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MedicalResearch.com - Medical Research Interviews Week in Review

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Medical Research news and exclusive interviews with medical researchers from major and specialty medical journals on MedicalResearch.com.

Medical Research news and exclusive interviews with medical researchers from major and specialty medical journals on MedicalResearch.com.

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  • 1. MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD info@medicalresearch.com April 12 2014 For Informational Purposes Only: Not for Specific Medical Advice.
  • 2. Medical Disclaimer | Terms and Conditions • The contents of the MedicalResearch.com Site, such as text, graphics, images, and other material contained on the Hemodialysis.com Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Hemodialysis.com Site! • If you think you may have a medical emergency, call your doctor or 911 immediately. MedicalResearch.com does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by MedicalResearch.com or other Eminent Domains Inc (EDI) websites, EDI employees, others appearing on the Site at the invitation of MedicalResearch.com or EDI, or other visitors to the Site is solely at your own risk. • The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an "as is" basis. Read more interviews on MedicalResearch.com
  • 3. Frequent PVCs: Catheter Ablation Improved Left Ventricular Function MedicalResearch.com Interview with: Professor Ben He Department of Cardiology Renji Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai China. • MedicalResearch.com: What are the main findings of the study? • Professor He: Elimination of PVCs by catheter ablation can improve LVEF and reverse LV dimensions. The pooled mean change in LVEF post-ablation meets the prespecified borderline (5%) and can be considered clinically effective. Beneficial effects of ablation of frequent PVCs in improving LV function are more significant in patients with reduced LVEF at baseline. • MedicalResearch.com: What should clinicians and patients take away from your report? • Professor He: PVC-associated with LV dysfunction represents a potentially reversible syndrome that deserved catheter ablation although the long-term successful rate needs further improved. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Professor He: Further studies are needed to target which group of patients would benefit the most in cardiac function improvement from frequent PVC ablation. • Citation: • Beneficial effects of catheter ablation of frequent premature ventricular complexes on left ventricular function • Minhua Zang, Tuo Zhang, Jialiang Mao, Shengheng Zhou, Ben He • Heart heartjnl-2013-305175Published Online First: 26 March 2014 doi:10.1136/heartjnl-2013- 305175 Read the rest of the interview on MedicalResearch.com
  • 4. Diabetes: How Long from Onset to Retinopathy? MedicalResearch.com Interview with: Massimo Porta, MD PhD Professor of Medicine Head, Unit of Internal Medicine 1 Department of Medical Sciences University of Turin • MedicalResearch.com: What are the main findings of the study? • Dr. Porta: Type 2 diabetes has a slow, insidious onset and may remain undiagnosed for several years, during which complications may arise and progress. As a result, many patients already have retinopathy at the time a clinical diagnosis is finally made. Previous attempts at estimating the duration of this period of “hidden” diabetes relied upon extrapolations of a linear correlation between known duration of diabetes and prevalence of retinopathy. • This led to overestimates, because: • a) the best fitting correlation may not be linear, b) series included insulin treated patients, who might have late-onset type 1 diabetes, c) patients with any mild retinopathy were included whereas we now know that up to 10% of non diabetic individuals may have minimal retinal signs. • By taking these variables into account, ie including only patients not on insulin and with moderate or more severe retinopathy and applying different mathematical models, we ended up with an estimated duration preceding diagnosis of type 2 diabetes of 4-6 years, against longer than 13 years using “standard” criteria. MedicalResearch.com: Were any of the findings unexpected? • Dr. Porta: Whereas we expected that the above corrections would somehow modify the estimated length of “hidden” diabetes, the magnitude of the above difference was somehow unexpected. Read the rest of the interview on MedicalResearch.com
  • 5. Diabetes: How Long from Onset to Retinopathy? MedicalResearch.com Interview with: Massimo Porta, MD PhD Professor of Medicine Head, Unit of Internal Medicine 1 Department of Medical Sciences University of Turin • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Porta: Perhaps reassuring is the suggestion that diabetes may be overlooked less that feared from previous reports. However, that is no reason to be off guard. A suggestion that comes out of this study is that, whatever disturbance of carbohydrate metabolism leads to developing retinopathy, it may not coincide with current criteria for diagnosis of type 2 diabetes. Part of the years preceding diagnosis might be spent in what we consider today a prediabetic state (impaired fasting glucose, impaired glucose tolerance, or others yet to be defined). • MedicalResearch.com:What recommendations do you have for future research as a result of this study? • Dr. Porta: One needs to better understand if a threshold really exists above which the risk starts to arise to develop not just isolated mild retinal lesions but proper diabetic retinopathy. • Citation: • Estimating the Delay Between Onset and Diagnosis of Type 2 Diabetes From the Time Course of Retinopathy Prevalence • Massimo Porta, Giulia Curletto, Dario Cipullo, Roberta Rigault de la Longrais, Marina Trento, Pietro Passera, Anna Viola Taulaigo, Sabrina Di Miceli, Antonella Cenci, Paola Dalmasso, and Franco Cavallo • Diabetes Care published ahead of print April 4, 2014, doi:10.2337/dc13-2101 1935-5548 Read the rest of the interview on MedicalResearch.com
  • 6. Acute Kidney Injury Risk From PCI Surgery Lower With Radial Approach MedicalResearch.com Interview with: Judith Kooiman Department of Thrombosis and Hemostasis Leiden University Medical Center Leiden, The Netherlands • MedicalResearch.com: What are the main findings of the study? • Dr. Kooiman: The main finding of our study is that trans radial PCI (TRI) is associated with a significantly lower risk of AKI compared with trans femoral PCI (TFI), after adjustment for confounding factors. MedicalResearch.com: Were any of the findings unexpected? • Dr. Kooiman: It is know from previous studies that major bleeding post PCI is associated with AKI. Major bleeding occurred more frequently in our cohort in patients undergoing TRI compared with TFI. We hypothesized that the increased risk of AKI post PCI could be mediated by the increased risk of major bleeding in the TFI group. However, our study results indicated that the increased risk of AKI post TRI was not influenced by the higher bleeding rates in this patient group. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Kooiman: Previous randomized trials have shown a benefit of TRI over TFI in terms of a lower risk of vascular (bleeding) complications. Our observational study adds to the already known benefits of TRI over TFI in terms of a lower AKI risk. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Kooiman: Over the last decade, several randomized controlled trials comparing TRI with TFI have been performed studying other outcomes such as vascular (bleeding) complications post PCI. It would be very interesting to look at the data from those studies to see whether they can confirm our finding of a lower AKI risk after TRI compared with TFI. • Citation: • Risk of Acute Kidney Injury After Percutaneous Coronary Interventions Using Radial Versus Femoral Vascular Access: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium • Judith Kooiman, Milan Seth, Simon Dixon, David Wohns, Thomas LaLonde, Sunil V Rao, and Hitinder S. Gurm • Circ Cardiovasc Interv. 2014;CIRCINTERVENTIONS.113.000778published online before print February 25 2014, doi:10.1161/CIRCINTERVENTIONS.113.000778 Read the rest of the interview on MedicalResearch.com
  • 7. Non-Small-Cell Lung Cancer: New Agent Effective Against EGFR TKI Resistant Cancer MedicalResearch.com Interview with: Dr. Heather Wakalee MD Associate Professor of Medicine (Oncology) Stanford University Medical Center • MedicalResearch.com: What are the main findings of the study? • Dr. Wakalee: CO-1686, with the new hydrobromide formulation, has been active at multiple dose levels (500, 750 or 1000 mg orally twice daily). The response rate in patients with EGFR mutant (non-small-cell Lung Cancer) NSCLC that has progressed after therapy with EGFR TKI, and has centrally confirmed T790M, is 64% per RECIST. The majority of responses are ongoing at the time of this report. The drug has been overall very well tolerated. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Wakalee: We are excited to see the high rate of response in patients with T790M. Unexpectedly we noted a toxicity of hyperglycemia in approximately a quarter of patients. The hyperglycemia was unexpected as it was not seen in animal models and work is being done to understand the mechanism of this toxicity. Now that we are aware of this issue it has been relatively easy to monitor and manage with oral hypoglycemic agents. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Wakalee: CO-1686 is an exciting compound with demonstrated activity in EGFR mutant non-small-cell Lung Cancer (NSCLC )with T790M and trials are ongoing to clearly establish the optimal dose and establish duration of response. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Wakalee: The TIGER trials in development will explore the drug as an option for patients whose tumor has progressed after first line EGFR TKI therapy and as a first line agent (phase III trial versus first line erlotinib) and will further explore different methods to test for T790M. • Citation: • Citation: • First-in-human evaluation of CO-1686, an irreversible, highly selective tyrosne kinase inhibitor of mutations of EGFR (activating and T790M). • Date: 27 Mar 2014 ELCC 2014 News: • Abstract 93O: First-in-human evaluation of CO-1686, an irreversible, highly selective tyrosine kinase inhibitor of mutations of EGFR (activating and T790M). Read the rest of the interview on MedicalResearch.com
  • 8. How Does Cardiorespiratory Fitness Affect Cognitive Function in Middle Age? MedicalResearch.com Interview with: David R. Jacobs Jr, PhD Divisions of Epidemiology School of Public Health University of Minnesota, Minneapolis • MedicalResearch.com: What are the main findings of this study? • Dr. Jacobs: Vigorous activity is what is well understood to improve cardiorespiratory fitness. People with high fitness are likely (based on this study) to • a) Lose fitness more slowly as they age and • b) To maintain sharper “thinking skills” into late middle age. • I think the message of this study is primarily for the people in the low to mid range of fitness in young adulthood. Thus, of more importance to the general population, if the people with low to moderate fitness simply do things, be engaged in family, job, community, move around, they would be able to do better on a treadmill test such as we used. Because those who lost less fitness over average age 25 to average age 45, people who start moving around are likely to reap the benefit of less loss of thinking skills by average age 50. Read the rest of the interview on MedicalResearch.com
