medicalresearch.com: medical research exclusive interviews july 20 2015

MedicalResearch.comExclusive Interviews with Medical Research and

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

Editor: Marie Benz, MD [email protected]

July 20 2015

For Informational Purposes Only: Not for Specific Medical Advice.

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Can a Low Methionine Diet Starve Triple-Negative Breast Cancer?MedicalResearch.com Interview with:Dr. Vincent L. Cryns MDChief of the Division of Endocrinology, Diabetes and Metabolism Department of Medicine

University of Wisconsin Carbone Cancer CenterUniversity of Wisconsin School of Medicine and Public Health Madison, Wisconsin

• Medical Research: What is the background for this study? What are the main findings?• Dr. Cryns: It’s been known for quite some time that many tumors are highly vulnerable to

deficiencies in certain amino acids such as methionine, causing tumor cells to stop growing or die. What’s been missing is a molecular explanation for these effects that would allow us incorporate this approach into a rationally designed clinical trial. In our work, we have demonstrated that “starving” triple-negative breast cancer cells of methionine uncovers a “fatal flaw” by increasing the expression of a cell death receptor (TRAIL-R2) that we can activate with a therapeutic antibody to efficiently kill the tumor cells. What’s especially exciting is that we can use a specific diet to metabolically prime cancer cells to respond to a targeted cancer therapy.

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

http://medicalresearch.com/cancer-_-oncology/can-a-low-methionine-diet-starve-triple-negative-breast-cancer/15789/












http://medicalresearch.com/cancer-_-oncology/breast-cancer/breast-cancer-7-triple-negative-subtypes-chemotherapy-response/2180/





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



• Medical Research: What should clinicians and patients take away from your report?• Dr. Cryns: We hope that our laboratory study will guide the way for a clinical trial of a low

methionine diet in combination with a TRAIL-R2 antibody in patients with clinically aggressive triple-negative breast cancer. Unfortunately, patients with triple-negative breast cancer have limited treatment options beyond standard surgery, radiation and chemotherapy.














http://medicalresearch.com/cancer-_-oncology/breast-cancer/novel-combination-treatment-may-help-some-patients-with-ovarian-and-triple-negative-breast-cancers13888/13888/








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

• Dr. Cryns: A critical first step to determine the feasibility of this approach in patients would be to do a small clinical trial in breast cancer patients to see if a low-methionine diet does indeed increase the expression of the TRAIL-R2 receptor in their breast tumors. This would provide a strong rationale for combining a low-methionine diet with a therapeutic TRAIL-R2 antibody in a clinical trial.

• Citation:• Clin Cancer Res. 2015 Jun 15;21(12):2780-91. doi: 10.1158/1078-0432.CCR-14-2792. Epub 20

15 Feb 27.• Methionine Deprivation Induces a Targetable Vulnerability in Triple-Negative Breast Cancer C

ells by Enhancing TRAIL Receptor-2 Expression.• Strekalova E1, Malin D1, Good DM1, Cryns VL2.














http://www.ncbi.nlm.nih.gov/pubmed/25724522


















Space Station Provides Ideal Environment For Study of Multiple Medical Research IssuesMedicalResearch.com Interview with:Patrick O’Neill CASIS Communications Manager andTara Ruttley Ph.D. NASA Staff ScientistNASA Office of the Chief Scientist

• Editor’s note: CASIS, the four year old Center for the Advancement of Science in Space, presented an informative update and display at the Biotech Conference 2015, in Philadelphia June 2015.

• CASIS, the manager of the International Space Station U.S. National Laboratory, facilitates space-based research for the good of mankind. To accomplish it’s goal of ‘driving scientific inquiry toward developing groundbreaking new technologies and products’, CASIS has at its disposal Seed Money, Expertise, Access to Launch, Administrative Support and Educational Outreach.

• Mr. O’Neill and Dr. Ruttley spoke with MedicalResearch.com about the work CASIS is doing and the opportunities CASIS is creating for entrepreneurs, educators and scientists.

• MedicalResearch: Why don’t you tell us a little about the background for CASIS?• Response: The mission of NASA is space exploration, while the complementary mission of

CASIS is to use ISS (the International Space Station) to better life on earth. CASIS is the non-profit arm of NASA that recruits, selects and manages the scientific research projects conducted on the space station.


http://medicalresearch.com/author-interviews/space-station-provides-ideal-environment-for-study-of-multiple-medical-research-issues/15584/%23more-15584



















• MedicalResearch: What is unique about the ISS environment? What is attractive about conducting research in that setting?

