Published on February 23, 2014
MedicalResearch.com Exclusive Interviews with Medical Research and Health Care Researchers Editor: Marie Benz, MD firstname.lastname@example.org February 22 2014 For Informational Purposes Only: Not for Specific Medical Advice.
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Maternal Influenza and Offspring Bipolar Disorder MedicalResearch.com Interview with: Alan S. Brown, M.D., M.P.H. Professor of Clinical Psychiatry and Clinical Epidemiology College of Physicians and Surgeons of Columbia University Director Unit in Birth Cohort Studies Division of Epidemiology New York State Psychiatric Institute New York, NY • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Brown: We found that a mother’s exposure to influenza during pregnancy, documented by antibodies in her serum, increased the risk of bipolar disorder with psychotic symptoms in her offspring. We did not show a relationship between influenza and bipolar disorder not accompanied by psychosis. MedicalResearch.com: Were any of the findings unexpected? Dr. Brown: We had expected to find a relationship between influenza and bipolar disorder without psychotic symptoms based on my previous study; however, influenza was assessed differently between the two studies. And my lab previously showed that prenatal influenza increased the risk of schizophrenia, so the findings of our current study were consistent with an effect of prenatal influenza on psychosis in general, rather than on a particular type of psychotic disorder. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Brown: The study provides support for influenza vaccinations in women planning a pregnancy and to consider vaccination while pregnant as recommended by several health organizations. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Brown: We wish to replicate the finding in other samples and examine the pathway by which maternal influenza and other inflammatory insults alter fetal brain development to lead to psychosis outcomes. Citation: Serological Documentation of Maternal Influenza Exposure and Bipolar Disorder in Adult Offspring Sarah E. Canetta, Ph.D.; Yuanyuan Bao, M.S.; Mary Dawn T. Co, M.D.; Francis A. Ennis, M.D.; John Cruz, B.S.; Masanori Terajima, M.D., Ph.D.; Ling Shen, Ph.D.; Christoph Kellendonk, Ph.D.; Catherine A. Schaefer, Ph.D.; Alan S. Brown, M.D., M.P.H. Am J Psychiatry 2014;:. doi:10.1176/appi.ajp.2013.13070943 Read the rest of the interview on MedicalResearch.com
COPD: Risk from Chinese WaterPipe Smoking MedicalResearch.com Interview with: Chunxue Bai, MD & PhD Director, Shanghai Respiratory Research Institute Professor of Medicine, Chairman, Shanghai Leading academic discipline Chair, Chinese Alliance against Lung Cancer • • • • • • • • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Bai: Recently, we found a dilemma phenomenon that the incidence of chronic obstructive pulmonary disease (COPD) and lung cancer has remained high in southwest China despite the 1976 National Stove Improvement Program for indoor air quality. However, little information is known to the public about a regional endemic related to Chinese waterpipe smoking, which is different from the Arabic waterpipe. The Chinese waterpipe has been traditionally misconceived as less harmful for three reasons: (1) no charcoal was used in contrast to the Arabic waterpipe, (2) tobacco smoke passed through the water as opposed to cigarette smoking and (3) smoking through a large volume waterpipe could “improve lung function.” In our study, we provide robust results that the large volume Chinese waterpipe use and exposure are associated with the elevated prevalence of COPD, which have been identified by epidemiologic, physiologic, radiology, and toxicologic findings for the first time. MedicalResearch.com: Were any of the findings unexpected? Dr. Bai: Noted is the five individuals in our study who were tested and confirmed as having lung cancer by computed tomography (CT) and pathology evaluations: 3 CWS (lung adenocarcinoma) 1 CWPS (lung adenocarcinoma) and 1 CS (lung squamous cell carcinoma). It will cause our attention and strengthen the monitoring of lung cancer. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Bai: The Chinese waterpipe has been mistaken as less harmful. Our study has provided evidence confirming this misconception. Exposure to active and passive Chinese waterpipe smoke may be a significant risk factor for developing COPD. The damage from Chinese waterpipe use and exposure are worse than cigarette. Our results highlight smoking cessation in Chinese waterpipe users is as important as in other tobacco products in preventive intervention of COPD. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Bai: In addition to Chinese waterpipe use and exposure are associated with COPD; the PM2.5 from the Chinese waterpipe smoke was twice as high as from cigarette smoke. Our results also predict the prevalence of COPD will be increased by long-term exposure to high concentrations of PM2.5, which will bring a huge economic and social burden to the globe and calls for more research to be directed toward preventive measures and efforts. Citation: Chinese waterpipe smoking and the risk of chronic obstructive pulmonary disease She J, Yang P, Wang Y, et al. Published online February 20, 2014. doi:10.1378/chest.13-1499. Chest. 2014. doi:10.1378/chest.13-1499 Read the rest of the interview on MedicalResearch.com
Atrial Fibrillation: Ablation Found Superior to Conventional Drug Therapy MedicalResearch.com Interview with: Carlos A. Morillo, MD, FRCPC, FACC, FHRS, FESC Professor Department of Medicine, Cardiology Division Program Director Cardiac Electrophysiology and Autonomic Physiology Fellowship ,Hamilton, ON, Canada • • • • • • • • • MedicalResearch.com Interview with: Carlos A. Morillo, MD, FRCPC, FACC, FHRS, FESC Professor Department of Medicine, Cardiology Division Program Director Cardiac Electrophysiology and Autonomic Physiology Fellowship ,Hamilton, ON, Canada MedicalResearch.com: What are the main findings of the study? Dr. Morillo: The main findings were that Ablation of atrial fibrillation was superior to conventional antiarrythmic drug therapy in patients with Paroxysmal atrial fibrillation that had not been treated with Antiarrhythmic medications. Ablation extended the time to first recurrence of atrial fibrillation within the 2 year follow-up of the study and significantly reduced the recurrence of repeated episodes of AF. MedicalResearch.com: Were any of the findings unexpected? Dr. Morillo: Not really many studies have shown that ablation is better than medications but in patients that have previously failed Antiarrhythmic drug treatment. We were expecting a greater effect of ablation but still documented a 44% relative risk reduction in recurrence of AF. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Morillo: This study provides further support to offering ablation as first line treatment of Atrial fibrillation in young patients with paroxysmal atrial fibrillation that have not received Antiarrhythmic drugs previously. The procedure is not free of risks and this procedure should be performed in centres with experience managing patients with atrial fibrillation. Citation: Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2)A Randomized Trial Morillo CA, Verma A, Connolly SJ, et al. Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2): A Randomized Trial. JAMA. 2014;311(7):692-700. doi:10.1001/jama.2014.467. Read the rest of the interview on MedicalResearch.com