  • 9. How Does Cardiorespiratory Fitness Affect Cognitive Function in Middle Age? MedicalResearch.com Interview with: David R. Jacobs Jr, PhD Divisions of Epidemiology School of Public Health University of Minnesota, Minneapolis • MedicalResearch.com: How does cardiovascular fitness actually help to preserve memory/thinking skills? • Dr. Jacobs: How brain function, “thinking skills” work is not well understood. One point is that the brain requires lots of oxygen which is delivered by blood vessels. Therefore behaviors and physical aspects that are good for the blood vessels (the vasculature) are also good for the brain. There are probably many other ways in which fitness and maintaining an active life are beneficial. One is tuning up mitochondria, which are central in maintaining energy turnaround in the body. From the perspective of individual and societal decision making, the mechanisms are less important, however; probably people who have poorer thinking skills in middle age have lesser jobs and less income, for example. The empirical finding is very helpful that thinking skills are higher in people who had better fitness in youth and who maintained for many years. • MedicalResearch.com: Why is the CARDIA study so important to people (like runners) who try to main high fitness? • Dr. Jacobs: The CARDIA study is important to everyone because it shows that association of “better thinking skills” in middle age with higher fitness across the range of fitness: from moderate fitness is better than low fitness and high fitness is better than moderate fitness. People should use their bodies, they should move their bodies. For those capable of high intensity activity, such as running or jogging, those are good activities. More generally, people should use their bodies to participate in their families, jobs, and community. Using your physical capacities keeps you thinner and promotes other activity associated with living. Read the rest of the interview on MedicalResearch.com
  • 10. How Does Cardiorespiratory Fitness Affect Cognitive Function in Middle Age? MedicalResearch.com Interview with: David R. Jacobs Jr, PhD Divisions of Epidemiology School of Public Health University of Minnesota, Minneapolis • MedicalResearch.com: How might improved cardiorespiratory fitness as a young man benefit verbal memory and other brain functions 25 years down the road? • Dr. Jacobs: We don’t know how it works, or if changes in fitness actually help (this would be subject of intervention studies, whereas our study is observational). Much of cognitive loss is mediated by vascular problems, so effects of fitness or on activity that leads to better fitness could operate through the same pathways as any cardiovascular disease risk factor works. The treadmill test we did involves many aspects of life, from heart and lung fitness to joint health to motivation and usual participation in activity. Even simple engagement with family and community can improve fitness, for example by not smoking, by maintaining lower body fatness, and by having a positive attitude towards moving your body. My guess is that better fitness incorporates all of these aspects of engagement and health. • MedicalResearch.com: What would your advice be to younger men? (How much cardio is optimal? And might certain types–swimming or running–be better than others?) • Dr. Jacobs: My advice to young men is to be active and engaged in family, community and life in general. Vigorous activity is well known to influence fitness. The “use it or lose it” principle applies in young men as in everyone; fitness is harder to recover the older one gets. I do not have advice about specific activities; any vigorous activity will do, and can be tailored to the life of each young man. More deeply, though, not smoking and being engaged with family and community will get a young man moving, and likely have a positive influence on fitness, even if no vigorous activities are done. Read the rest of the interview on MedicalResearch.com
  • 11. How Does Cardiorespiratory Fitness Affect Cognitive Function in Middle Age? MedicalResearch.com Interview with: David R. Jacobs Jr, PhD Divisions of Epidemiology School of Public Health University of Minnesota, Minneapolis • MedicalResearch.com: Do you or your colleagues have any plans for future research, given your new findings? • Dr. Jacobs: CARDIA has several unique features among studies. It is a life course study, first examining people at age 18-30 and about to enter its 9th detailed examination at age 48-60, 30 years later. We can link relative youth to late middle age. The hope is to carry this through old age, which will give a glimpse of how youth affects old age. We have already published several studies showing relationships of youth lifestyle and physical status with cognitive function in late middle age; more papers are in the pipeline. Funding permitting (which depends on the funding for the National Institutes of Health), we will continue study of cognitive function. • Citation: • Cardiorespiratory fitness and cognitive function in middle age The CARDIA Study • Na Zhu, MD, MPH, David R. Jacobs Jr, PhD, Pamela J. Schreiner, PhD, Kristine Yaffe, MD, Nick Bryan, MD, PhD, Lenore J. Launer, PhD, Rachel A. Whitmer, PhD, Stephen Sidney, MD, MPH, Ellen Demerath, PhD, William Thomas, PhD, Claude Bouchard, PhD, Ka He, MD, ScD, Jared Reis, PhD and Barbara Sternfeld, PhD • Published online before print April 2, 2014, doi: 10.1212/WNL.0000000000000310 Read the rest of the interview on MedicalResearch.com
  • 12. Brain Mapping May Allow Earlier Detection of Brain Abnormalities MedicalResearch.com Interview with: Alex Leow, MD PhD Psychiatric Institute Chicago, IL 60612 and Tony J. Simon, PhD University of California, Davis MIND Institute Sacramento, CA 95817 • MedicalResearch.com: What are the main findings of the study? • Answer: Fragile X syndrome (FXS) is the most common inherited cause of intellectual disabilities and the most prevalent known single-gene cause of autism in males. The fragile X mental retardation 1 gene (FMR1) can be mutated with expanded numbers of CGG trinucleotide repeats in the 5’ untranslated region on the Xq27.3 site of the X chromosome. Normally, unaffected individuals have fewer than 45 CGG repeats in FMR1. When the size of the CGG repeat exceeds 200 FMR1 is silenced and the mutation is categorized as full, generating the FXS phenotype. If the expansion is between 55–200 repeats, then the individual is generally classified as a fragile X premutation carrier (fXPC). An estimated 40% of male and 8-16% of female premutation carriers later develop Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS), which is a late-onset (usually 50-70 years old) neurodegenerative disorder. • We recruited 46 neurologically symptomless young to middle aged carriers of the FMR1 gene mutation. They were age and gender matched with 42 unaffected control individuals without the gene mutation. Both groups were evaluated by cognitive testing as well as novel neuroimaging techniques termed “brain connectomics,” based on diffusion tensor imaging (DTI) whole-brain tractography. A connectome is a comprehensive map, like a wiring diagram, of neural connections in the brain. Our study is the first-ever connectome study to compare fXPCs and controls. Read the rest of the interview on MedicalResearch.com
  • 13. Brain Mapping May Allow Earlier Detection of Brain Abnormalities MedicalResearch.com Interview with: Alex Leow, MD PhD Psychiatric Institute Chicago, IL 60612 and Tony J. Simon, PhD University of California, Davis MIND Institute Sacramento, CA 95817 In short, brain connectomics enable scientists for the first time to study the global organizational properties of the human brain by applying cutting edge computational techniques, based on graph theory, to these comprehensive maps of neural connections (i.e., the brain graphs). Our main finding was that, in neurologically symptomless male carriers we detected a correlation between brain graphs’ efficiency in processing information and the number of CGG repeats in the mutated region of FMR1 (we estimated that each additional CGG repeat that in these males represents an effective increase of ~1.5 years of “brain aging”). The correlation may prove to be an effective marker of early brain aging in otherwise neurologically symptomless premutation carriers. The study also further confirmed previous findings of smaller brain stem volumes in male fXPCS than in male controls. Read the rest of the interview on MedicalResearch.com
  • 14. Brain Mapping May Allow Earlier Detection of Brain Abnormalities MedicalResearch.com Interview with: Alex Leow, MD PhD Psychiatric Institute Chicago, IL 60612 and Tony J. Simon, PhD University of California, Davis MIND Institute Sacramento, CA 95817 • MedicalResearch.com: Were any of the findings unexpected? • Answer: Unexpectedly, among the female participants, we detected volume differences in specific brain regions, with the premutation carriers having more tissue in those regions than controls. These areas were the superior temporal gyrus, the superior parietal gyrus, and the posterior cingulate in the right hemisphere. Since our behavioral testing also found subtle but significant impairments in some tasks involving processing information about space and time in these women, our novel findings suggest the presence of compensatory mechanisms in neurologically symptomless female but not similar male carriers of the gene mutation. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Our findings suggest that the brain changes of premutation carriers at risk for FXTAS may begin to develop about two decades before the symptoms occur. While we have not been able to confirm this by following those individuals with the greatest brain changes for later neurological symptoms, it might be the case that identifying these brain changes in premutation carriers is important because they could turn out to be “biomarkers” or indicators that might help to identify which individuals are at least or greatest risk for later developing FXTAS. Read the rest of the interview on MedicalResearch.com
  • 15. Brain Mapping May Allow Earlier Detection of Brain Abnormalities MedicalResearch.com Interview with: Alex Leow, MD PhD Psychiatric Institute Chicago, IL 60612 and Tony J. Simon, PhD University of California, Davis MIND Institute Sacramento, CA 95817 • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Since researchers are now investigating cutting edge medical interventions that may in near future lead to treatment options for such individuals, combining cognitive and imaging analyses in children and adults who are premutation carriers might indeed point out markers of risk and protection. With this new information, more carefully targeted cognitive functioning and imaging assessments need to be carried out based on what we learned. Then, exploring whether or not these can act as targets for behavioral and pharmacological interventions would allow researchers to determine whether identifying changes in childhood or young adulthood could help reduce or even eliminate subtle cognitive and later neurological and psychiatric problems. • Citation: • Altered structural brain connectome in young adult fragile X premutation carriers • Leow A1, Harvey D, Goodrich-Hunsaker NJ, Gadelkarim J, Kumar A, Zhan L, Rivera SM, Simon TJ. Hum Brain Mapp. 2014 Feb 27. doi: 10.1002/hbm.22491. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 16. Designing A Neural Prosthesis Using Light Activated Nerve Stem Cells MedicalResearch.com Interview with: Dr. Ivo Lieberam Lecturer, MRC Centre for Developmental Neurobiology King’s College London New Hunt’s House, Guy’s Hospital Campus London, SE1 1UL UK • MedicalResearch.com: What are the main findings of the study? • Dr. Lieberam: In this study, which my group undertook in collaboration with Linda Greensmith’s group at University College London, we found that we could artificially control muscle activity using transplanted stem cell-derived nerve cells as an interface between an opto-electronic pacemaker and paralysed muscle in mice. The nerve cells were equipped with a molecular photosensor, so that they could be activated by light. We think that long- term, this technology may be used in neural prosthesis designed to re-establish relatively simple motor functions, such as breathing or swallowing, in patients suffering from spinal cord injury or neuromuscular diseases such as Motor Neuron Disease. MedicalResearch.com: Were any of the findings unexpected? • Dr. Lieberam: While we had to solve a number of technical problems along the way, we knew from the start that light-activation of grafted nerve cells, and muscle control through the graft, might be possible from two earlier pioneering studies: Rob Brownstone’s group at Dalhousie University/Canada had previously shown that stem cell-derived nerve cells can survive in peripheral nerves in mice and connect to muscle, and Scott Delp’s group (Stanford University/USA) had used a light-activated genetic probe to control muscle contractions in transgenic mice. In our study, we merged these two strands of research, and to our delight, it turned out that transplanted stem cell-derived nerve cells can be activated with the photosensor, and we were able to control fine-tuned rhythmic muscle contractions via the neural graft. Read the rest of the interview on MedicalResearch.com