• Response: The microgravity (weightlessness), extreme conditions and low earth orbit provide an ideal environment for many research questions, including materials testing, crystal growth, systems dynamics, and combustion.

• From a biological standpoint, the microgravity environment is unique for the study of three-dimensional aggregation of cells, bone density and muscle wasting, aging, protein growth including monoclonal antibodies, STEM cell research and microbiology.





















• MedicalResearch: Can you tell us some about some of the ongoing research on the ISS?

• Response: Several of many on-board experiments include:• 1: A yearlong twin study with homozygous twins, Scott and Mark Kelly. Astronaut Scott Kelly

will spend a year in space (March 2015-March 2016) while his brother, Mark Kelly, a retired astronaut, will live his life on earth. The investigation will focus on “analysis of human molecular responses to the physical, physiological and environmental stressors associated with human spaceflight”.

• 2. Bone density loss and muscle wasting are problems associated with weightlessness and space flight. They are also common problems linked to aging here on earth. In the past, Amgen conducted research on its drug Prolia (denosumab) for osteoporosis on the ISS.

• One unique ongoing study by Lenore Rasmussen, Ph.D. and colleagues from the Princeton Plasma Physics Laboratory, is attempting to develop synthetic muscle for both robotic and human prosthetic use. Temperature and radiation resistant synthetic muscle may be used to build hands that could work in places unsafe for humans, such as potential nuclear disasters.















http://www.nasa.gov/mission_pages/station/research/news/astronaut-twins.html

http://www.nasa.gov/mission_pages/station/research/news/astronaut-twins.html







• 3. The Fruit Fly Lab has “the combined capabilities of artificial gravity, day/night lighting, video observation, tissue preservation and the ability to separate multiple generations of flies”. The current fruit fly experiments are focusing on how spaceflight affects the immune system’s response to infection.

• 4. The Fluid Shifts study, is examining the effects of fluids (blood and water) shifting in an astronaut’s head during flight. What is learned from the Fluid Shifts research may be applicable to patients with brain swelling from a variety of causes.

Response: Human monoclonal antibody studies: Merck Research Laboratories is capitalizing on the fact that “Protein crystals grown in microgravity can reach much larger sizes and more perfect structures than those grown on Earth, where gravity interferes with their formation”. Merck is investigating a monoclonal antibody for potential use in autoimmune disease.















http://www.nasa.gov/mission_pages/station/research/news/fruit_fly_lab01

http://www.nasa.gov/mission_pages/station/research/news/fruit_fly_lab01

http://www.nasa.gov/mission_pages/station/research/experiments/1257.html









• MedicalResearch: How are supplies transported to the space station?• Response: The Space X Dragon is a free-flying spacecraft that delivers both cargo and people

to the international space station. The ISS also had 3D printing equipment to replace worn or provide new tools as needed.

• MedicalResearch.com: What is the educational mission of CASIS?• Response: The educational mission of CASIS is to equip educators to be able to excite their

students in the pursuit of knowledge about their home, Earth and space. It is a major goal of CASIS to provide STEM educators with the resources they need to inform and encourage their students in the pursuit of a science education. CASIS actively recruits experimental proposals from students and at the present time has 30-40 ongoing student-triggered experiments on the space station.





















• More information as CASIS can be found here:• 1: Results of microgravity studies are featured on the Nature journal Microgravity.• 2. CASIS website• 3. CASIS Fact Sheet for Researchers















http://www.nature.com/npjmgrav/npj

http://www.iss-casis.org/Home.aspx

http://www.iss-casis.org/CASISBasics/ForResearchers.aspx






Acne Causing Bacteria Killed By Nitric Oxide Generated From NanoparticlesMedicalResearch.com Interview with: Adam Friedman, MD, FAADAssociate Professor of Dermatology Residency Program DirectorDirector of Translational

Research Department of DermatologyGeorge Washington School of Medicine and Health Sciences