Colon Cancer Patients Have Less Diverse Gut Bacteria MedicalResearch.com Interview with: Jiyoung Ahn, PhD Assistant Professor of Epidemiology Department of Population Health NYU School of Medicine New York, NY 10016 • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Ahn: Before we did our research, it was suspected that gut bacteria were related to colorectal cancer. We, for the first time, found colorectal cancer patients have a different gut bacteria composition than healthy subjects. MedicalResearch.com: Were any of the findings unexpected? Dr. Ahn: Not really. Humans host trillions of gut bacteria that help in digestion and other normal functions. The diverse types of bacteria are important to carry out these activities. A decrease in diversity may indicate a lack of balance in the complex bacterial population. Our research shows that subjects with colon cancer have a less diverse population of gut bacteria. It will take more research to determine if this decreased diversity leads to colon cancer or is a response to having the disease. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Ahn: This research, although in an early stage, is pointing to the possibility that gut microbes are involved in colon cancer development. If this is correct, the research could open up new ways to protect from this serious disease. Beyond our research program, it remains important now to maintain a healthy diet and follow physician recommendations for screening for the early detection of colon cancer. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Ahn: Our group is working on diet and lifestyle factors determining gut microbe profile. For example, dietary factors, such as dietary fruit and vegetable and bean intakes, rich sources of dietary fiber, and obesity are suspected factors. Citation: Human Gut Microbiome and Risk for Colorectal Cancer Jiyoung Ahn, Rashmi Sinha, Zhiheng Pei, Christine Dominianni, Jing Wu, Jianxin Shi, James J. Goedert, Richard B. Hayes, and Liying Yang Human Gut Microbiome and Risk of Colorectal Cancer JNCI J Natl Cancer Inst djt300 doi:10.1093/jnci/djt300 first published online December 6, 2013 Read the rest of the interview on MedicalResearch.com
After Ear Tubes: Eardrops Found Superior to Oral Antibiotics for Ear Discharge MedicalResearch.com Interview with: Dr. T. M. A van Dongen, MD Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care, Dept Epidemiol Utrecht, Netherlands. • • MedicalResearch.com: What are the main findings of the study? Answer: We performed a pragmatic trial, in which we randomly assigned 230 children who had acute tympanostomy-tube otorrhea to receive antibiotic-glucocorticoid eardrops, oral antibiotics or to undergo initial observation. The primary outcome of our study was the presence of ear discharge, 2 weeks after study-group assignment. We also looked at, among others, the duration of the initial otorrhea episode and the total number of days of otorrhea and the number of otorrhea recurrences during 6 months of followup. We found that antibiotic–glucocorticoid eardrops were superior to oral antibiotics and initial observation for all outcomes. • • MedicalResearch.com: Were any of the findings unexpected? Answer: Since acute tympanostomy-tube otorrhea, like acute otitis media, can be self-limiting, initial observation was thought by some to be a good alternative for antibiotic treatment. We are the first to compare the effectiveness of oral or topical treatment with initial observation. Approximately one in two children managed by initial observation still had otorrhea at 2 weeks and initial observation resulted in more days with otorrhea in the following months than did topical or oral antibiotics. So our results actually suggest that initial observation is not an adequate management strategy in such children. MedicalResearch.com: What should clinicians and patients take away from your report? Answer: · Standard patient information usually advises parents to contact a physician when their child’s symptoms of tube otorrhea persist for more than a week. At that stage, so when parents contact a physician, recommendations from clinical practice guidelines vary widely: some advise physicians to manage with oral antibiotics or more observation, while others suggest prescribing antibiotic eardrops. We recommend updating current patient information and clinical practice guidelines. Our results show it’s best to inform parents to contact a physician when otorrhea occurs, rather than waiting for a week or more to see if otorrhea abates without treatment. In addition, we recommend physicians to treat these children with eardrops shortly after onset of symptoms. • • • Read the rest of the interview on MedicalResearch.com
After Ear Tubes: Eardrops Found Superior to Oral Antibiotics for Ear Discharge MedicalResearch.com Interview with: Dr. T. M. A van Dongen, MD Univ Med Ctr Utrecht Julius Ctr Hlth Sci & Primary Care, Dept Epidemiol Utrecht, Netherlands. • • • • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: For many years, the use of topical antibiotics in children with acute tympanostomy-tube otorrhea has been questioned for their presumed inability to reach the middle ear. In vivo studies in children with a ‘clean’ ear canal and patent tympanostomy tube as well as in vitro studies reported low rates of spontaneous penetration of eardrops into the middle ear. These studies raised even more doubt about eardrops reaching the middle ear in children with active tube otorrhea. Yet our study of children with middle ear fluid visibly draining through the tympanostomy tube into the ear canal showed that eardrops were highly effective, indicating that its active components do reach the site of infection. As such, one could therefore question whether antibiotic(-glucocorticoid) eardrops may also be effective in children without tubes who develop acute otitis media and present with spontaneous otorrhea. So far, this has not been evaluated in a randomized clinical trial, presumably based upon the same rationale, i.e. that the eardrops would not reach the infected middle ear. Since topical treatment is usually well tolerated, causes no systemic side effects and is less likely to cause antimicrobial resistance as compared to oral antibiotics, a trial of the effectiveness of topical antibiotics versus oral antibiotics in children with acute otitis media presenting with spontaneous otorrhea seems warranted. Citation: A Trial of Treatment for Acute Otorrhea in Children with Tympanostomy Tubes hijs M.A. van Dongen, M.D., Geert J.M.G. van der Heijden, Ph.D., Roderick P. Venekamp, M.D., Ph.D., Maroeska M. Rovers, Ph.D., and Anne G.M. Schilder, M.D., Ph.D. N Engl J Med 2014; 370:723-733 February 20, 2014DOI: 10.1056/NEJMoa1301630 Read the rest of the interview on MedicalResearch.com