  • 17. Designing A Neural Prosthesis Using Light Activated Nerve Stem Cells MedicalResearch.com Interview with: Dr. Ivo Lieberam Lecturer, MRC Centre for Developmental Neurobiology King’s College London New Hunt’s House, Guy’s Hospital Campus London, SE1 1UL UK • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Lieberam: We think that our approach holds a lot of promise, and we are keen to move on from the proof-of-principle stage towards pre-clinical trials. However, we would like to caution clinicians and patients that it may take several years and a lot of work until we can start to apply this technology to humans. In addition, the muscle pacemaker device we are developing will initially be suitable only for restoring basic motor functions, not complex ones like walking. The reason for this is that while walking may seem like an every-day activity, it is in fact quite complicated: In each leg alone, about 40 muscles need to be activated in a defined sequence during each step cycle, and constant corrections based on sensory feedback are required. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Lieberam: We believe that over the next two decades, light-gated genetic switches, such as the one we use to activate nerve cells connected to muscle, may evolve from a research tool in basic neuroscience into molecular therapeutics which will be used to restore defective neural circuits in humans. The medical applications of these so-called ‘optogenetic’ probes will not be limited to muscle control, but may also proof effective in other neurological conditions, such as epilepsy. • Citation: • Optical Control of Muscle Function by Transplantation of Stem Cell–Derived Motor Neurons in Mice • J. Barney Bryson, Carolina Barcellos Machado, Martin Crossley, Danielle Stevenson, Virginie Bros- Facer, Juan Burrone, Linda Greensmith, and Ivo Lieberam • Science 4 April 2014: 344 (6179), 94-97. [DOI:10.1126/science.1248523] Read the rest of the interview on MedicalResearch.com
  • 18. Number of Low Income Uninsured Higher In States Not Expanding Medicaid MedicalResearch.com Interview Sandra L. Decker, Ph.D. Distinguished Consultant Centers for Disease Control and Prevention National Center for Health Statistics Hyattsville, MD 20782 • MedicalResearch.com: What are the main findings of the study? • Dr. Decker: One of the main findings is that the percent of the low income population that is uninsured is higher in states not expanding Medicaid than those expanding. The low income uninsured in non- expansion states are more likely to report having or having had certain health conditions such as hypertension, cancer, stroke, emphysema, or a heart condition than those in expansion states. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Decker: Since about half the states have decided to expand their Medicaid programs and half have not, we didn’t have particular expectations about whether the number of uninsured who will be offered Medicaid or their health conditions would be different in non-expansion states versus expansion states. However, we were curious if the number of uninsured or their health conditions were different in the two groups of states. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Decker: In non-expansion states, low income, uninsured adults with chronic health conditions will be likely to seek subsidized purchase of private health insurance through the Marketplace. Those under the poverty level are likely to remain uninsured, however. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Decker: Hopefully, researchers will be able to track how low income adults use health services and how their health is impacted in expansion states compared to non-expansion states going forward. • Citation: • Characteristics of Uninsured Low-Income Adults in States Expanding vs Not Expanding Medicaid • Decker, Sandra L., Genevieve M. Kenney, and Sharon Long. 2014. “Characteristics of Uninsured Low- Income Adults in States Expanding Vs. Not Expanding Medicaid,” JAMA Internal Medicine. Read the rest of the interview on MedicalResearch.com
  • 19. Neurobiology May Explain Why Some Teenage Drivers Take More Risks MedicalResearch.com Interview with: Dr. Marie Claude Ouimet, Ph.D. Assistant Professor/ Professeure adjointe University of Sherbrooke/ Université de Sherbrooke Faculty of Medicine and Health Sciences/ Faculté de médecine et des sciences de la santé Longueuil, QC, Canada, J4K 0A8 • MedicalResearch.com: What are the main findings of the study? Dr. Ouimet :The goal of our study was to examine if teenagers’ driving risk was associated with a neurobiological factor. Driving was continuously observed with cameras and sensors installed in the vehicles of teenagers during their first 18 months of licensure. Cortisol response was measured within the first weeks of licensing. Our study showed two main findings: • 1) Higher cortisol response to a stressful event was associated with lower crash and near crash rates over the study period; • 2) Higher cortisol response was also linked to a sharper decrease in crash and near crash rates over time. Read the rest of the interview on MedicalResearch.com
  • 20. Neurobiology May Explain Why Some Teenage Drivers Take More Risks MedicalResearch.com Interview with: Dr. Marie Claude Ouimet, Ph.D. Assistant Professor/ Professeure adjointe University of Sherbrooke/ Université de Sherbrooke Faculty of Medicine and Health Sciences/ Faculté de médecine et des sciences de la santé Longueuil, QC, Canada, J4K 0A8 • MedicalResearch.com: Were any of the findings unexpected? • Dr. Ouimet : This study was initially planned to solely examine behavior, but we succeeded in transforming it into a fruitful collaboration between researchers trained in different research fields including neuroscience, psychology, and engineering. The level of insight that can be achieved when an important yet complex public health problem like driving risk is addressed using a novel multidisciplinary approach was an unexpected finding for us. These insights also raised the possibility that other opportunities and discoveries are missed when similar questions are not addressed using the multidisciplinary approach. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Ouimet : Road traffic crashes are one of the leading causes of mortality and morbidity for young individuals worldwide, and risk is particularly high during the first months and years of licensing. Interventions targeting young drivers such as the Graduated Driving Licensing programs are associated with some reduction in risk, but risk remains elevated. While these findings are preliminary, they are suggestive of both why some young drivers engage in more risky driving than others or are less affected by prevention strategies. For clinicians, the results imply that some patients may be more neurobiologically predisposed to risk taking, or may be less able to change their risky driving as a result of their experience. For these drivers, extra preventative measures may be needed, though at present we do not have the data to know what these measures could be. Read the rest of the interview on MedicalResearch.com
  • 21. Neurobiology May Explain Why Some Teenage Drivers Take More Risks MedicalResearch.com Interview with: Dr. Marie Claude Ouimet, Ph.D. Assistant Professor/ Professeure adjointe University of Sherbrooke/ Université de Sherbrooke Faculty of Medicine and Health Sciences/ Faculté de médecine et des sciences de la santé Longueuil, QC, Canada, J4K 0A8 • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Ouimet : This study’s findings justify pursuing research into the neurobiological processes of risky driving, a behavior that teenagers and young adults are more susceptible to compared to other age groups. • This study was one of the first to examine teenagers’ driving risk in a naturalistic, longitudinal design. Naturalistic driving studies are very expensive and this study was therefore limited in terms of the number of participants that could be observed. As technology becomes more affordable and analytic methods more efficient, a future study with a larger sample should validate and build upon these preliminary findings. • Continued research into the mechanisms underlying the observed relationships is needed. While this study is one of the first to examine the relationship between driving risk and cortisol response, other risky behaviors (e.g., alcohol misuse, treatment refractoriness, externalizing behavior) have also been associated with lower cortisol response. A number of hypotheses have been put forward to explain the mechanisms underlying the relationship between risky behavior in general and cortisol response. • Two which we believe are plausible in the context of driving include: • 1) Some drivers have more need for the arousal that comes with engaging in risky behavior than others, and • 2) Drivers who do not experience much stress when engaging in risky driving are less likely to try to avoid involvement in this behavior in the future than those who do. These hypotheses need to be tested more directly in the context of driving risk. • Citation: • Ouimet MC, Brown TG, Durbin DR, et. al. Higher Crash and Near-Crash Rates in Teenaged Drivers With Lower Cortisol ResponseAn 18-Month Longitudinal, Naturalistic Study. JAMA Pediatrics. 2014 Read the rest of the interview on MedicalResearch.com
  • 22. Diabetes: Patients Still Face High Out of Pocket Expenses MedicalResearch.com Interview with: Dr. Rui Li Division of Diabetes Translation Centers for Disease Control and Prevention Atlanta, GA • MedicalResearch.com: What are the main findings of the study? • Answer: The proportion of people with diabetes facing high out-of-pocket (OOP) burden declined between 2001 and 2011. Although insurance and income related disparities have declined, almost one- fourth of all people with diabetes still face a high out-of-pocket burden. • MedicalResearch.com: Were any of the findings unexpected? • Answer: The change in out-of-pocket burden over this time period had not been studied before. Thus, there was no reason to expect any change. The decline was, in this sense, unexpected. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Out-of-pocket spending from prescription drugs contributed a large share of the total out-of- pocket spending. Switching from brand name drugs to generic drugs might reduce the out-of-pocket spending because the copayment and coinsurance for generic drugs are much lower than the brand name drugs. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: • First, continue to monitor the change of high out-of-pocket burden to inform healthcare decision makers. • Second, we observed a reduction in disparity in high out-of-pocket burden associated with insurance status and income level. Future studies could examine whether this reduced disparity in high out-of- pocket burden has indeed reduced disparity in access to health care and in health outcomes across the diabetic subgroups of the overall population aged <65 years. • Citation: • Changes Over Time in High Out-of-Pocket Health-Care Burden in U.S. Adults With Diabetes, 2001-2011 • Diabetes Care published ahead of print March 25, 2014, doi:10.2337/dc13-1997 1935-5548 Rui Li, Lawrence E. Baker, Sundar Shrestha, Ping Zhang, O. Kenrick Duru, Tony Pearson-Clarke, and Edward W. Gregg Read the rest of the interview on MedicalResearch.com
  • 23. Could Caffeine Slow Progression of Alzheimer’s Disease? MedicalResearch.com Interview with: Prof. Dr. Christa E. Müller University of Bonn Pharmaceutical Institute Pharmaceutical Chemistry I An der Immenburg 4 D-53121 Bonn (Endenich) Germany • MedicalResearch.com: What are the main findings of the study? • Prof. Dr. Christa E. Müller: Genetically altered mice which show an aggregation of Tau protein and many symptoms of Alzheimer’s Disease which progressively worsen with time was used. • Caffeine was given to one group of mice at an early stage, when the symptoms were still moderate. • The caffeine-treated mice showed better memory and less inflammation and brain damages in comparison to the non- treated control mice. This means that caffeine protected the mice to some extent. The side effects were moderate. • MedicalResearch.com: Were any of the findings unexpected? • Prof. Dr. Christa E. Müller: In research one never knows. We had a hypothesis, but the result was unclear. Fortunately, the hypothesis, that caffeine (and selective adenosine receptor antagonists) could slow the progression of Alzheimer’s Disease in a specific mouse-model, could be confirmed. • MedicalResearch.com: What should clinicians and patients take away from your report? • Prof. Dr. Christa E. Müller: For healthy patients normal intake of caffeine might protect from neurodegenerative diseases. The same may be true for Alzheimer patients in initial states of the disease. However, patients suffering for example from serious heart diseases like high blood pressure, should be careful and first consult their physician. Also, pregnant women should avoid caffeine. • Clinical studies have to be undertaken to finally prove this in patients. MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Prof. Dr. Christa E. Müller: One of the next steps will be to perform a small clinical study with patients suffering from mild cognitive impairment to study whether caffeine prevents or at least delays the onset of Alzheimer’s disease. • Initial studies will probably be performed with caffeine. However, it would be better to use selective antagonists for adenosine A2A receptors, which are more potent and show less side-effects. • Citation: • Cyril Laurent, Sabiha Eddarkaoui, Maxime Derisbourg, Antoine Leboucher, Dominique Demeyer, Sébastien Carrier, Marion Schneider, Malika Hamdane, Christa E. Müller, Luc Buée, David Blum. Beneficial effects of caffeine in a transgenic model of Alzheimer’s Disease-like Tau pathology. Neurobiology of Aging, 2014; DOI: 10.1016/j.neurobiolaging.2014.03.027 Read the rest of the interview on MedicalResearch.com