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

Dr. Friedman: Acne vulgaris is one of the most common skin disease that affects approximately 40-50 million people in the United States. Acne’s multifactorial etiology, resulting from a mix of androgen-induced elevations in sebum production, abnormal follicular epithelial desquamation and proliferation, hypercolonization of Propionibacterium acnes and host inflammatory reactions, make treatment often times challenging. In looking at the topical therapeutic armament for Acne Vulgaris, which includes benzoyl peroxide, salicyclic acid, topical antibiotics such as clindamycin, and retinoids, all suffer from various related side effects including irritation, erythema, dryness, peeling and scaling, bacterial resistance, and resulting dyschromia from the associated irritation in patients of darker skin types. These adverse events often serve as major limiting factors influencing patient compliance and ultimately impacting efficacy. Therefore new treatments which target all of the complexities of acne are needed, especially given we have not had anything really new brought to market in years. Here, we looked to biology for the answer. Our bodies generate Nitric Oxide, a diatomic lipid loving gaseous molecule, to perform a broad range of biological activities, including but not limited to killing bacteria/fungi/viruses and inhibiting inflammation – key elements in Acne. Its action however is very short lived and therefore using Nitric Oxide as a treatment is difficult as one would need a delivery system that would allow for continued and controlled release. Enter nanotechnology. We designed exceedingly small particles (of note, 1 nanometer = 1 billionth of a meter) which allow for the generation of nitric oxide gas from nitrite salt, and will only release the gas when exposed to moisture over time. The size of the particles also enables them to better interact with their environment, i.e. cells, pathogens, improving their activity as compared to large sized treatments


http://medicalresearch.com/technology/acne-causing-bacteria-killed-by-nitric-oxide-generated-from-nanoparticles/15800/




















In this study, we showed that the nitric oxide generating/releasing nano particles effectively killed the organism, P. acnes but was not toxic to both human skin cells and a live vertebrae model (embryonic zebra fish). More importantly, we found that the nano particles inhibits the activation of a newly recognized but exceedingly important inflammatory pathway that is directly tied to the formation of an acne lesion, called the NLRP3 inflammasome. Research has shown that our bodies already regulate this pathway with nitric oxide, and therefore once again, we are looking to biology for answers. As opposed to a drug that may only have one target, the nanoparticles inhibited multiple components/elements of the inflammasome pathway, giving some insight into its potential as a treatment for acne as well as other inflammatory diseases.






















• Medical Research: What should clinicians and patients take away from your report?• Dr. Friedman I think one theme of this paper is targeted medicine: Elucidating the

the underpinnings of disease, correlating with normal physiology, and creating a therapy based on this understanding. This has been the modern template for many new therapies for a broad range of diseases from cancer to psoriasis. Having a strong grasp on the biology allows the practitioner to both use medication off label based on their mechanism as well as help guide the development of new therapies. Focusing more on the paper, I think a broader appreciation of nanotechnology, specifically nanomedicine is important as there is limitless potential to both improve the sustainability and efficacy of established medications and allow for the delivery of unstable or previously undeliverable agents like nitric oxide.























• Dr. Friedman: The next steps for this research is clinical trials. There are currently no great animal models for acne so very often once the standard quality assurance and safety studies are complete, one can enter the clinical space. We are currently working towards commercializing this technology through a company named Nano BioMed inc, and hope to move this into the clinical space with great speed.

• In terms of broader future research initiatives, a better understanding of how or if both old and new drugs effect the inflammasome pathway is an important step in the right direction as this is clearly an important target.

• Citation:• Nitric Oxide Releasing Nanoparticles Prevent Propionibacterium acnes Induced Inflammation

by both Clearing the Organism and Inhibiting Microbial Stimulation of the Innate Immune Response.

• Min Qin1, Angelo Landriscina2, Jamie Rosen2, Gabrielle Wei1, Stephanie Kao1, William Olcott1

, George W Agak1, Karin Blecher Paz2, Josephine Bonventre3, Alicea Clendaniel3, Stacey Harper3,4, Brandon Adler2, Aimee Krausz2, Joel Friedman5, Joshua Nosanchuk6,7, Jenny Kim1,8

and Adam J Friedman2,5,9

• Journal of Investigative Dermatology accepted article preview 14 July 2015; doi: 10.1038/jid.2015.277















http://medicalresearch.com/infections/benzoyl-peroxide-may-reduce-risk-of-p-acnes-infection-after-surgery/15555/

http://www.nature.com/jid/journal/vaop/naam/abs/jid2015277a.html












































Cost-Effective Clinical Pathway Determined Hospitalized Patients’ Risk of Sleep ApneaMedicalResearch.com Interview with:

Sunil Sharma, M.DAssociate professor of pulmonary medicine

Sidney Kimmel Medical College at Thomas Jefferson University


Dr. Sharma: Obstructive sleep apnea (OSA) is a highly prevalent disorder with significant cardiovascular implications. In this condition the patient may repeatedly quit breathing during sleep, sometimes hundreds of times, leading to loss of oxygen and frequent arousals throughout the night. OSA has been associated with high blood pressure, congestive heart failure, coronary artery disease, arrhythmias and stroke, among other conditions. While overall awareness is improving, the condition is under-recognized in hospitalized patients. Due to multiple co-morbid conditions these patients may be at higher risk for complications. Recent studies have also shown that early recognition of OSA in hospitalized patients may reduce readmission rates. In our study, we used a simple and cost-effective clinical pathway to determine high-risk patients. Of the 149 patient’s determined to be high risk by our protocol, 128 (87%) were confirmed with the diagnosis by a polysomnography (gold standard test). Furthermore, data derived from a simple and cost-effective oxygen measuring device (pulse-oximeter) was found to co-relate well with the polysomnography.


http://medicalresearch.com/author-interviews/cost-effective-clinical-pathway-determined-hospitalized-patients-risk-of-sleep-apnea/15808/

http://medicalresearch.com/sleep-disorders/cpap-for-sleep-apnea-may-decrease-atrial-fibrillation-recurrence/13675/






Cost-Effective Clinical Pathway Determined Hospitalized Patients’ Risk of Sleep ApneaMedicalResearch.com Interview with:

Sunil Sharma, M.DAssociate professor of pulmonary medicine

Sidney Kimmel Medical College at Thomas Jefferson University

• Medical Research: What should clinicians and patients take away from your report?• Dr. Sharma: Obstructive sleep apnea is common but under-recognized condition in

hospitalized patients. Not only can it increase risk of complications in these patients but early recognition and treatment has been found to reduce readmission rates. Clinicians should have a high index of suspicion and develop simple protocols to screen their patients in the hospital.


• Dr. Sharma: This is data from a single, tertiary care teaching hospital. To confirm that these clinical pathways are applicable in all settings a multi-centric study is recommended.

• Citation:• Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience• Sunil Sharma, MD1; Paul J. Mather, MD2; Jimmy T. Efird, PhD, MSc3,4; Daron Kahn, MD1

; Kristin Y. Shiue, MPH3,4; Mohammed Cheema, MD1; Raymond Malloy, RRT1

; Stuart F. Quan, MD5,6

• Journal of Clinical Sleep Medicine Volume: 11 Number: 07http://dx.doi.org/10.5664/jcsm.4842



http://medicalresearch.com/heart-disease/sleep_apnea_predicts_atrial_fibrillation_after_cabg/9534/

http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30090
























Genetic Testing Can Detect, Protect Patients Prone To Thoracic Aortic AneurysmMedicalResearch.com Interview with:John A. Elefteriades, MDWilliam W.L. Glenn Professor of Surgery Chief of Cardiothoracic Surgery

Director, Aortic Institute at Yale-New HavenYale University School of Medicine

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

Dr. Elefteriades: The race to map the human genome was declared completed in 2003, at a cost of 3 billion dollars for the international collaborative university group and 300 million dollars for Craig Venter at Celera. Whole exome sequencing can now be performed at a cost of only several thousand dollars per individual. So, whole exome sequencing (also called Next Generation Sequencing) can now be applied to understand and treat diseases of many organ systems.

• In this study, we applied whole exome sequencing to study over 100 patients with thoracic aneurysm.

• In the late 1990s, both Dr. Diana Milewicz in Texas and our group at Yale had determined that many thoracic aortic aneurysms were genetically transmitted. Dr. Milewicz went on to identify many of the causative mutations. In this study, we were able to look, by whole exome sequencing performed on saliva, for all 21 mutations known to cause thoracic aortic aneurysm–all at one time in one comprehensive genetic test. We were able to protect patients with the most serious discovered mutations by early surgery, the need for which could not otherwise have been apparent.


http://medicalresearch.com/genetic-research/genetic-testing-can-detect-protect-patients-prone-to-thoracic-aortic-aneurysm/15816/












http://medicalresearch.com/genetic-research/germline-mutations-studied-in-patients-with-family-history-of-early-onset-colon-cancer/12619/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Elefteriades: A comprehensive test for the genetic underpinnings of

thoracic aortic aneurysm is now available. This is accomplished via whole exome sequencing (Next Generation Sequencing).

