than 65 yChristophe E Graf, Véronique L Karsegard, Adrian Spoerri, Anne-Marie Makhlouf, Sylvain Ho, François R Herrmann, and Laurence Genton

• Am J Clin Nutr 2015 ajcn.102566; First published online February 11, 2015. doi:10.3945/ajcn.114.102566



http://medicalresearch.com/pediatrics/aerobic_and_or_resistance_exercise_improves_fitness_and_body_composition/8782/





Varenicline – Chantix – Helped More Smokers Quit GraduallyMedicalResearch.com Interview with:

Jon Ebbert, M.D.Associate director for research

Mayo Clinic Nicotine Dependence Center


Dr. Ebbert: Some cigarette smokers prefer to reduce the number cigarettes that they smoke before quitting smoking completely. Previous studies have evaluated the use of nicotine replacement therapy and one smaller study looked at varenicline to help smokers quit through smoking reduction. We wanted to conduct a larger study with varenicline using a longer duration of treatment.

• We enrolled cigarette smokers who had no intention of quitting in the next month but who were willing to reduce the number of cigarettes they smoked while working toward a quit attempt in the next 3 months.


• Dr. Ebbert: We found that participants receiving varenicline were over 4 times more likely to quit than participants receiving placebo at 6 months and over 2 times more likely to quit than participants receiving a placebo at 12 months. No differences were observed in medication discontinuation rates or serious adverse events between varenicline and placebo.

• This study is important because this opens the door to treatment for approximately 14 million smokers who have no intention of quitting in the next 30 days but are willing to reduce their smoking rate while working toward a quit attempt. In the past, these smokers may have not received medication therapy.


http://medicalresearch.com/tobacco-research/smoking/chantix-helped-more-smokers-quite-gradually/11680/

http://medicalresearch.com/tobacco-research/smoking/combination-services-have-higher-smoking-cessation-rates/10473/

http://medicalresearch.com/tobacco-research/smoking/smoking_cessation_odds_improved_by_combining_chantix_with_nicotine_patches/6280/



Varenicline – Chantix – Helped More Smokers Quit GraduallyMedicalResearch.com Interview with:

Jon Ebbert, M.D.Associate director for research

Mayo Clinic Nicotine Dependence Center


• Dr. Ebbert: The next question to answer is how best to disseminate and implement this this information into clinical practice. Clinicians can use the behavioral techniques for reduction that we provided in the report of this study, but some questions remain as to what are the ideal behavioral strategies for helping smokers quit through gradual reduction.

• Citation:

• Effect of Varenicline on Smoking Cessation Through Smoking Reduction: A Randomized Clinical Trial

• Jon O. Ebbert MD, MSc, John R. Hughes MD, Robert J. West PhD, Stephen I. Rennard MD, Cristina Russ MD, Thomas D. McRae MD, Joan Treadow RN, BSN, Ching-Ray Yu PhD, Michael P. Dutro PharmD, Peter W. Park PhD

• JAMA. 2015;313(7):687-694. doi:10.1001/jama.2015.280



http://medicalresearch.com/tobacco-research/smoking/tips_from_former_smokers_campaign_proves_cost_effective/9800/

http://jama.jamanetwork.com/article.aspx?articleid=2110968





Could There Be A Salivary Diagnostic Test For Autism?MedicalResearch.com Interview with:

Alisa G. Woods, Ph.D., MS Assistant ProfessorBiochemistry & Proteomics Group

Department of Chemistry & Biomolecular Science Clarkson University, Potsdam, NY, 13699


Dr. Woods: Objective assessments for autism are greatly needed in order to understand autism cause and also to diagnose autism. Currently autism is diagnosed based on behavior, despite theories that autism may have a biological cause. We sought to develop a non-invasive biological test for autism, using saliva and mass spectrometry-based proteomics. We found nine statistically significant proteins that were elevated in the saliva of children with autism relative to typically developing controls and three proteins that were significantly decreased or absent.


• Dr. Woods: These results are very promising, but certainly they need to be validated in a larger scale study. Ultimately, these data could form the basis for an autism diagnostic test or help us to understand the causes of autism.


http://medicalresearch.com/mental-health-research/autism/could-there-be-a-salivary-diagnostic-test-for-autism/11768/

http://medicalresearch.com/mental-health-research/autism/brain-study-reveals-emotional-instability-foci-in-autism/11022/

http://medicalresearch.com/mental-health-research/autism/pediatric-office-visits-may-miss-autism-diagnosis/10610/



Could There Be A Salivary Diagnostic Test For Autism?MedicalResearch.com Interview with:

Alisa G. Woods, Ph.D., MS Assistant ProfessorBiochemistry & Proteomics Group

Department of Chemistry & Biomolecular Science Clarkson University, Potsdam, NY, 13699


• Dr. Woods: We need to validate these results in a larger group of individuals, and also to compare our biochemical results with gold-standard autism diagnostic tests, such as the ADOS (autism diagnostic observation schedule).