  • 24. Restless Legs Syndrome Linked to Decreased Physical Function MedicalResearch.com Interview with: Xiang Gao, MD, PhD Assistant Professor in Medicine Harvard Medical School Associate Epidemiologist Brigham and Women’s Hospital • MedicalResearch.com: What are the main findings of the study? • Dr. Gao: In this study including 12,556 men in the Health Professionals Follow-up Study, we found that the participants with Restless Legs Syndrome at baseline had significantly lower physical function (PF) score 6 years later than those without RLS, after adjusting for potential confounders. The magnitude of difference in physical function score for RLS symptoms ≥15 times/month vs no Restless Legs Syndrome was more than that of a 5-year increase of age or moderate amount of smoking. We also found that having daily daytime sleepiness and sleep duration ≥9 hours/day were associated with lower mean physical function value than not having these symptoms . MedicalResearch.com: Were any of the findings unexpected? • Dr. Gao: None because previous cross-sectional studies have reported similar relationship between Restless Legs Syndrome and lower physical function. However, this is the first large study to examine the potential impact of Restless Legs Syndrome and subsequent physical function several years later. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Gao: Individuals with Restless Legs Syndrome could have a higher risk of several unfavorable health outcome, including overall physical function. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Gao: To replicate our results in other longitudinal studies and to understand potential underlying mechanisms for these observed associations. • Citation: • Restless legs syndrome status as a predictor for lower physical function • Chunbai Zhang, MD, MPH, Yanping Li, PhD, Atul Malhotra, MD, Yi Ning, MD, MPH, ScD and Xiang Gao, MD, PhD Published online before print March 5, 2014, doi: 10.1212/WNL.0000000000000284 Neurology April 8, 2014 vol. 82 no. 14 1212-1218 Read the rest of the interview on MedicalResearch.com
  • 25. Higher Social Class Linked To Lower Risk of Bone Fractures MedicalResearch.com Interview with: Dr. Carolyn Crandall, M.D. Division of General Internal Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, 90024, USA • MedicalResearch.com: What are the main findings of the study? • Dr. Crandall: We found that higher social class was linked with a lower risk of fractures among non-Caucasian women. Compared with non-Caucasian women who had no more than a high school education, those with at least some postgraduate education had nearly 90% lower rates of non-traumatic fracture. These results were present even after we accounted for income. MedicalResearch.com: Were any of the findings unexpected? • Dr. Crandall: It was at first surprising that higher education was associated with decreased fracture risk only among non- Caucasian, but not Caucasian women. We suspect that minority race women who are less educated are exposed to more life stresses than are less educated Caucasian women. The stresses faced by less educated Caucasian women may not affect bone strength enough to influence fracture risk in mid-life. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Crandall: Traditionally, clinicians have not considered socioeconomic factors when they assess fracture risk. Women, especially minority women, with socioeconomic stressors, may want to be especially vigilant in seeing that they maintain “bone healthy” habits, such as avoiding cigarette smoking, getting daily weight-bearing exercise (such as walking), avoiding heavy alcohol intake, and ensuring that they get adequate calcium and vitamin D intake. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Crandall: Future studies are needed to determine what are the biological and behavioral reasons for the apparent protection that is provided by higher educational level on osteoporotic fracture risk. In that way, we can better target women at increased risk of future fracture, and design preventive strategies for them. • Citation: • Higher social class linked to fewer bone fractures among non-white women • C. J. Crandall, W. Han, G. A. Greendale, T. Seeman, P. Tepper, R. Thurston, C. Karvonen, Gutierrez, A. S. Karlamangla • Osteoporosis International Volume 25, Issue 4 , pp 1379-1388 Read the rest of the interview on MedicalResearch.com
  • 26. Aerobic Exercise May Increase Memory Performance MedicalResearch.com Interview with: Teresa Liu-Ambrose, PhD, PT Associate Professor, Canada Research Chair Department of Physical Therapy Aging, Mobility, and Cognitive Neuroscience Laboratory Vancouver Coastal Health Research Institute & University of British Columbia Vancouver, BC • MedicalResearch.com: What are the main findings of the study? • Dr. Liu-Ambrose: With respect to dementia risk, the hippocampus is a brain structure of intense interest. We demonstrated that six months of 2x/week aerobic training significantly increased hippocampal volume in older women with probable mild cognitive impairment (MCI). Notably, we observed a 4 percent increase in the total hippocampal volume. This is equivalent to reversing age-related loss in hippocampal volume by more than two years. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Liu-Ambrose: While we previously reported that six months of 2x/week aerobic training significantly increased memory performance in the same sample of older women with MCI, in this analysis, we found that increased hippocampal volume was associated with reduced verbal learning and memory performance. This finding suggests that the relationship between change in brain structural volume and change in cognitive performance is complex, likely not at a 1:1 relationship, and required further research Read the rest of the interview on MedicalResearch.com
  • 27. Aerobic Exercise May Increase Memory Performance MedicalResearch.com Interview with: Teresa Liu-Ambrose, PhD, PT Associate Professor, Canada Research Chair Department of Physical Therapy Aging, Mobility, and Cognitive Neuroscience Laboratory Vancouver Coastal Health Research Institute & University of British Columbia Vancouver, BC • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Liu-Ambrose: Our research suggests that twice-weekly aerobic exercise can positively impact hippocampal volume – a structure essential for memory and yet, sensitive to both aging and neurodegeneration – among older adults at risk for dementia . Therefore, we recommend that exercise should be included in the management plan of older adults at risk for cognitive decline. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Liu-Ambrose: Future research should focus on comparing the effects of different types of exercise training as well as combined training on both cognitive and brain health. More research is also needed to examine whether the benefit of exercise is evident among different neurodegenerative diseases (e.g., Alzheimer’s disease, vascular dementia, Parkinson’s disease). Lastly, more research examining the underlying mechanisms by which different types of exercise benefits the brain is needed. • Citation: • Aerobic exercise increases hippocampal volume in older women with probable mild cognitive impairment: a 6-month randomised controlled trial Read the rest of the interview on MedicalResearch.com
  • 28. NSAIDS Associated with Atrial Fibrillation MedicalResearch.com Interview with: Bruno Stricker, MB PhD Professor of Pharmaco-epidemiology Professor of Pharmacoepidemiology Erasmus MC • MedicalResearch.com: What are the main findings of the study? • Dr. Stricker: NSAIDs/painkillers may cause atrial fibrillation. • MedicalResearch.com: What should patients and provider take away from this study? • Dr. Stricker: • Atrial fibrillation is the main risk factor of stroke. • Patients with cardiovascular disease should be careful with NSAIDs • Citation: • Krijthe B, et al “Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: a population-based follow-up study” BMJ Open 2014; DOI: 10.1136/ bmjopen-2013-004059. Read the rest of the interview on MedicalResearch.com
  • 29. Eating Disorders in Men Under Recognized MedicalResearch.com Interview with Ulla Räisänen Senior Researcher HERG Health Experiences Research Group Department of Primary Care Health Sciences University of Oxford Oxford OX1 2ET • MedicalResearch.com : What are the main findings of the study? • Answer: We conducted a qualitative interview study exploring how young men (aged 16-25) recognise eating disorder symptoms and decide to seek help, and to examine their experiences of initial contacts with primary care in the UK. • Our data suggest that the widespread perception of eating disorders as uniquely or predominantly a female problem led to an initial failure by young men to recognise their behaviours as symptoms of an eating disorder. Many presented late in their illness trajectory when eating disorder behaviours and symptoms were entrenched, and some felt that opportunities to recognise their illness had been missed because of others’ lack of awareness of eating disorders in men. In addition, the men discussed the lack of gender-appropriate information and resources for men with eating disorders as an additional impediment to making sense of their experiences, and some felt that health and other professionals had been slow to recognise their symptoms because they were men. • MedicalResearch.com : Were any of the findings unexpected? Answer: To date, there exists very little research into eating disorders in men. No previous work that we are aware of has explored men’s accounts of symptom recognition and help-seeking. In contrast to previous research among women with eating disorders which suggests that whilst recognising an eating disorder and seeking help can be a prolonged and complex issue, with issues around ambivalence towards recovery, our data shows that men may not even come to consider the possibility of having an eating disorder because of the inappropriateness of an eating disorder as a diagnosis for them as men. Read the rest of the interview on MedicalResearch.com
  • 30. Eating Disorders in Men Under Recognized MedicalResearch.com Interview with Ulla Räisänen Senior Researcher HERG Health Experiences Research Group Department of Primary Care Health Sciences University of Oxford Oxford OX1 2ET • MedicalResearch.com : What should clinicians and patients take away from your report? Answer: The data highlights perceived failure among professionals, patients themselves and the wider public to recognise eating disorders as something that also affect men. We hope to raise awareness and sensitivity among men, their friends and families as well as health care professionals to recognise such symptoms much earlier on for improved prognosis. • MedicalResearch.com : What recommendations do you have for future research as a result of this study? Answer: Eating disorders in men is a much neglected and under-research area that demands a great deal of future research and recognition. Particularly studies focusing solely on men’s experiences, across men of different ages, are paramount in order to understand men’s developing understandings of eating disorders across a longer illness trajectory. • Citation: • The role of gendered constructions of eating disorders in delayed help-seeking in men: a qualitative interview study • Ulla Räisänen, Kate Hunt • BMJ Open 2014;4:e004342 doi:10.1136/bmjopen-2013-004342 Read the rest of the interview on MedicalResearch.com