• It can be extremely important for patients and their family members to have this testing done. Firstly, personalized care (including early surgery) can be performed for individuals with the most dangerous mutations (genetic alterations).

• Secondly, if a mutation is indeed found, then a simple test on family members can determine which relatives will be vulnerable to thoracic aortic aneurysm and which are completely spared. The ones who are genetically spared can “forget” about the possibility of aneurysm disease, “like it never happened”














http://medicalresearch.com/author-interviews/early-primary-care-follow-may-reduce-readmissions-high-risk-surgery-patients/6054/









• Dr. Elefteriades: Widespread application of whole exome sequencing for thoracic aortic aneurysm will expand our roster of causative mutations rapidly and dramatically. We envision a “dictionary” or “encyclopedia” of mutations causing thoracic aneurysm that will number in the hundreds or thousands very soon.

• Thoracic aortic aneurysm is a silent disease, lethal if not detected. Detection by genetic means will save vulnerable lives by permitting identification of disease and effective surgical therapy.

• Citation:• Routine Genetic Testing for Thoracic Aortic Aneurysm and Dissection in a Clinical Setting• Bulat A. Ziganshin, Allison E. Bailey, Celinez Coons, Daniel Dykas, Paris Charilaou, Lokman H. T

anriverdi, Lucy Liu, Maryann Tranquilli, Allen E. Bale, John A. Elefteriades• DOI: http://dx.doi.org/10.1016/j.athoracsur.2015.04.106

Publication stage: In Press Corrected ProofPublished online: July 15 2015














http://www.annalsthoracicsurgery.org/article/S0003-4975(15)00735-3/abstract











Health Lifestyle Reduces Risk of Atrial FibrillationMedicalResearch.com Interview with:Carl “Chip” Lavie MD, FACC FACP, FCCPMedical Director, Cardiac Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner

Heart and Vascular InstituteProfessor of MedicineOchsner Clinical School-UQ School of Medicine


Dr. Lavie: This was a review of the literature on this topic.The main findings are that various lifestyle choices, including obesity, hypertension, metabolic syndrome/diabetes, obstructive sleep apnea , moderate and high alcohol intakes, and sedentary lifestyle but also very high exercise doses are all associated with increased risk of atrial fibrillation (AF).

• Medical Research: What should clinicians and patients take away from your report?• Dr. Lavie: Patients can reduce their risk of atrial fibrillation by keeping alcohol doses low (<2

drinks per day for large size people and only 1 per day for smaller body sizes),preventing obesity and especially severe obesity or by losing weight, especially > 10% on severe obesity, controlling blood pressure and sugar, treating sleep apnea, and performing regular physical activity/exercise but avoiding prolonged exercise.


http://medicalresearch.com/heart-disease/health-lifestyle-reduces-risk-of-atrial-fibrillation/15821/
















http://medicalresearch.com/heart-disease/atrial-fibrillation-increase-leading-to-more-hospitalizations-and-higher-costs/15608/

http://medicalresearch.com/sleep-disorders/cpap-for-sleep-apnea-may-decrease-atrial-fibrillation-recurrence/13675/






Health Lifestyle Reduces Risk of Atrial FibrillationMedicalResearch.com Interview with:Carl “Chip” Lavie MD, FACC FACP, FCCPMedical Director, Cardiac Rehabilitation and Prevention Director, Exercise Laboratories John Ochsner

Heart and Vascular InstituteProfessor of MedicineOchsner Clinical School-UQ School of Medicine


• Dr. Lavie: Future studies are needed to determine the optimal non-phamacologic programs to reduce atrial fibrillation risk.

• Citation:• Healthy Lifestyle Interventions to Combat Noncommunicable Disease-A Novel Nonhierarchica

l Connectivity Model for Key Stakeholders: A Policy Statement From the American Heart Association, European Society of Cardiology, European Association for Cardiovascular Prevention and Rehabilitation, and American College of Preventive Medicine.

• Arena R, Guazzi M, Lianov L, Whitsel L, Berra K, Lavie CJ, Kaminsky L, Williams M, Hivert MF, Franklin NC, Myers J, Dengel D, Lloyd-Jones DM, Pinto FJ, Cosentino F, Halle M, Gielen S, Dendale P, Niebauer J, Pelliccia A, Giannuzzi P, Corra U, Piepoli MF, Guthrie G, Shurney D.