Glioblastoma: Avastin Did Not Improve Survival or Symptoms MedicalResearch.com Interview with: Minesh P. Mehta, M.B., Ch.B. F.A.S.T.R.O. Professor of Radiation Oncology, University of Maryland School of Medicine Radiation oncologist, University of Maryland Marlene and Stewart Greenebaum Cancer Center • • • • MedicalResearch.com: What are the main findings of the study? Dr. Mehta: RTOG 0825 was a clinical trial evaluating whether the addition of a novel drug that inhibits tumor vascular growth, bevacizumab, to the standard of care for glioblastoma, an aggressive brain tumor, would prolong survival. Patients were allocated randomly to one of two different treatment regimens – the standard of care, which includes radiotherapy and a drug known as temozolomide, or another regimen of radiation, temozolomide and bevacizumab. The trial design was double-blinded, and therefore, on one arm patients received the bevacizumab, whereas on the other arm they received a placebo. The survival on both arms was equivalent, and therefore it was fairly concluded that bevacizumab failed to prolong survival when given initially as part of treatment for glioblastoma. Freedom from progression, referred to as progression-free survival was also measured on this trial, and although bevacizumab appeared to lengthen progression-free survival, this level of benefit did not meet the pre-defined goals, and is therefore regarded as statistically not demonstrating an improvement. Additional endpoints included outcomes reported by the patient, including the burden of symptoms, and the impact of these on the quality of life, as well as effects on the brain, known as neurocognitive changes. Bevacizumab did not improve these endpoints either. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Mehta: This trial was based on an earlier trial in which patients with recurrent glioblastoma were treated with bevacizumab. In that trial, progression of disease was delayed, and tumor shrinkage on brain MRI scans was noted, resulting in FDA approval for use in recurrent glioblastoma. Based on those results, as well as the known biology of this tumor, there was good expectation that a survival benefit would be observed. Failure to observe that was somewhat unexpected and truly disappointing. Read the rest of the interview on MedicalResearch.com
Glioblastoma: Avastin Did Not Improve Survival or Symptoms MedicalResearch.com Interview with: Minesh P. Mehta, M.B., Ch.B. F.A.S.T.R.O. Professor of Radiation Oncology, University of Maryland School of Medicine Radiation oncologist, University of Maryland Marlene and Stewart Greenebaum Cancer Center • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Mehta: This agent bevacizumab is known to help several patients with recurrent glioblastoma, and the results of this trial should not detract from that; patients and physicians need to keep this in mind and recognize that the drug has value in the recurrent setting. Upfront use cannot be supported in terms of improving duration of survival. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Mehta: improved, but in that trial, the patient-reported outcomes were more favorable for the bevacizumab arm. Therefore, the collective data from both trials regarding these endpoints are expected to be analyzed in greater detail. Further, it is possible that certain subsets of patients might have benefited from the agent, and specific molecular evaluation of individual patients’ tumors is ongoing to tease this out. Citation: A Randomized Trial of Bevacizumab for Newly Diagnosed Glioblastoma Mark R. Gilbert, M.D., James J. Dignam, Ph.D., Terri S. Armstrong, Ph.D., A.N.P.-B.C., Jeffrey S. Wefel, Ph.D., Deborah T. Blumenthal, M.D., Michael A. Vogelbaum, M.D., Ph.D., Howard Colman, M.D., Ph.D., Arnab Chakravarti, M.D., Stephanie Pugh, Ph.D., Minhee Won, M.A., Robert Jeraj, Ph.D., Paul D. Brown, M.D., Kurt A. Jaeckle, M.D., David Schiff, M.D., Volker W. Stieber, M.D., David G. Brachman, M.D., Maria Werner-Wasik, M.D., Ivo W. Tremont-Lukats, M.D., Erik P. Sulman, M.D., Kenneth D. Aldape, M.D., Walter J. Curran, Jr., M.D., and Minesh P. Mehta, M.D. N Engl J Med 2014; 370:699-708 February 20, 2014DOI: 10.1056/NEJMoa1308573 Read the rest of the interview on MedicalResearch.com
Breast Cancer Brain Metastasis: Genomic and Epigenomic Analysis MedicalResearch.com Interview with: Bodour Salhia, PhD Assistant Professor Integrated Cancer Genomics Division Translational Genomics Research Institute Phoenix, Arizona, 85004 • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Salhia: Our study identified novel rare genomic and epigenomic events underlying breast cancer metastasis to brain. We demonstrated that we could molecularly subtype breast cancer brain metastasis the same way we can subtype primary breast cancer. From this analysis we found that the Luminal B subtype was the most common subtype in our cohort, followed by Her2+/ER- enriched tumors and Basal-like tumors. Each of these subtypes displayed genetic and epigenetic features reminiscent of primary breast cancer. We demonstrated that these tumors have a strong predilection to grow by activating pathways involved in G2/M cell cycle progression, whereas, many genes involved in cell migration were epigenetically silenced. Broad amplification of chromosome 8q was common, which resulted in the upregulation of important genes. MedicalResearch.com: Were any of the findings unexpected? Dr. Salhia: Certainly, gain of 8q has been previously described for breast cancer and has been associated with disease progression and poor patient prognosis. What was surprising to us was the amplification of the cMYC oncogene on 8q without concomitant expression. If we assume that the 8q locus is important in the development of brain metastasis, this data suggests that other genes on 8q (not cMYC) may be driving metastasis to brain. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Salhia: This is an important study that integrated multiple genomic datasets to determine underlying molecular characteristics of brain metastasis. Survival with brain metastasis remains quite poor. So we want patients to walk away with a sense of hope, as we get closer to finding better ways to treat this disease. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Salhia: Breast cancer brain metastasis is a really significant problem and a huge unmet need. We now want to dig deeper and uncover more specific genomic links and study new ways to treat these patients so we can dramatically improve outcomes. Citation: Integrated Genomic and Epigenomic Analysis of Breast Cancer Brain Metastasis Bodour Salhia, Jeff Kiefer, Julianna T. D. Ross, Raghu Metapally, Rae Anne Martinez, Kyle N. Johnson, Danielle M. DiPerna, Kimberly M. Paquette, Sungwon Jung, Sara Nasser, Garrick Wallstrom, Waibhav Tembe, Angela Baker, John Carpten, Jim Resau, Timothy Ryken, Zita Sibenaller, Emanuel F. Petricoin, Lance A. Liotta, Ramesh K. Ramanathan, Michael E. Berens, Nhan L. Tran Research Article | published 29 Jan 2014 | PLOS ONE Read the rest of the interview on MedicalResearch.com
Promising Approach to Treat Non-Alcoholic Fatty Liver Disease and Visceral Obesity MedicalResearch.com Interview with: Norbert Stefan, MD Heisenberg Professorship for Clinical and Experimental Diabetology Department of Internal Medicine IV University Hospital Tübingen Tübingen, Germany • • • MedicalResearch.com: What are the main findings of the study? Dr. Stefan: Currently there is little evidence for an effective and safe pharmacological treatment of nonalcoholic fatty liver disease (NAFLD). Based on the fact that inhibition of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), the enzyme, that converts inactive cortisone into active cortisol in metabolic tissues such as liver and adipose, was found to be effective to improve lipid metabolism in animals, we hypothesized that inhibition of 11βHSD1 may also prove to be effective to decrease liver fat content in patients with NAFLD. In our 12 week trial in 82 patients with NAFLD, inhibition of 11β-HSD1 with RO5093151 resulted in a 14 % decrease of liver fat content and in a resolution of NAFLD in 20 % of the patients. This was accompanied by a decrease of liver enzymes. Furthermore, inhibition of 11β-HSD1 brought about a reduction of body weight and total body- and visceral adipose tissue mass, while insulin sensitivity did not change. In agreement with findings from other trials, also in our study 11β-HSD1 inhibition was well tolerated and safe. MedicalResearch.com: Were any of the findings unexpected? Dr. Stefan: These findings were not unexpected. High 11β-HSD1 activity in metabolic tissues as the liver and adipose tissue is known to be closely related to features of the Cushing’s disease. Thus, the observed decrease in liver fat content and visceral adipose tissue mass was in agreement with the expected mode of action of a compound that specifically inhibits 11βHSD1 activity. This supports the hypothesis that targeting 11β-HSD1 is a promising approach to treat NAFLD and visceral obesity. Read the rest of the interview on MedicalResearch.com