  • 31. Aspirin Found Generally Not Effective in Reducing Pregnancy Loss MedicalResearch.com Interview with: Enrique F. Schisterman, Ph.D. Chief and Senior Investigator Epidemiology Branch, DIPHR Eunice Kennedy Shriver National Institute of Child Health and Human Development Rockville, MD 20854 • MedicalResearch.com: What are the main findings of the study? • Dr. Schisterman: Our results indicate that aspirin is not effective for reducing the chances of pregnancy loss in most cases. For the total number of women in the study, 13 percent of women who took aspirin and became pregnant subsequently experienced another loss, compared with 12 percent who took the placebo. Ultimately, 58 percent of women taking aspirin and 53 percent of the placebo group got pregnant and later gave birth. • However, additional research is needed to investigate the finding that women who had experienced a single, recent pregnancy loss (before 4 1/2 months of pregnancy and within the past year) had an increased rate of pregnancy and live birth while on aspirin therapy. Among this group, 78 percent of those who took aspirin became pregnant, compared with 66 percent of those who took the placebo. For this subset of women, 62 percent of the aspirin group and 53 percent of the placebo group gave birth. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Schisterman: We hypothesized that aspirin therapy might increase the conception rate by increasing blood flow to the uterus. Therefore our findings were not unexpected. However, we are excited by how dramatic the difference in the live birth rate is, particularly the almost 10% difference in live birth rates between women who took aspirin and placebo in the group of women who had experienced a single, recent pregnancy loss. Read the rest of the interview on MedicalResearch.com
  • 32. Aspirin Found Generally Not Effective in Reducing Pregnancy Loss MedicalResearch.com Interview with: Enrique F. Schisterman, Ph.D. Chief and Senior Investigator Epidemiology Branch, DIPHR Eunice Kennedy Shriver National Institute of Child Health and Human Development Rockville, MD 20854 • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Schisterman: Our data do not support the general use of low-dose aspirin to decrease pregnancy loss or increase live birth rates. We found that daily low-dose aspirin started before conception was not associated with an increase in live births or a decrease in pregnancy loss in women with one to two previous losses. However, it was associated with an increased rate of positive urine pregnancy tests and a nearly 10% increase in live birth rate in women with a single pregnancy loss at less than 20 weeks’ gestation during the previous year. Because of the low cost, availability, and apparent safety of low-dose aspirin, these findings should prompt further investigation into its effects on fecundity and implantation. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Schisterman: Because we hypothesized that aspirin therapy might increase the conception rate by increasing blood flow to the uterus, we call for for additional research to determine if aspirin therapy might be helpful for improving fertility in other subgroups as well, such as women who can’t establish a pregnancy because the embryo fails to implant in the uterus. • Citation: • Preconception low-dose aspirin and pregnancy outcomes: results from the EAGeR randomised trial Dr Enrique F Schisterman PhD,Prof Robert M Silver MD,Laurie L Lesher MBA,Prof David Faraggi PhD,Prof Jean Wactawski-Wende PhD,Prof Janet M Townsend MD,Anne M Lynch MD,Neil J Perkins PhD,Sunni L Mumford PhD,Noya Galai PhD The Lancet – 2 April 2014 DOI: 10.1016/S0140-6736(14)60157-4 Read the rest of the interview on MedicalResearch.com
  • 33. Why Do Some Patients Fail To Get Their Prescriptions Filled? MedicalResearch.com Interview with: Robyn Tamblyn BScN Msc PhD McGill University and Scientific Director Institute of Health Services and Policy Research Canadian Institutes of Health Research • MedicalResearch.com: What are the main findings of the study? • Dr. Tamblyn: Higher drug costs are associated with a higher probability of primary non- adherence, whereas better follow-up by the prescribing physician, and a policy to provide medication at no cost for the very poor increase the likelihood of adherence • MedicalResearch.com: Were any of the findings unexpected? • Dr. Tamblyn: This is the first opportunity to evaluate whether free medication for the poor increased adherence. It was surprising to see that this simple policy reversed the usual trend to see poorer adherence in the low income groups. Read the rest of the interview on MedicalResearch.com
  • 34. Why Do Some Patients Fail To Get Their Prescriptions Filled? MedicalResearch.com Interview with: Robyn Tamblyn BScN Msc PhD McGill University and Scientific Director Institute of Health Services and Policy Research Canadian Institutes of Health Research • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Tamblyn: When there is a failure to respond to prescribed treatment such as poor control of blood pressure or glycemic control in diabetes, a clinician needs to consider the possibility that the the person did not fill the original prescription. • As high drug costs increase the risk of non-adherence, even among insured patients who pay a percentage of the cost, clinicians need to both know and consider the cost of possible therapies in making treatment decisions • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Tamblyn: Two issues need to be addressed. • First what is the consequence of primary non-adherence? If primary non-adherence results in avoidable complications then a new approach to drug policy may be needed to cover the cost of drugs for patients with disease modifiable conditions. • Second, what are the attitudes, knowledge and beliefs of patients who fill and do not fill prescriptions and what interventions would be appropriate in addressing gaps in these areas? • Citation: • Robyn Tamblyn, Tewodros Eguale, Allen Huang, Nancy Winslade, Pamela Doran; The Incidence and Determinants of Primary Nonadherence With Prescribed Medication in Primary CareA Cohort StudyPrimary Nonadherence With Prescribed Medication in Primary Care. Annals of Internal Medicine. 2014 Apr;160(7):441-450. Read the rest of the interview on MedicalResearch.com
  • 35. Diet-Induced Obesity: EPO Has Anti-Inflammatory Effect on White Adipose Tissue MedicalResearch.com Interview witih: Dr. Constance Tom Noguchi, Ph.D. Molecular Medicine Branch and Dr. Mawadda Al-Naeeli Mouse Metabolism Core Facility National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892 • MedicalResearch.com: What are the main findings of the study? • Answer: The main findings of our study are: 1) EPO treatment has an anti-inflammatory effect on white adipose tissue macrophage population during diet-induced obesity in addition to its associated metabolic improvements on glucose tolerance and insulin sensitivity in vivo. 2) In this model of obesity, EPO treatment was found to reduce M1-like [pro-inflammatory] and increased M2-like [anti-inflammatory] macrophages in visceral white adipose tissue depot. 3) In addition, EPO decreased circulating inflammatory monocytes. 4) These anti-inflammatory effects of EPO were found to be driven, at least in part, by direct EPO-R response in macrophages via Stat3 activation, where EPO effects on M2 but not M1 macrophages required interleukin-4 receptor/Stat6 axis. 5) The anti-inflammatory effects of EPO are not restricted to treatment with exogenous high dose EPO (1000U/kg), but also include endogenous physiological EPO levels as demonstrated by the series of studies conducted using ΔEpoR mice with EPO-R restricted to erythroid cells. Read the rest of the interview on MedicalResearch.com
  • 36. Diet-Induced Obesity: EPO Has Anti-Inflammatory Effect on White Adipose Tissue MedicalResearch.com Interview witih: Dr. Constance Tom Noguchi, Ph.D. Molecular Medicine Branch and Dr. Mawadda Al-Naeeli Mouse Metabolism Core Facility National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892 • MedicalResearch.com: Were any of the findings unexpected? • Answer: Yes. The most unexpected findings were • 1) The observation that EPO promotes the expansion of the white adipose tissue M2-like macrophage population, as a result of increased IL-4 levels that drive their proliferation in situ. • 2) the anti-inflammatory effects of EPO emerging prior to any detectable changes in body weight or composition, and • 3) the absence of metabolic effects for EPO on glucose uptake locally in the white adipose tissue, despite high levels of EPO-R expression. Read the rest of the interview on MedicalResearch.com
  • 37. Diet-Induced Obesity: EPO Has Anti-Inflammatory Effect on White Adipose Tissue MedicalResearch.com Interview witih: Dr. Constance Tom Noguchi, Ph.D. Molecular Medicine Branch and Dr. Mawadda Al-Naeeli Mouse Metabolism Core Facility National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892 • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The main message from our report is that EPO/EPO-R signaling regulates inflammation in the white adipose tissue during obesity. We know based on previous reports that EPO can inhibit macrophage inflammatory response in the gut and systemically as published by Nairz et al Immunity 2011. • Our findings further emphasize and extend the nonerythroid activity of EPO to encompass effects on both macrophage infiltration and subset composition,at least in fat, with potential implications in clinical practice. If EPO has anti-inflammatory effects in humans, and can expand anti-inflammatory macrophage population in vivo, the potential contribution of EPO stimulated macrophage response to improve insulin sensitivity warrants further investigation. In addition, the contribution of EPO stimulated macrophage response may also relate to the increase tumor growth reported in some cancer patients receiving high dose EPO therapy to treat anemia, especially in light of the strong correlation between tumor infiltrating macrophages and poor prognosis. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: Existing reports in the literature already show that EPO has the potential to regulate human immune responses especially in renal dialysis patients and in multiple myeloma patients. The recommendation for future research is translational studies to investigate the effect for clinically relevant EPO doses on inflammatory and immune response effector cells/functions in humans to shed light on the biology involved during health and disease. • Citation: • Erythropoietin signaling: A novel regulator of white adipose tissue inflammation during diet-induced obesity • Mawadda Alnaeeli, Bruce M Raaka, Oksana Gavrilova, Ruifeng Teng, Tatyana Chanturiya, and Constance Tom Noguchi • Diabetes published ahead of print March 19, 2014, doi:10.2337/db13-0883 1939-327X Read the rest of the interview on MedicalResearch.com
  • 38. Autism: Brain Imaging Shows Mitochondrial Dysfunction In Some Patients MedicalResearch.com Interview with: Bradley S. Peterson, MD Director of the Center for Developmental Neuropsychiatry New York State Psychiatric Institute Suzanne Crosby Murphy Professor in Pediatric Neuropsychiatry, Columbia University, NY • MedicalResearch.com: What are the main findings of the study? • Dr. Peterson: We detected the presence of lactate in the brains of 13% of 75 participants who had ASD (Autism Spectrum Disorder), compared with 1% of the brains of 96 typically developing control participants. The presence of lactate was especially more common in adults who have ASD. Lactate is a product of anaerobic metabolism, which generally should not occur in healthy, living brains under normal circumstances. The presence of lactate in the brains of persons with Autism Spectrum Disorder therefore suggests the presence of deficient production of energy stores by a component of brain cells called “mitochondria”. We detected lactate most commonly in the cingulate gyrus, a region that supports the higher-order control of thought, emotion, and behavior, and that has been implicated previously in Autism Spectrum Disorder. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Peterson: Diseases of the mitochondria are known causes of Autism Spectrum Disorder, but until now were thought to be responsible for less than 1% of all cases of ASD. Therefore, the large number of individuals in the ASD group who had detectable lactate was surprising. Moreover, this number was almost certainly an underestimate of those who actually had elevated lactate, because measuring lactate in the brains of living people is difficult — available techniques for measuring lactate are not yet very sensitive, which means that they will frequently miss the presence of lactate when it is truly present. Prior studies have reported high rates of lactate in the body tissues of people with Autism Spectrum Disorder, but not in their brains. Therefore, seeing these high rates in the brains of persons with Autism Spectrum Disorder was also surprising. We attribute our success in detecting brain lactate in Autism Spectrum Disorder largely to the use of technical advances that made our brain imaging measures more sensitive than the techniques used to assess lactate in past studies. Read the rest of the interview on MedicalResearch.com