• Citation:

• A Pilot Proteomic Analysis of Salivary Biomarkers in Autism Spectrum Disorders

• Ngounou Wetie AG1, Wormwood KL, Russell S, Ryan JP, Darie CC, Woods AG.Autism Res. 2015 Jan 27. doi: 10.1002/aur.1450. [Epub ahead of print]



http://medicalresearch.com/genetic-research/parental_profiles_modify_genetic_predisposition_to_cognitive_performance/9601/



Nanoparticle Pollution Worse At Red LightsMedicalResearch.com Interview with:

Dr. Prashant Kumar PhD (Cantab), MTech, BEng, FHEA, FCPS, FCCT, CEng(IEI), MIEnvSc, MIAQM, MIAAPCSenior Lecturer in Wind Engineering

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

Dr. Kumar: Pollution is disproportionately spread in urban areas due to scattered mobile and stationary sources. Exhaust emissions from vehicles are one of the major sources of air pollution in urban areas. When vehicles stop at red lights, they go through different driving cycles such as idling, acceleration and deceleration. At the same time, a number of other vehicles are also queuing at red lights, emitting further emissions – these emissions take more time to disperse, especially in built-up areas, and end up accumulating in the air at traffic lights. In our study, we found that because drivers were decelerating and stopping at lights, then revving up to move quickly when lights go green, peak particle concentration was 29 times higher than that during free flowing traffic conditions. We also found that while drivers spent just two per cent of their journey time passing through traffic intersections managed by lights, that short duration contributes to about 25 per cent of their total exposure to these harmful particles.


http://medicalresearch.com/author-interviews/nanoparticle-pollution-worse-at-red-lights/11766/

http://medicalresearch.com/cancer-_-oncology/lung-cancer/lung-cancer-incidence-and-air-pollution/1283/






• Dr. Kumar: Vehicles emit a number of gaseous pollutants, as well as particles in various sizes. All these pollutants are known to cause damage to human health, including cardiovascular and respiratory diseases. In this work, we studied nanoparticles, which are particles below 100 nm – these are known to cause more harm than particles of larger sizes. These particles have the potential for lung deposition and translocation to other parts of the body. At traffic lights, we found that when we closed the windows and switched off the fan, this gave us the lowest exposure. When the windows were closed but fan was on, the exposure was at its highest. This is due to the fact that the air outside the vehicle at red lights is generally much more polluted compared with the air inside the car. Switching on the fan sucks the dirty air from outside to the inside the vehicle, and the air inside takes some time to dilute or escape out of the vehicle, resulting in accumulation of pollutants inside. In light of this, if it is not always possible to change your route to avoid these intersections, the best ways to limit your exposure is to keep windows shut, fans off and try to increase the distance between you and the car in front where possible. If walking on foot, pedestrians could perhaps consider changing routes and see whether there might be other paths less dependent on traffic light crossings. As far as clinicians are concerned, if they could bring awareness to patients during their sessions, this will assist in understanding the issue of high pollution exposure and allow patients to consider simple changes to limit their exposure.



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






• Dr. Kumar: Our study presents new information about the effect of dynamic driving on nanoparticle concentrations and exposure at the traffic lights. This provides a sound basis for future studies which could cover a diverse range of traffic intersections in different geographical settings, so that a database of exposure profiles in different settings could be developed. This could assist in estimating the contribution of exposure at traffic lights towards the daily commuting exposure in diverse city environments. Furthermore, toxicological studies could provide information on the type of serious and less-serious health issues, while the better dispersion models to apportion these high pollution zones are needed to mitigate and control the exposure of city dwellers at hotspot locations.

• Citation:

• Goel, A., Kumar, P., 2015. Characterisation of nanoparticle emissions and exposure at traffic intersections through fast-response mobile and sequential measurements. Atmospheric Environment, doi: 10.1016/j.atmosenv.2015.02.002. [Online Link] http://dx.doi.org/10.1016/j.atmosenv.2015.02.002



http://medicalresearch.com/heart-disease/nanoparticle-exposure-may-increase-atherosclerosis-and-heart-disease-risk/10671/



medicalresearch.com: medical research exclusive interviews february 17 2015

Health & Medicine