Promising Approach to Treat Non-Alcoholic Fatty Liver Disease and Visceral Obesity MedicalResearch.com Interview with: Norbert Stefan, MD Heisenberg Professorship for Clinical and Experimental Diabetology Department of Internal Medicine IV University Hospital Tübingen Tübingen, Germany • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Stefan: Our trial was a phase 1b study. Currently there is no approved drug available that inhibits 11β-HSD1 activity. However, our findings are encouraging in that in more advanced phases such a pharmacological concept may prove to be effective in larger studies. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Stefan: Further clinical studies are now needed to evaluate whether longer term 11β-HSD1 inhibition might be more effective to reduce liver fat content in NAFLD, and whether it may have beneficial effects in non-alcoholic steatohepatitis. In addition, such trials should further explore whether 11β-HSD1 inhibition may qualify as a pharmacological treatment option for obesity. Citation: Inhibition of 11β-HSD1 with RO5093151 for non-alcoholic fatty liver disease: a multicentre, randomised, double-blind, placebo-controlled trial Prof Norbert Stefan MD,Markus Ramsauer PhD,Paul Jordan PhD,Bettina Nowotny MD,Konstantinos Kantartzis MD,Jürgen Machann PhD,Jong-Hee Hwang PhD,Peter Nowotny PhD,Sabine Kahl MD,Jürgen Harreiter MD,Silke Hornemann MD,Prof Arun J Sanyal MD,Prof Paul M Stewart MD,Prof Andreas F Pfeiffer MD,Prof Alexandra Kautzky-Willer MD,Prof Michael Roden MD,Prof Hans-Ulrich Häring MD,Sabine Fürst-Recktenwald MD The Lancet Diabetes & Endocrinology – 17 February 2014 DOI: 10.1016/S2213-8587(13)70170-0 Read the rest of the interview on MedicalResearch.com
Many Pregnant Women Have Not Taken Folic Acid to Reduce Neural Tube Defects MedicalResearch.com Interview with: Prof. Nicholas J. Wald Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry Queen Mary University of London London, United Kingdom • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Prof Wald: The percentage of women who become pregnant without having taken folic acid supplements to reduce the risk of a neural tube defect declined from a relatively low proportion (35%) to an even lower one (31%) between 1999 and 2012. Moreover such use of folic acid in some groups of the population is much lower for example 17% in AfroCaribbean women and 6% in women aged under 20. MedicalResearch.com: Were any of the findings unexpected? Prof Wald: Only about half of women who had already had a neural tube defect pregnancy took folic acid supplements prior to their current pregnancy – a group at much higher risk MedicalResearch.com: What should clinicians and patients take away from your report? Prof Wald: The main takeaway message is directed to public health authorities and governments rather than clinicians or patients. The main message for clinicians and patients is that many women who have already had a neural tube defect pregnancy are not receiving folic acid supplements before pregnancy and these should be routinely offered and prescribed to all such women. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Prof Wald: The message of this paper is not further research, but further action needed. Citation: Prevention of Neural Tube Defects: A Cross-Sectional Study of the Uptake of Folic Acid Supplementation in Nearly Half a Million Women Jonathan P. Bestwick, Wayne J. Huttly, Joan K. Morris, Nicholas J. Wald Research Article | published 19 Feb 2014 | PLOS ONE 10.1371/journal.pone.0089354 Read the rest of the interview on MedicalResearch.com
Increased Sitting Time Linked to Disability MedicalResearch.com Interview with: Dorothy D Dunlop, PhD Professor, Medicine-Rheumatology Center for Healthcare Studies – Institute for Public Health and Medicine and Preventive Medicine Northwestern University Feinberg School of Medicine • • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Dunlop: We know being active, especially doing moderate activity like taking a brisk walk, is good for health. We know a sedentary lifestyle leads to health problems. What we do not know is whether or not those are two ways of looking at the same question. Does being sedentary like sitting just reflect insufficient activity OR is sedentary time is a separate and distinct risk factor for health problems. Our physical activity research group looked at national US data from the National Health and Nutrition Examination Survey. This is an important study because they monitored physical activity using an accelerometer. We found sedentary behavior such as sitting was its own separate risk factor for disability. MedicalResearch.com: Were any of the findings unexpected? Dr. Dunlop: We were impressed at the strength and consistency of the relationship between sedentary time and disability. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Dunlop: “There are two messages here. First, being physically active is very important. It is well documented that recommended levels of moderate activity reduces the risk for disability. Second, being sedentary is a separate and important risk factor. People should focus on both. Be as active as possible. And for people who spend a large portion of their day sitting, it is beneficial to find opportunities to replace some of that sitting with other activities. The bottom line is to stay active and reduce sitting MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Dunlop: Because our study examined data collected at one point in time, it does not determine sedentary behavior causes disability. It does draw our attention to the fact sedentary behavior is a problem. Future studies need to look at the relationship of sedentary time and the subsequent development of disability. Citation: Sedentary Time in U.S. Older Adults Associated With Disability in Activities of Daily Living Independent of Physical Activity JPAH In Press Authors: Dorothy Dunlop1, Jing Song1, Emily Arnston2, Pamela Semanik3, Jungwha Lee4, Rowland Chang4, and Jennifer M. Hootman5 Acceptance Date: November 12, 2013 DOI: http://dx.doi.org/10.1123/jpah.2013-0311 Read the rest of the interview on MedicalResearch.com
Blood Clot Risk Elevated for 12 Weeks After Childbirth MedicalResearch.com Interview with: Dr.Hooman Kamel MD Department of Neurology and the Brain and Mind Research Institute Weill Cornell Medical College in New York City. • • MedicalResearch.com: What are the main findings of the study? Dr. Kamel: The risk of thrombotic events remains higher than normal for twice as long after childbirth as previously thought. However, the absolute risk in any given patient is low, especially after the first 6 weeks. • • MedicalResearch.com: Were any of the findings unexpected? Dr. Kamel: Our hypothesis was that the risk of thrombotic events would be higher than normal beyond 6 weeks, and that is indeed what we found. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Kamel: Patients and providers should be aware that thrombotic risk remains elevated until 12 weeks after delivery, so that any symptoms of possible thrombosis (e.g., shortness of breath, chest pain, leg swelling or pain, sudden neurological symptoms) are evaluated appropriately. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Kamel: Our findings suggest that future studies should evaluate the risks and benefits of extended postpartum prophylactic therapy in high-risk women (e.g., those with prior thrombosis). Citation: Risk of Thrombosis Remains Elevated for 12 Weeks After Labor and Delivery American Stroke Association 2014 Meeting Report: ISC abstract: Abstract: 216 • • • • • • • Read the rest of the interview on MedicalResearch.com