  • 39. Autism: Brain Imaging Shows Mitochondrial Dysfunction In Some Patients MedicalResearch.com Interview with: Bradley S. Peterson, MD Director of the Center for Developmental Neuropsychiatry New York State Psychiatric Institute Suzanne Crosby Murphy Professor in Pediatric Neuropsychiatry, Columbia University, NY • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Peterson: Our strong evidence for the common presence of mitochondrial dysfunction in persons with Autism Spectrum Disorder suggests that patients should undergo clinical evaluation for the presence of mitochondrial disease. In addition, novel treatments for known mitochondrial diseases are under development and showing promise. These might one day prove helpful in the treatment of mitochondrial dysfunction in persons who have Autism Spectrum Disorder. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Peterson: Large-scale imaging studies that use sensitive techniques for the measurement of lactate in living persons should relate lactate levels to the clinical symptoms, clinical course, and treatment outcomes in Autism Spectrum Disorder. These studies are needed to use the identification of mitochondrial dysfunction for the improvement of clinical care in people who have ASD. • Citation: • Goh S, Dong Z, Zhang Y, DiMauro S, Peterson BS. Mitochondrial Dysfunction as a Neurobiological Subtype of Autism Spectrum Disorder: Evidence From Brain Imaging. JAMA Psychiatry. 2014;():. doi:10.1001/jamapsychiatry.2014.179. Read the rest of the interview on MedicalResearch.com
  • 40. Alzheimer’s Disease: Pathology Starts 10-20 Years Before Diagnosis MedicalResearch.com Interview with: Prof. Dr. med. Piotr Lewczuk Head,Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics Universitätsklinikum Erlangen, 91054 Erlangen, Germany • MedicalResearch.com: What are the main findings of the study? • Prof. Dr. med. Piotr Lewczuk: In our study, we investigated the concentrations of four isoforms of amyloid beta peptides in the blood of healthy young volunteers without memory complains. The participants were stratified into three groups according to their apolipoprotein E (APOE) genotype, which is the mostly investigated and generally accepted genetic risk factor for sporadic Alzheimer’s Disease (AD). It is known that the alterations of the amyloid beta metabolism are the earliest changes in the course of AD, occurring many years (or even decades) before the onset of the clinical symptoms, but it is actually not known how early these alterations start. Correspondingly, we wanted to investigate if healthy persons with genetic risk factor show changes in their amyloid beta metabolism already 30- 40 years before the age when AD is usually diagnosed. We did not find any differences between the groups with and without APOE-driven risk, which might be carefully interpreted as no signs of Alzheimer’s Disease pathology in persons at risk at such an early life stage. Taken together, we think that the Alzheimer’s Disease pathology starts some 10-20 years before the beginning of the clinical symptoms, but not earlier. Read the rest of the interview on MedicalResearch.com
  • 41. Alzheimer’s Disease: Pathology Starts 10-20 Years Before Diagnosis MedicalResearch.com Interview with: Prof. Dr. med. Piotr Lewczuk Head,Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics Universitätsklinikum Erlangen, 91054 Erlangen, Germany • MedicalResearch.com: Were any of the findings unexpected? • Prof. Dr. med. Piotr Lewczuk: Not really. As a matter of fact this study was, to my best knowledge, the first of this type, so it was difficult to make any predictions on its outcome. We were prepared to see and interpret any variants of the results. It was, however, interesting to see that the group of Dr. Andy Simmons, whose paper appeared currently in the Journal of Alzheimer’s Disease, came to the same conclusions using different methodological approach (they investigated the hippocampal volumes with neuroimaging methods). • MedicalResearch.com: What should clinicians and patients take away from your report? • Prof. Dr. med. Piotr Lewczuk: The interpretation of our results in the scientific context is quite straightforward: no differences between the groups of persons with and without APOE risk. The interpretation for the individuals is, however, much more complex: as we state in the discussion of the paper, we cannot fully exclude that some cognitively normal persons bearing the genetic risk factor do show alterations of their amyloid beta metabolism, but that these alterations are statistically counter balanced by the normal results of other persons. For example, the persons with the lowest concentrations of amyloid beta 1-42 might indeed show the fist neurochemical Alzheimer’s Disease alterations, which are however “hidden” by the results of the subjects which have normal concentrations. Personally, I think this is the main problem of the translation of the research results into the messages for the practitioners and the patients: in science we investigate groups, but physicians and patients are not interested in the analyses of the groups, they always face individuals. Read the rest of the interview on MedicalResearch.com
  • 42. Alzheimer’s Disease: Pathology Starts 10-20 Years Before Diagnosis MedicalResearch.com Interview with: Prof. Dr. med. Piotr Lewczuk Head,Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics Universitätsklinikum Erlangen, 91054 Erlangen, Germany • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Prof. Dr. med. Piotr Lewczuk: We would like to perform a follow up study with the individuals with the extreme phenotypes (in this case, with the highest or the lowest concentrations of the amyloid beta in the blood) to see if they indeed are cognitively stable for up to the age when the usual amyloid beta alterations are observed as the first metabolic changes of Alzheimer’s Disease. Of course this rises major ethical and logistic problems, so it might be a project for many years and decades. • Citation: • Plasma Concentrations of the Amyloid-β Peptides in Young Volunteers: The Influence of the APOE Genotype • Zimmermann R1, Huber E1, Schamber C1, Lelental N1, Mroczko B2, Brandner S3, Maler JM1, Oberstein T1, Szmitkowski M4, Rauh M5, Kornhuber J1, Lewczuk P1. J Alzheimers Dis. 2014 Feb 20. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
  • 43. Breast Cancer: High Fat Diet Raises Risk of Hormone Sensitive Cancer MedicalResearch.com Interview with: Sabina Sieri, PhD Epidemiology and Prevention Unit Department of Preventive & Predictive Medicine Fondazione IRCCS Istituto Nazionale dei Tumori 20133 Milan – Italy • MedicalResearch.com: What are the main findings of this study? • Dr. Sieri: In our study we found that there was an increased risk of developing breast cancer from high saturated fat intake. High total and saturated fat intake were associated with greater risk of ER PR positive breast cancer. High saturated fat intake was also associated with a greater risk of HER2 negative disease. So, a high-fat diet increases breast cancer risk and, most conspicuously, a high saturated fat intake increases the risk of developing hormone- sensitive diseases, suggesting saturated fat involvement in the etiology of hormone-sensitive breast cancer. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Sieri: No, but I am surprised by the congruousness of the results that we found. We found a positive association between fat intake and breast cancer risk and a greater effect of fat on receptor positive breast cancers and HER2 negative tumors. All these breast cancer subtypes are more influenced by risk factors known to be linked to estrogen metabolism. It has been hypothesized that high dietary fat intake may raise endogenous estrogen levels which stimulates the proliferation of breast cancer cells. Read the rest of the interview on MedicalResearch.com
  • 44. Breast Cancer: High Fat Diet Raises Risk of Hormone Sensitive Cancer MedicalResearch.com Interview with: Sabina Sieri, PhD Epidemiology and Prevention Unit Department of Preventive & Predictive Medicine Fondazione IRCCS Istituto Nazionale dei Tumori 20133 Milan – Italy • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Sieri: Saturated fatty acids intake should be as low as is possible within the context of a nutritionally balanced diet. The percentage of total calories from saturated fat should not exceed the 10% limit suggested by main dietary recommendations • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Sieri: It is important that these finding be replicated in other studies focusing on breast cancer subtypes instead of overall breast cancer. • Citation: • Dietary Fat Intake and Development of Specific Breast Cancer Subtypes JNCI J Natl Cancer Inst dju068 doi:10.1093/jnci/dju068 first published online April 9, 2014 • Sabina Sieri, Paolo Chiodini, Claudia Agnoli, Valeria Pala, Franco Berrino, Antonia Trichopoulou, Vassiliki Benetou, Effie Vasilopoulou, María-José Sánchez, Maria-Dolores Chirlaque, Pilar Amiano, J. Ramón Quirós,Eva Ardanaz, Genevieve Buckland, Giovanna Masala, Salvatore Panico, Sara Grioni,Carlotta Sacerdote, Rosario Tumino, Marie-Christine Boutron-Ruault, Françoise Clavel- Chapelon, Guy Fagherazzi, Petra H. M. Peeters, Carla H. van Gils, H. Bas Bueno-de-Mesquita, Henk J. van Kranen, Timothy J. Key, Ruth C. Travis, Kay Tee Khaw, Nicholas J. Wareham, Rudolf Kaaks, Annekatrin Lukanova, Heiner Boeing, Madlen Schütze, Emily Sonestedt, Elisabeth Wirfält, Malin Sund, Anne Andersson, Veronique Chajes, Sabina Rinaldi, Isabelle Romieu, Elisabete Weiderpass, Guri Skeie, Engeset Dagrun, Anne Tjønneland, Jytte Halkjær, Kim Overvard, Melissa A. Merritt, David Cox, Elio Riboli, and Vittorio Krogh • JNCI J Natl Cancer Inst Advance Access 10.1093/jnci/dju068 Read the rest of the interview on MedicalResearch.com
  • 45. New Marker to Predict Recurrence of Hepatocellular Carcinoma MedicalResearch.com Interview with: Wei-ping Zhou, MD, PhD Department of Hepatic Surgery Eastern Hepatobiliary Surgery Hospital Shanghai, China • MedicalResearch.com: What are the main findings of the study? • Answer: The main finding is that Quantitative HBsAg can be used as a new prognostic factor of Hepatocellular Carcinoma recurrence after partial hepatectomy in patients with a low HBV-DNA level. • MedicalResearch.com: Were any of the findings unexpected? • Answer: We are some surprised to our results. It is difficulty to find a good marker which actually reflects the status of HBV infection and predicts postoperative prognosis in HCC patients with a low HBV-DNA load. Previous study showed that HBsAg assay using a quantitative measure could indicate activity of HBV infection and high HBsAg level (HBsAg >1000 IU/ml) can be used as an independent risk factor of HCC development. Our results suggested that HBsAg level may be used to complement HBV-DNA level in predicting Hepatocellular Carcinoma recurrence, especially in patients with low HBV-DNA levels. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: Our results suggested that low HBV-DNA did not represent inactivity and low HBsAg level maybe represent true inactivity. We should pay more attention to the Hepatocellular Carcinoma patients with low HBV-DNA level but high HBsAg level. There were still activity of in some of this patients. This patients should be under more close supervision. • Citation: Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels Huang G, Lau W, Zhou W, et al. Prediction of Hepatocellular Carcinoma Recurrence in Patients With Low Hepatitis B Virus DNA Levels and High Preoperative Hepatitis B Surface Antigen Levels. JAMA Surg. 2014;():. doi:10.1001/jamasurg.2013.4648. Read the rest of the interview on MedicalResearch.com