Advanced Cervical Cancer: Adding Avastin to Chemotherapy Prolonged Survival MedicalResearch.com Interview with: Krishnansu S. Tewari, MD, FACOG, FACS| Professor & Director of Research Principal Investigator – The Gynecologic Oncology Group at UC Irvine, Division of Gynecologic Oncology University of California, Irvine Medical Center Orange, CA 92868 • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Tewari: The main findings of this study were that the addition of bevacizumab to chemotherapy resulted in a significantly improved survival of 3.7 months in a population of patients that have very limited options. This improvement in overall survival was not accompanied by any significant deterioration in quality of life and serious side effects were limited to 3% to 8% of the study population. MedicalResearch.com: Were any of the findings unexpected? Dr. Tewari: The findings were not unexpected. We have known for decades that angiogenesis (ie., the formation of new blood vessels between the cancer and the patient) is an important process in cervical cancer. Angiogenesis allows the cancer to obtain nutrients to supports its growth. We now have a drug that can block angiogenesis and we were very pleased to learn that using this drug resulted in improved survival for these patients. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Tewari: We may have identified a therapeutic mechanism through which we can now improve survival in this population of patients to allow them to obtain further benefits from newer drugs currently being studied such as other inhibitors of angiogenesis, immunologic therapies, etc. Previously, advanced cervical cancer was a disease in which patients rarely could tolerate multiple lines of chemotherapy (unlike ovarian and breast cancers which can be made into chronic diseases with patients receiving many lines of therapy for many years). Now, with bevacizumab we may be on the cusp of being able to convert this disease into a more chronic one that doesn’t kill patients so quickly. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Tewari: First thing that needs to be done is to get the drug approved by the US FDA so that patients in greatest need can benefit from this therapy. Then we need to study other types of anti-angiogenesis therapy and immunologic therapy in this population of patients – many such trials are already underway. Citation: Improved Survival with Bevacizumab in Advanced Cervical Cancer Krishnansu S. Tewari, M.D., Michael W. Sill, Ph.D., Harry J. Long, III, M.D., Richard T. Penson, M.D., Helen Huang, M.S., Lois M. Ramondetta, M.D., Lisa M. Landrum, M.D., Ana Oaknin, M.D., Thomas J. Reid, M.D., Mario M. Leitao, M.D., Helen E. Michael, M.D., and Bradley J. Monk, M.D. N Engl J Med 2014; 370:734-743February 20, 2014DOI: 10.1056/NEJMoa1309748 Read the rest of the interview on MedicalResearch.com
Good Sleep Habits for Children: Early Consistent Bedtime, No Evening TV MedicalResearch.com Interview with: Dr Abi Fisher PhD Senior Researcher, Cancer Research UK Health Behaviour Research Centre University College London • • MedicalResearch.com: What are the main findings of the study? Dr. Fisher: Getting sufficient sleep at night is essential to the health and development of young children. Before the age of 5 years, children who regularly sleep less than 11 hours a night are at an increased risk of poor health, so understanding the factors that determine short sleep is very important. Some key factors were related to shorter sleep in our study, including being from ethnic minority backgrounds, lower socioeconomic groups and watching more than an hour of television in the evening. Whilst these factors have been related to childhood sleep in previous studies, ours was the first to show that the effects of these variables on children’s sleep may be operating through a later bedtime. • • • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Fisher: These findings are important as they can be used to give parents, caregivers and health professionals constructive advice on how to improve child sleep; an emphasis on an early and consistent bedtime could help promote healthy sleep. Parents should also be encouraged not to allow evening television viewing. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Fisher: Our study was observational, so randomised controlled trials should be carried out with short sleeping children and their families, to determine whether introducing earlier bedtimes do indeed improve sleep length and quality and improve health outcomes. Citation: Predictors of Shorter Sleep in Early Childhood Laura McDonald, Jane Wardle, Clare H. Llewellyn, Cornelia H.M. van Jaarsveld, Abigail Fisher Sleep Medicine – 10 February 2014 (10.1016/j.sleep.2014.01.005) Read the rest of the interview on MedicalResearch.com
Pediatric Oncology: Radiation Free Imaging Test as Alternative to PET/CT Scans MedicalResearch.com: Interview with: Dr Heike Daldrup-Link Associate Professor of Radiology Stanford University School of Medicine, Palo Alto • • MedicalResearch.com: What are the main findings of the study? Answer: We use magnetic resonance imaging, a technology based on magnetic fields rather than radiotracers or x-rays. The underlying technology is not new – it has been used for tumor staging for many years. This is an advantage as MR scanners are available in nearly every major Children’s Hospital where children with cancer are treated. What is new about our approach is that we combined anatomical and functional images, similar to current approaches that use radiotracers and CT (PET/CT): We first acquired scans that showed the anatomy of the patient very well and we then acquired scans that depict tumors as bright spots with little or no background information. We did that by using an iron supplement as a contrast agent: The iron supplement can be detected by the MRI magnet and improved tumor detection and vessel delineation MR scans. We then fused the anatomical scans with the tumor scans. • One could compare this to highlighting roads and points of interests (the tumors) simultaneously on a geographic map. Previous MR imaging approaches have either shown the point of interest very well or the anatomical map, but not both. By fusing MR scans that highlight the tumor with MR scans that provide a very detailed anatomical map of the body, we created radiation-free images that shows us very clearly, where tumors are in relation to anatomical landmarks. Our radiation free WB-DW MR imaging technique detected 158 of 174 malignant tumors and FDGPET/CT detected 163 of 174 malignant tumors. The resultant sensitivities, specificities, and diagnostic accuracies were all excellent, with values above 90%, and were not significantly different between the two imaging modalities. Tumour staging results also showed very good agreement between both imaging modalities with a κ of 0.93. At the same time, the associated radiation exposure could be reduced from about 12.5 mSv for the PET scans to zero for the WB-DW scans. Both exams required roughly the same time between tracer injection and end of scan and the estimated exam costs were comparable. • Read the rest of the interview on MedicalResearch.com
Pediatric Oncology: Radiation Free Imaging Test as Alternative to PET/CT Scans MedicalResearch.com: Interview with: Dr Heike Daldrup-Link Associate Professor of Radiology Stanford University School of Medicine, Palo Alto • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: Accurate staging of malignant tumors in children and adolescents is critical, as the presence and location of tumor manifestations throughout the body determines therapy management and prognosis. However, several human population studies have shown that exposure to ionizing radiation above doses of about 50-100 mSv increases the risk for development of secondary cancers later in life. This is especially concerning for young patients because they are more susceptible to the effects of radiation than older patients and they live long enough to encounter secondary cancers later in live. We demonstrate that it is possible to provide sensitive tumor staging of children with malignant tumors by using a completely radiation free imaging test as an alternative to PET/CT scans. Maybe, one could compare this to replacing conventional light bulbs with LED lights, which eliminate unwanted heat production. Just as we want light only for our lamps, we want tumor detection only without associated side effects from radiation. Current imaging techniques do not meet our high standards of patient care without side effects. Creating a potential risk of inducing new cancers with our diagnostic imaging tests is not acceptable. Our new radiation-free imaging test provides a solution for this problem. The next step will be to prove our findings in larger patient populations, beyond our single center. We are currently planning a multi-institutional initiative of six major Children’s hospital in the US, who want to compare the value of whole body MRI and PET/CT for staging of Hodgkins lymphoma. And we were recently also contacted by centers in Europe who want to join in. This could potentially evolve into a truly global initiative that could make this imaging test widely available. Our ultimate goal is to provide global access to tumor staging tests with substantially reduced or eliminated radiation exposure. Read the rest of the interview on MedicalResearch.com
Pediatric Oncology: Radiation Free Imaging Test as Alternative to PET/CT Scans MedicalResearch.com: Interview with: Dr Heike Daldrup-Link Associate Professor of Radiology Stanford University School of Medicine, Palo Alto • • • • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Answer: We evaluated the value of our new imaging test for the initial diagnosis of tumors in pediatric patients. Further studies have to show if this imaging test is also useful for evaluation of a response of the detected tumors to treatment. Such studies are also under way. There are new technological developments that combine radiotracer based imaging studies with our MRI technique. Those imaging tests still have a substantially reduced radiation exposure compared to classical PET/CT scans, but may provide additional information compared to our radiation free scan. Future studies will have to show, which patients will benefit most from a completely radiation-free whole body imaging test, as described in our article, versus new ULD (ultra low dose) PET/MR imaging tests. This is a major focus of our future multi-institutional research efforts. Citation: Published online February 19, 2014 http://dx.doi.org/10.1016/S1470-2045(14)70021-X1 Christopher Klenk, Rakhee Gawande, Lebriz Uslu, Aman Khurana, Deqiang Qiu, Andrew Quon, Jessica Donig, Jarrett Rosenberg, Sandra Luna-Fineman, Michael Moseley, Heike E Daldrup-Link. Ionising radiation-free wholebody MRI versus ¹⁸F-fluorodeoxyglucose PET/CT scans for children and young adults with cancer: a prospective, non-randomised, single-centre study Lancet (2014) doi.org/10.1016/S1470-2045( Read the rest of the interview on MedicalResearch.com
Mesh Hernia Repairs Associated with Fewer Recurrences MedicalResearch.com Interview with: Mike K.Liang, MD, Department of Surgery, The University of Texas Health Sciences Center, Lyndon B. Johnson Hospital,Houston, TX 7702 • • • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Liang: Compared to suture repair, mesh repair of primary ventral hernias (umbilical, epigastric, spigelian, lumbar), the most common type of ventral hernias, is associated with fewer hernia recurrence but slightly more seromas and surgical site infections. MedicalResearch.com: Were any of the findings unexpected? Dr. Liang: In current practice, many surgeons continue to repair primary ventral hernias with suture repair only believing that they can obtain the same outcomes. This study reinforces the concept that even for small hernias, mesh reinforcement is associated with improved long term outcomes at a slightly increased risk of more short term adverse events. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Liang: Clinicians: meta-analysis is not to answer questions but rather to frame questions properly. Further prospective randomized controlled trials are needed to properly assess the best role of mesh and suture repair of primary ventral hernias. Patients: in most situations, mesh repair of primary hernias improve long term outcomes with slight increase in more short term adverse events. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Liang: More high quality prospective randomized controlled trials are needed to asses the role of mesh versus suture repair of primary ventral hernias. Given the current evidence, use of mesh in most primary hernias will yield better long term outcomes with a slight increase in short term complications. Citation: Comparison of Outcomes of Synthetic Mesh vs Suture Repair of Elective Primary Ventral Herniorrhaphy A Systematic Review and Meta-analysis Nguyen MT, Berger RL, Hicks SC, et al. Comparison of Outcomes of Synthetic Mesh vs Suture Repair of Elective Primary Ventral Herniorrhaphy: A Systematic Review and Meta-analysis. JAMA Surg. 2014;():. doi:10.1001/jamasurg.2013.5014. Read the rest of the interview on MedicalResearch.com
Carcinogens in Food Packaging MedicalResearch.com Interview with: Dr. Jane Muncke PhD Managing Director Food Packaging Forum Foundation Zurich, Switzerland • • MedicalResearch.com: What are the main conclusions from your work? Answer: Food packaging is a relevant, but still under-recognized source of chemical contamination in foods. Everybody is exposed to these chemicals on a daily basis, but we have very little understanding of the actual health effects caused by this chronic exposure source. We propose that epidemiological research tackles chemical exposures from food packaging as a new and highly relevant exposure source. Epidemiologist have played crucial roles in advancing understanding of health issues, for example cardiovascular disease caused by fine particulate air pollution. Through their work they have encouraged toxicologists to ask different questions, thereby supporting the generation of critical knowledge and, essentially, enabling prevention. • • MedicalResearch.com: Which insights were most unexpected to you? Answer: We were surprised to find known carcinogens being authorized for the use in food contact materials. As such, the FDA lists asbestos fiber as indirect food additive for the use in rubbers intended for food contact applications. This means that its use is, at least in theory, completely legal in the US. Another chemical of concern is formaldehyde, a known human carcinogen which is used as monomer in melamine formaldehyde tableware. Formaldehyde is also a non-intentionally added substance leaching from plastic soda bottles. Considering how many people consume beverages from such containers on a daily basis we have to assume that exposures to formaldehyde at low levels affect the entire population. Read the rest of the interview on MedicalResearch.com