  • 46. Heart Failure Treatment with Diuretic Spironolactone MedicalResearch.com Interview with: Marc A. Pfeffer, M.D., Ph.D. Dzau Professor of Medicine Harvard Medical School Cardiovascular Division Brigham and Women’s Hospital • MedicalResearch.com: What are the main findings of the study? • Dr. Pfeffer: We randomized 3445 patients with symptomatic heart failure and a left ventricular ejection fraction greater than or equal to 45% (heart failure with preserved ejection fraction or diastolic heart failure) to spironolactone or placebo and followed them for over 3 years. Our primary outcome the composite of death from cardiovascular causes, aborted cardiac arrest, or hospitalization for management of heart failure was not significantly reduced in the group randomized to spironolactone. We did, however, observe that fewer patients in the spironolactone group were hospitalized for the management of heart failure following randomization. Spironolactone therapy was associated with higher incidence of hyperkalemia and rises in serum creatinine. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Pfeffer: This NHLBI Sponsored study was conducted in six countries and we found a marked regional heterogeneity in the event rates in the placebo-treated arms. In Russia and Georgia, the prognosis of the patients randomized was more benign than in the four other countries in the Americas. Read the rest of the interview on MedicalResearch.com
  • 47. Heart Failure Treatment with Diuretic Spironolactone MedicalResearch.com Interview with: Marc A. Pfeffer, M.D., Ph.D. Dzau Professor of Medicine Harvard Medical School Cardiovascular Division Brigham and Women’s Hospital • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Pfeffer: With the neutral primary finding, our observation of lower risk for subsequent hospitalizations for heart failure must be considered as non-definitive. However, we believe this is a noteworthy finding for this difficult to manage population and, if physicians choose to use spironolactone, the importance of monitoring electrolytes and renal function must be underscored. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Pfeffer: Our study does highlight the heterogeneity of outcomes in patients with signs and symptoms of heart failure yet a relatively preserved ejection fraction. Attempts to better phenotype this diverse group of patients perhaps using echocardiographic measurements beyond ejection fraction and ascertainment of biomarkers such as BNP may help future studies. • Citation: • Spironolactone for Heart Failure with Preserved Ejection Fraction • Bertram Pitt, M.D., Marc A. Pfeffer, M.D., Ph.D., Susan F. Assmann, Ph.D., Robin Boineau, M.D., Inder S. Anand, M.D., Brian Claggett, Ph.D., Nadine Clausell, M.D., Ph.D., Akshay S. Desai, M.D., M.P.H., Rafael Diaz, M.D., Jerome L. Fleg, M.D., Ivan Gordeev, M.D., Ph.D., Brian Harty, M.A., John F. Heitner, M.D., Christopher T. Kenwood, M.S., Eldrin F. Lewis, M.D., M.P.H., Eileen O’Meara, M.D., Jeffrey L. Probstfield, M.D., Tamaz Shaburishvili, M.D., Ph.D., Sanjiv J. Shah, M.D., Scott D. Solomon, M.D., Nancy K. Sweitzer, M.D., Ph.D., Song Yang, Ph.D., and Sonja M. McKinlay, Ph.D. for the TOPCAT Investigators • N Engl J Med 2014; 370:1383-1392 April 10, 2014 Read the rest of the interview on MedicalResearch.com
  • 48. Mental Illness Raises Risk of HIV Infection MedicalResearch.com Interview with: Michael B. Blank, PhD Associate Professor of Psychology in Psychiatry Perelman School of Medicine University of Pennsylvania Philadelphia, PA 19104-3309 • MedicalResearch.com: What are the main findings of the study? • Dr. Blank: We found that people in treatment for mental illnesses in inpatient and outpatient settings in Philadelphia and Baltimore were about times as likely to be infected with HIV as the general population in those cities and about 16 times as likely to be HIV infected as the general population of the US. We also found that severity of psychiatric symptoms increased the likelihood of infection. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Blank: We found the same patterns of risk related to substance use and sex with men who have sex with men was true for people with mental illness as in the general population. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Blank: We suggest that routine HIV testing should be conducted in all mental health clinics in accordance with CDC and IOM guidelines. At the very least I hope that mental health professionals learn that collectively, the people they serve are at higher risk for HIV and other infectious diseases. I also hope that it adds to the growing evidence that mental health centers can serve as “health homes” for their consumers, and incorporate simple point-of-care testing not just for HIV, but also for other common conditions that disproportionately affect persons with mental illness such as diabetes, hypertension, hyperlipidemia, obesity and the like. Depending on the level of expertise available in a particular clinic, they can either refer out or provide integrated care in-house. In either case, they can also reinforce adherence to treatment regimens for chronic co-occurring conditions. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Blank: It is important to conduct controlled studies of the effectiveness of different treatments for people with complex co-occurring conditions such as HIV and mental illness. Cost-effectiveness information is also important in order to inform health policy moving forward. • Citation: • A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings • Michael B. Blank, Seth S. Himelhoch, Alexandra B. Balaji, David S. Metzger, Lisa B. Dixon, Charles E. Rose, Emeka Oraka, Annet Davis-Vogel, William W. Thompson, and James D. Heffelfinger. (2014). A Multisite Study of the Prevalence of HIV With Rapid Testing in Mental Health Settings. American Journal of Public Health. e-View Ahead of Print. • doi: 10.2105/AJPH.2013.30163 Read the rest of the interview on MedicalResearch.com
  • 49. Poor Urban Dwellers At Greater Risk of Contracting, Dying from AIDS MedicalResearch.com Interview with: Amy Nunn, ScD, MS Assistant professor (research) of Behavioral and Social Sciences Brown University School of Public Health • MedicalResearch.com: What are the main findings of the study? • Answer: The main findings are that people living in poor, mostly-minority urban neighborhoods, where health resources such as HIV testing and linkages to care are often lacking, are at a greater risk of contracting HIV and dying of AIDS. This is not because of differences in behavior. It’s because they live in medically underserved areas where HIV incidence is very high and fewer people know their status. Fewer people knowing their status means fewer people on treatment. Fewer people on treatment means it’s easier for people to come into contact with the virus, even if they don’t engage in any higher risk behavior. • In the paper, my colleagues and I call for increasing the focus of public health efforts on these neighborhoods where the epidemic is concentrated and contributing heavily to racial and economic disparities in AIDS mortality. Read the rest of the interview on MedicalResearch.com
  • 50. Poor Urban Dwellers At Greater Risk of Contracting, Dying from AIDS MedicalResearch.com Interview with: Amy Nunn, ScD, MS Assistant professor (research) of Behavioral and Social Sciences Brown University School of Public Health • MedicalResearch.com: Were any of the findings unexpected? • Answer: Even for people who are well versed in the extent of the epidemic, it can still be shocking that HIV incidence is eight times higher for African-Americans and three times higher among Hispanics than among whites. In some of the urban neighborhoods we discuss in the paper, the reported rates of infection rival those reported in sub-Saharan Africa. • We also found that your chances of surviving with HIV are a function of where you live in the United States. • Lastly, we demonstrated that several campaigns have been effective in promoting HIV screening and treatment across entire neighborhoods. These campaigns should be replicated in other parts of the country. • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: The epidemic is heavily concentrated in certain neighborhoods of many cities, such as New York, Philadelphia, Washington DC, and across the Deep South. Clinicians who are practicing medicine in areas of the country with high rates of HIV infection should be offering everyone who walks into their office an HIV test as part of their routine clinical care. In our Philadelphia project, a federally qualified health center we partner with offers HIV screening at the same time that patients’ vital signs are taken. This is a very effective way to address this problem. Read the rest of the interview on MedicalResearch.com
  • 51. Poor Urban Dwellers At Greater Risk of Contracting, Dying from AIDS MedicalResearch.com Interview with: Amy Nunn, ScD, MS Assistant professor (research) of Behavioral and Social Sciences Brown University School of Public Health • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: I and some of my co-authors have been engaged in such campaigns (I’ve been working in Philadelphia, PA and Jackson, Miss.) Others have been working in other cities. We need to study the results and best practices of working in neighborhoods with media, local institutions and leaders and by going door-to-door to promote testing and treatment. Then we need to generate new campaigns and assess their impact. We also need to engage community leaders in these communities to ask them how to do this in a way that makes sense for their neighborhoods. • Citation: • Amy Nunn, Annajane Yolken, Blay Cutler, Stacey Trooskin, Phill Wilson, Susan Little, Kenneth Mayer. Geography Should Not Be Destiny: Focusing HIV/AIDS Implementation Research and Programs on Microepidemics in US Neighborhoods. American Journal of Public Health, 2014; 104 (5): 775 DOI: 10.2105/AJPH.2013.301864 Read the rest of the interview on MedicalResearch.com
  • 52. Rheumatoid Arthritis Patients Have Higher Risk of Kidney Disease MedicalResearch.com Interview with: Eric Matteson, M.D. Chairman of Rheumatology Mayo Clinic, Rochester, Minn • MedicalResearch.com: What are the main findings of the study? • Dr. Matteson: “The main points are that kidney disease is more common in patients with rheumatoid arthritis than in the general population and that moderate reduction in kidney function was more likely to be associated with cardiovascular disease in these patients as well. Patients with more active disease week are also at higher risk for kidney disease. “ • MedicalResearch.com: Were any of the findings unexpected? • Dr. Matteson: “This is the first large study that examined this question. We did not know what to expect starting out, but did think that as patients with rheumatoid arthritis have more vascular disease, and are taking medications which might affect renal function, we might find a relationship between having rheumatoid arthritis and a higher risk for developing kidney disease.” • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Matteson: “Clinicians should be aware of this risk, and consider monitoring patients for renal disease, as well as making every effort to avoid medications such as NSAIDs that may worsen kidney disease and paying particular attention to blood pressure control and disease control of the rheumatoid arthritis in these patients. “ • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Matteson: “Future studies could focus on measures for risk reduction, and assessment of these measures. A particular area of interest would be to longitudinally follow patients to see how disease control of rheumatoid arthritis affects risk of kidney disease. “ • Citation: • Development of Reduced Kidney Function in Rheumatoid Arthritis • LaTonya J. Hickson, Cynthia S. Crowson, Sherine E. Gabriel, James T. McCarthy, Eric L. Matteson • American Journal of Kidney Diseases – February 2014 (Vol. 63, Issue 2, Pages 206-213, DOI: 10.1053/j.ajkd.2013.08.010) Read the rest of the interview on MedicalResearch.com
  • 53. Decreased Cancer Mortality In Patients With Faster Cognitive Decline MedicalResearch.com Interview with: Julian Benito-Leon University Hospital “12 de Octubre”, Madrid, Spain • MedicalResearch.com: What are the main findings of the study? • Dr. Benito-León: It has been suggested that a major problem with epidemiologic studies that have reported an inverse association between Alzheimer’s disease and cancer is the very likely underdiagnosis of cancer once dementia has been diagnosed. The results of the current study suggest that elderly people without dementia with faster cognitive decline are at reduced risk of mortality from malignant neoplasm. Indeed, the current study GIVES CREDIBILITY TO the inverse association of both conditions, recognized in other studies, since there was no possibility of underdiagnosis of cancer because the subjects with a faster cognitive decline were nondemented, • Cognitively healthy elderly people who are experiencing subtle cognitive decline within the normal range may be undergoing a clinically silent pathologic cascade of brain changes, during this phase, with b-amyloid deposition as the primary event in this cascade. Neural cells may become vulnerable to cytotoxicity by amyloid-forming peptides, such as b-amyloid, which shares the same mechanism of toxicity with host defense peptides, components of innate immune response, whose mission is to eradicate a broad range of microbes and cancer cells. Read the rest of the interview on MedicalResearch.com
  • 54. Decreased Cancer Mortality In Patients With Faster Cognitive Decline MedicalResearch.com Interview with: Julian Benito-Leon University Hospital “12 de Octubre”, Madrid, Spain • MedicalResearch.com: Were any of the findings unexpected? • Dr. Benito-León: No, they weren’t. In NEDICES (the population-based study we conducted) study we also demonstrated that Alzheimer’s disease decreased the risk of cancer mortality (please, see attached the paper). Therefore, after demonstrating that association, just next, I analyzed the current association (nondemented with faster cognitive decline and decreased risk of cancer mortality) in our dataset and found these results. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Benito-León: As I said previously, the current study GIVES CREDIBILITY TO the inverse association of Alzheimer’s disease and cancer. If we disentangle the mechanisms related to a decreased risk of cancer in Alzheimer’s disease, we could develop improved drugs to treat each one of the two conditions. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Benito-León: More studies are needed to try to determine the mechanisms behind this relationship between a disease that causes abnormal cell death and one that causes abnormal cell growth. With the increasing number of people with both dementia and cancer, understanding this association could help us better understand and treat both diseases. • Citation: • Faster cognitive decline in elders without dementia and decreased risk of cancer mortality: NEDICES StudyJournal of Alzheimer’s Disease 40 (2014) 465–473 DOI 10.3233/JAD-132048 • Read the rest of the interview on MedicalResearch.com
  • 55. Chronic Hepatitis C: Combination Pill Achieves High Cure Rates MedicalResearch.com Interview with: Kris V. Kowdley, MD Director of Research & Director of the Liver Center of Excellence Digestive Disease Institute Virginia Mason Medical Center Seattle, WA 98111 • MedicalResearch.com: What are the main findings of the study? • Dr. Kowdley: A fixed-dose combination of ledipasvir and sofosbuvir in chronic Hepatitis C (HCV) genotype 1 patients without cirrhosis for 8 weeks without ribavirin was equally effective as the same combination with ribavirin added and also a 12 week combination of ledipasvir-sofosbuvir (without ribavirin). MedicalResearch.com: Were any of the findings unexpected? • Dr. Kowdley: No, but the study highlights that a large number of patients may be cured with this combination pill without ribavirin. • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Kowdley: Treatment of chronic HCV genotype 1 in patients without cirrhosis with a combination pill once a day for 8 weeks can achieve high rates of cure. • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Kowdley: To perform additional studies explore whether these results also apply in patients with cirrhosis. • Citation: • Ledipasvir and Sofosbuvir for 8 or 12 Weeks for Chronic HCV without Cirrhosis • NEJM April 12, 2014 | N. Afdhal and Others (DOI: 10.1056/NEJMoa1402454 • International Liver Congress 2014 Read the rest of the interview on MedicalResearch.com
  • 56. Tooth Loss Associated with Risk Factors for Coronary Heart Disease MedicalResearch.com Interview with: Dr Ola Vedin University of Uppsala, Sweden • MedicalResearch.com: What are the main findings of the study? • Dr. Vedin: That self-reported tooth loss as a marker of periodontal disease is common in patients with established coronary heart disease and is associated with higher levels of LDL cholesterol, glucose levels, systolic blood pressure and waist circumference as well as diabetes and smoking, i.e. risk factors for coronary heart disease. Gum bleeding, another marker of periodontal disease, was associated with higher levels of LDL cholesterol and systolic blood pressure. In summary, patients with few remaining teeth and gum bleeding demonstrated a heavier burden of cardiovascular risk factors. • MedicalResearch.com: Were any of the findings unexpected? • Dr. Vedin: That as many as 40% of all patients had fewer than 15 remaining teeth, roughly corresponding to less than half of their teeth left. There were substantial differences in prevalence between geographic regions but more surprising were the differences in prevalence seen between countries even within the same region. We were also surprised by the association between tooth loss and such a wide spectrum of cardiovascular risk factors. Read the rest of the interview on MedicalResearch.com
  • 57. Tooth Loss Associated with Risk Factors for Coronary Heart Disease MedicalResearch.com Interview with: Dr Ola Vedin University of Uppsala, Sweden • MedicalResearch.com: What should clinicians and patients take away from your report? • Dr. Vedin: Our report shows that self-reported periodontal disease and more specifically, self- reported tooth loss and gum bleeding are linked to several cardiovascular risk factors in patients who have coronary heart disease. This could support the possibility that periodontal disease and coronary heart disease are two associated conditions. However, our results cannot determine whether an independent association between periodontal disease and coronary heart disease exists. Therefore, judging by these results, we cannot, for instance, advocate periodontal therapy as a means to reduce coronary heart disease. In order to determine this, further studies are needed. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Dr. Vedin: The next step for us will be very important and is currently being planned, namely to determine whether these associations also translate into adverse cardiovascular outcomes for the patients. Outside of our planned analyses, this scientific field would also really benefit from an intervention study, i.e to determine whether periodontal treatment reduces cardiovascular events. That would truly answer the question of causality between the conditions but such a study would face substantial challenges for many reasons. • Citation: • Periodontal disease in patients with chronic coronary heart disease: Prevalence and association with cardiovascular risk factors • Should dental health now be considered a marker of coronary heart disease? • Presented April 10 2014 at European Journal of Preventive Cardiology. Read the rest of the interview on MedicalResearch.com
  • 58. Early Alzheimer’s Detection Using Computerized Cognitive Screening MedicalResearch.com Interview with: Ioannis Tarnanas M.Sc Senior Researcher Gerontechnology and Rehabilitation Research Group, ARTORG Centre for Biomedical Engineering, University of Bern, 3010 Bern, Switzerland • MedicalResearch.com: What are the main findings of the study? • Answer: We examined 75 healthy older people and 134 patients with mild cognitive impairment. Our aim was to collect neuropsychological, neurophysiological, neuroimaging and behavioural data by means of a virtual reality serious game, in order to model the profile of the patients who will progress to dementia within the next 2-4 years. We found that the prediction based on the performance at the virtual reality based computerized assessment instrument is comparable to that of more established and widely accepted biomarkers, such as ERP and MRI. This can be explained by the cognitive fidelity and richness of behavioural data collected with virtual reality based measures, which directly reflect neurocognitive processes affected at a very early stage. MedicalResearch.com: Were any of the findings unexpected? • Answer: Our findings were not expected because the research investigating the usefulness of biomarkers, such as ERP and MRI for the prediction of dementia is ongoing for a couple of decades, whereas research in the field of virtual reality based serious games for the early detection of dementia is quite recent. Previous studies were using virtual reality environments in order to evaluate its predictive value between healthy older people and Alzheimer’s Disease but not within patients with mild cognitive impairment. Read the rest of the interview on MedicalResearch.com
  • 59. Early Alzheimer’s Detection Using Computerized Cognitive Screening MedicalResearch.com Interview with: Ioannis Tarnanas M.Sc Senior Researcher Gerontechnology and Rehabilitation Research Group, ARTORG Centre for Biomedical Engineering, University of Bern, 3010 Bern, Switzerland • MedicalResearch.com: What should clinicians and patients take away from your report? • Answer: There is a growing interest in the use of computerized behavioural data screening technologies, such as digital apps and serious games as an early screening a valid and reliable indicator of cognitive decline in elderly persons. If virtual reality based computerized assessments are to be widely recognized as an early screening tool for early dementia, there need to be more longitudinal clinical trials and correlations with more biomarkers, such as cerebrospinal fluid (CSF). This will enable clinicians to better clinically validate our cut-off scores. • MedicalResearch.com: What recommendations do you have for future research as a result of this study? • Answer: This research was partially funded by the European project PharmaCog (Prediction of Cognitive Properties of New Drug Candidates for Neurodegenerative Diseases in Early Clinical Development). PharmaCog was started in 2010, and it is a partnership of 32 academic and industry actors from seven countries and one of the most ambitious European projects for tackling bottlenecks in Alzheimer’s disease research and drug discovery. We believe that serious gaming shows great promise as a novel computerized assessment of cognition and could assist Alzheimer’s disease research and drug discovery by creating early screening behavioural profiles for Alzheimer disease using low cost, internet delivered and non-invasive out-of-the box technologies. • Citation: • Can a novel computerized cognitive screening test provide additional information for early detection of Alzheimer’s disease? • Ioannis Tarnanas, Magda Tsolaki, Tobias Nef, René M. Müri, Urs P. Mosimann • Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association – 20 March 2014 (10.1016/j.jalz.2014.01.002) Read the rest of the interview on MedicalResearch.com
  • 60. Meningococcal Vaccine Menveo Response in Adolescents MedicalResearch.com Interview with: Roger Paul Baxter, MD Co-Director Kaiser Permanente Vaccine Study Center Oakland, CA 94612. • MedicalResearch.com What are the main findings of the study? • Dr. Baxter: Menveo, the currently licensed CRM-conjugate meningococcal vaccine, showed an excellent booster response in adolescents, regardless of which conjugate vaccine they had received previously. Also, although titers from the priming dose waned, at 3 years there were still protective antibodies in the majority of immunized individuals. The other US-licensed meningococcal conjugate vaccine, Menactra, uses a different protein conjugate. MedicalResearch.com Were any of the findings unexpected? • Dr. Baxter: No, based on prior studies, and from what is known about conjugate vaccine, a good booster dose was expected. These are very good vaccines. • MedicalResearch.com What should clinicians and patients take away from your report? • Dr. Baxter: This conjugate vaccine provides protection from meningococcal disease with one dose for several years, and a booster drives antibodies to high levels. The immune response to Group A, the predominant serotype in the African meningococcal belt, is not as good as to the other serotypes, which are more common in the US. • MedicalResearch.com What recommendations do you have for future research as a result of this study? • Dr. Baxter: We need to know how long the booster protects, and if there is any way to increase the response to serotype A. • • Citation: • Antibody Persistence and Booster Response of a Quadrivalent Meningococcal Conjugate Vaccine in Adolescents. • Baxter R, Reisinger K, Block SL, Izu A, Odrljin T, Dull P The Journal of Pediatrics – 24 March 2014 (10.1016/j.jpeds.2014.02.025) Read the rest of the interview on MedicalResearch.com

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