Carcinogens in Food Packaging MedicalResearch.com Interview with: Dr. Jane Muncke PhD Managing Director Food Packaging Forum Foundation Zurich, Switzerland • • • • • • MedicalResearch.com: What should clinicians and patients take away from your report? Answer: As a consumer, we can make choices to eat as many fresh, unprocessed, organic and, if possible, unpackaged foods as possible—a recommendation many doctors most likely make already. Furthermore, it is essential to avoid potentially harmful chemical exposures especially during pregnancy, for example arising from increased chemical leaching into hot foods. However, our influence as consumers is unfortunately limited, because we do not know how foods were stored or processed before they reach the stores. And, we do not always have a choice what kind of foods we eat, due to availability, time or budget restrictions. What we need most therefore are chemical regulations that are informed by the most current scientific understanding, with prevention of chronic diseases as main target. MedicalResearch.com: What recommendations do you have for future research as a result of your work? Answer: We hope to inspire epidemiologists to integrate knowledge about chemical exposures from food packaging in their studies. Such exposures are a relatively discrete and measurable route of exposure that would lend itself for amending existing methods, like food frequency questionnaires, dietary intake records or 24h recalls. Ideally, such efforts would be supplemented by biomonitoring for specific target compounds. Consumer behavior at home may be another interesting area of research, i.e. understanding in what container types foods are stored and reheated. Citation: Food packaging and migration of food contact materials: will epidemiologists rise to the neotoxic challenge? JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Published Feb 19 2014 Read the rest of the interview on MedicalResearch.com
Online Physician Rating Sites: Public Awareness and Participation Increasing MedicalResearch.com Interview with: Dr. David Hanauer, MD Associate Professor, University of Michigan Medical School 1500 East Medical Center Drive Ann Arbor, MI 48109-5940 • • • • • • • MedicalResearch.com: What are the main findings of the study Dr. Hanauer: From my perspective, the primary findings were that 65% of the general public is now aware of physician rating web sites and among those who are aware, about 36% had used them in the prior year. Awareness and usage seems to be rapidly increasing compared to what has been reported in prior studies from just a few years ago. We also found that patients consider word of mouth recommendations (from family/friends) to be almost twice as important as ratings sites are. MedicalResearch.com: Were any of the findings unexpected? Dr. Hanauer: I was surprised that the public was truly using these online rating sites to make decisions. In our study, among those who had sought online physician ratings in the prior year, 35% had chosen a doctor based on good ratings and 37% had avoided a doctor based on bad ratings. This is important to because the implications of using these sites are potentially much larger than using similar rating sites for standard consumer goods and services (choosing a movie to watch, for example). One thing that wasn’t surprising is how few people actually leave ratings themselves. In our study, 5% of the public had left a rating about a physician. We know from prior work that one of the biggest concerns about such sites is that, because so few people leave ratings, it is hard for people to make judgements about how accurate or representative the ratings are. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Hanauer: Clinicians should be aware that the public is actually using these sites more and more to make decisions so the information on them could impact whether or not the next potential patient chooses to see them or not. Many clinicians have long been resistant to such ratings, but they seem to be here to stay, and may even be proliferating. It seems as if there are an increasing number of online rating sites for clinicians these days. However, from the patient perspective it is important to realize that there isn’t much (if any) regulation of the sites, and it is hard to know how trustworthy many of them are. For example, even for the few (potentially non-represenative) ratings about a physician on a site, can we even know if the rating was real, or what factors it was based on? This may be why patients are still seeking input from family and friends more than rating sites. Read the rest of the interview on MedicalResearch.com
Online Physician Rating Sites: Public Awareness and Participation Increasing MedicalResearch.com Interview with: Dr. David Hanauer, MD Associate Professor, University of Michigan Medical School 1500 East Medical Center Drive Ann Arbor, MI 48109-5940 • • • • • MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Hanauer: Given that ratings sites are likely not going away, I think in the future it will be important to understand how to make the sites more reliable so that both clinicians and patients can feel that at least the data are trustworthy. I think it will be important to better understand what patients would like to see in ratings sites, and what clinicians think are reasonable measures to include. Finding the right balance will be tricky. Another very important aspect to consider is what actually should go into defining a “good” clinician rating? While some may seem obvious (bedside manners, skills, etc), others may be more controversial (decor of the waiting room, for example). Right now there is no consensus, and as a result different rating sites often measure different things. So a potential healthcare “consumer” may develop a different perspective depending on which site(s) he/she visited. Citation: Hanauer DA, Zheng K, Singer D, Gebremariam A, Davis M. Public Awareness, Perception, and Use of Online Physician Rating Sites. JAMA. (In Press) Read the rest of the interview on MedicalResearch.com
Pulmonary Fibrosis: High Resolution CT Diagnosis MedicalResearch.com Interview with: Ganesh Raghu, M.D.,FCCP, FACP Professor of Medicine & Lab Medicine (Adjunct) Division of Pulmonary & Critical Care Medicine University of Washington(UW) Director,CENTER for Interstitial Lung Disease (ILD),UW Medicine, ILD, Sarcoid and Pulmonary Fibrosis Program Co-Director, Scleroderma Clinic, UW Medical center(UWMC) Seattle, WA 98195 • • MedicalResearch.com: What are the main findings of the study? Dr. Raghu: In a subgroup of patients with typical clinical features of Idiopathic pulmonary fibrosis ( IPF) , further evaluation by a thorough evlauation by regional experts experienced in management of idiopathic pulmonary fibrosis and related diseases may lead to a diagnosis of idiopathic pulmonary fibrosis without the need for surgical lung biopsy if the HRCT features have a Possible-UIP pattern AND if there are no suspicion for environmental factors or collagen vascular diseases to explain the pulmonary fibrosis . • MedicalResearch.com: Were any of the findings unexpected? Dr. Raghu: The HRCT pattern of Inconsistent- UIP does not exclude UIP in surgical lung biopsy MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Raghu: General clinicians and confronted patients must familiarise themselves with clinical manifestations of Interstitial lung diseases , Idiopathic interstitial pneumonias and Idiopathic pulmonary fibrosis( IPF ) These findings MUST not be extrapolated to the interpretation of HRCT pattern of possible UIP by general /community physicians and general radiologists Prompt referral to regional experts, experienced with management of ILD for an accurate diagnosis. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Raghu: Ascertain sensitivity and specificity of the possible-UIP pattern in consecutive patients evalutated for ILD / idiopathic interstitial pneumonia Citation: • • • • • • • • • • • Diagnosis of idiopathic pulmonary fibrosis with high-resolution CT in patients with little or no radiological evidence of honeycombing: secondary analysis of a randomised, controlled trial Ganesh Raghu, David Lynch, J David Godwin, Richard Webb, Thomas V Colby, Kevin O Leslie, Juergen Behr, Kevin K Brown, James J Egan, Kevin R Flaherty, Fernando J Martinez, Athol U Wells, Lixin Shao, Huafeng Zhou, Patricia S Pedersen, Rohit Sood, A Bruce Montgomery, Thomas G O’Riordan Read the rest of the interview on MedicalResearch.com
TAVR vs Surgical Aortic Valve Replacement for Aortic Stenosis with LV Dysfunction MedicalResearch.com Interview with: Sammy Elmariah, MD, MPH Massachusetts General Hospital Boston, MA • • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Elmariah: Within the randomized PARTNER I trial, we evaluated the effect of left ventricular (LV) dysfunction on clinical outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) and the impact of valve replacement technique on recovery of LV function. We found that LV dysfunction, defined as an LV ejection fraction < 50%, had no impact on 30-day and 1-year mortality after either TAVR or SAVR. In those with baseline LV dysfunction, marked improvement in LV ejection fraction was observed within 30-days of valve replacement in approximately half of patients, with an equivalent degree of improvement observed after TAVR and SAVR. Permanent pacemaker at study entry, low mean aortic valve gradient, and high LV ejection fraction were associated with reduced odds of LV functional recovery after valve replacement. MedicalResearch.com: Were any of the findings unexpected? Dr. Elmariah: Yes, we found that patients with LV dysfunction that did not demonstrate improvement in LV function within 30-days of TAVR possessed an increased risk of death at 1-year follow-up. Surprisingly, lack of early LV functional improvement did not influence clinical outcomes after SAVR. The reason for this discrepancy is not readily apparent, although we suspect that injury of the LV during transapical TAVR, paravalvular aortic regurgitation, and conduction abnormalities after TAVR may be involved. MedicalResearch.com: What should clinicians and patients take away from this study? Dr. Elmariah: Our findings highlight the beneficial impact of aortic valve replacement in patients with aortic stenosis and LV dysfunction and demonstrate that TAVR should be considered a feasible alternative to SAVR regardless of the presence of LV systolic dysfunction. MedicalResearch.com: What further research do you recommend as a result of your study? Dr. Elmariah: Further efforts are needed to identify the reasons responsible for poor clinical outcomes in patients with persistent LV dysfunction after TAVR. If in fact LV injury during transapical TAVR is found to mediate this observation, alternative approaches may prove to be beneficial in patients with LV dysfunction undergoing TAVR. Citation: Outcomes of Transcatheter and Surgical Aortic Valve Replacement in High-Risk Patients With Aortic Stenosis and Left Ventricular Dysfunction: Results From the Placement of Aortic Transcatheter Valves (PARTNER) Trial (Cohort A) Sammy Elmariah, Igor F. Palacios, Thomas McAndrew, Irene Hueter, Ignacio Inglessis, Joshua N. Baker, Susheel Kodali, Martin B. Leon, Lars Svensson, Philippe Pibarot, Pamela S. Douglas, William F. Fearon, Ajay J. Kirtane, Hersh S. Maniar, and Jonathan J. Passeri Circ Cardiovasc Interv. 2013;CIRCINTERVENTIONS.113.000650published online before print November 12 2013, doi:10.1161/CIRCINTERVENTIONS.113.000650 Read the rest of the interview on MedicalResearch.com
Pre-Op Vitamin D and Infection Risk Following Gastric Bypass Surgery MedicalResearch.com Interview with: Sadeq A. Quraishi, MD, MHA Massachusetts General Hospital, Harvard Medical School Boston, Massachusetts • • • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Quraishi: Our retrospective study suggests that there is an association between pre-operative 25-hydroxyvitamin D [25(OH)D] levels and the risk of hospital-acquired infections after gastric bypass surgery. In particular, patients with 25(OH)D levels <30 ng/ml before surgery were almost 4 times more likely to develop a surgical site infection within 30 days of surgery than patients with pre-operative 25(OH)D levels at 30 ng/ml or higher. MedicalResearch.com: Were any of the findings unexpected? Dr. Quraishi: While the findings themselves are not surprising, given our emerging understanding of how vitamin D status affects immune function, the magnitude of this association is rather surprising. We did select a patient cohort at high risk for low 25(OH)D levels and high risk for hospital-acquired infections. As such, further studies are needed to extend our work, to assess the generalizability of our findings to all surgical patients, and to test whether vitamin D supplementation can influence the risk of developing hospital-acquired infections. MedicalResearch.com: What should clinicians and patients take away from your report? Dr. Quraishi: We believe that 25(OH)D optimization before surgery is a promising strategy for supporting immune health through the perioperative setting. Active research in this area by our group and others will help us to better understand whether vitamin D supplementation is indeed helpful, and if so, how much to take and when to take it. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Dr. Quraishi: Observational research (such as this study) helps us to generate more questions and provides a rationale to further pursue an idea – it does not address the issue of causality. To answer the question of whether vitamin D supplementation can reduce the risk of hospital-acquired infections, well-designed, placebo-controlled clinical trials are the next step. Citation: Association Between Preoperative 25-Hydroxyvitamin D Level and Hospital-Acquired Infections Following Roux-en-Y Gastric Bypass Surgery. Quraishi SA, Bittner EA, Blum L, Hutter MM, Camargo CA Jr. JAMA Surg. 2013 Nov 27. doi: 10.1001/jamasurg.2013.3176. [Epub ahead of print] Read the rest of the interview on MedicalResearch.com
Alzheimer’s: Celexa Reduced Agitation, Has Modest Cognitive, Cardiac Side Effects MedicalResearch.com Interview with: Anton P. Porsteinsson M.D. William B. and Sheila Konar Professor of Psychiatry Director, Alzheimer’s Disease Care, Research and Education Program (AD-CARE) University of Rochester School of Medicine and Dentistry Rochester, N.Y. 14620 • • • • • • • • • MedicalResearch.com: What are the main findings of the study? Dr. Porsteinsson: Identifying drugs outside the antipsychotic class with targeted anti-agitation effects that provide greater benefit or lower risk among patients with Alzheimer’s disease is a research priority
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