• Mayo Clin Proc. 2015 Jun 26. pii: S0025-6196(15)00349-3. doi: 10.1016/j.mayocp.2015.05.001.


















http://medicalresearch.com/weight-research/weight-reduction-lowers-risk-of-atrial-fibrillation/14502/















Combination Targeted Therapy Promising For Difficult Peripheral T-Cell LymphomaMedicalResearch.com Interview with:Dr Yeow Tee Goh MBBSDepartment of HaematologySingapore General HospitalRepublic of Singapore


Dr. Goh: Relapsed or refractory peripheral T-cell lymphoma after conventional chemotherapy is associated with a very poor prognosis and there is currently no recommendation on the standard approach to helping these patients. Novel targeted treatments for relapsed or refractory peripheral T-cell lymphoma such as romidepsin, pralatrexate, belinostat, and brentuximab vedotin has been approved by the US Food and Drug Administration (FDA) based on the results of their Phase II studies. With the exception of the remarkable efficacy of brentuximab vedotin in systemic anaplastic large cell lymphoma (86% of patients responding to treatment), the efficacy of romidepsin, pralatrexate, and belinostat in relapsed or refractory peripheral T-cell lymphoma is only modest with objective response rates between 25% and 29%. To our knowledge, no other clinical study has reported on the use of novel combination of targeted agents in in relapsed or refractory peripheral T-cell lymphoma. In our study, Of 23 patients assessable for responses, 10 (43%, 95% CI 23–63) patients had an objective response, of which 5 were complete responses. The combined proteasome and histone deacetylase inhibitor treatment shows promising activity for patients with peripheral T-cell lymphoma.


http://medicalresearch.com/author-interviews/combination-targeted-therapy-promising-for-difficult-peripheral-t-cell-lymphoma/15825/




















• Medical Research: What should clinicians and patients take away from your report?• Dr. Goh: Peripheral T-cell lymphoma is clinically heterogeneous and associated with a very

poor prognosis. There is an unmet need to improve the effectiveness of currently approved novel agents to induce remission and reduce disease burden to enable stem-cell transplantation. Our data compare favorably with the modest single-agent activities of novel targeted compounds and ours is the first study to show that the combination of two novel agents is safe, feasible, and promising in peripheral T-cell lymphoma. Our findings validate data from abundant preclinical studies suggesting that a combination approach is synergistic.























• Dr. Goh: The identification of synergistic novel combinations pre-clinically and the translation to clinical studies represents the most rational way forward in harnessing the full potential of novel agents in peripheral T-cell lymphoma. This approach will certainly fill the emergent need for improved treatment strategies in these patients. Studies involving larger pools of patients would be required for further validation of the efficacy of proteasome and histone deacetylase inhibitor combination treatment for peripheral T-cell lymphoma patients. Optimum dosing schedules and dose combinations of various proteasome and histone deacetylase inhibitors combinations should be explored to further harness the full potential of such novel agents in peripheral T-cell lymphoma .





















Antidepressants Plus NSAIDS May Increase Risk of Bleeding in BrainMedicalResearch.com Interview with:Byung-Joo Park, MD, MPH, PhD ProfessorDepartment of Preventive MedicineSeoul National University College of Medicine


Response: Antidepressants and NSAIDs are each thought to increase the risk of abnormal bleeding. However, previous studies found neither antidepressants nor NSAIDs alone to be associated with an increased risk of intracranial haemorrhage. Our research found that combined use of NSADIs in antidepressant users showed the increased relative risk of intracranial haemorrhage risk within the initial 30-days of combined use.


http://medicalresearch.com/author-interviews/antidepressants-plus-nsaids-may-increase-risk-of-bleeding-in-brain/15747/















• Medical Research: What should clinicians and patients take away from your report?• Response: For the clinicians, special attention should be paid for the antidepressant users

when they additionally start the NSAIDs prescription. Monitoring bleeding risk is particularly needed at the initial combined use of both medicines. For the patients who have been taking antidepressants, in case they need additional NSAIDs, they should tell doctors considering the possibility of drug-drug interaction which can induce intracranial haemorrhage.











http://medicalresearch.com/heart-disease/supplement-may-reduce-cardiovascular-risks-linked-nsaids/9680/








• Response: Present study was focused on the antidepressants users, and the differential risk according to the type of antidepressants. Future research would be needed whether the type of NSAIDs such as Cox2 selective vs. non-selective affects the risk associated with combined use of antidepressant. Considering the frequent OTC use of NSAIDs, record linkage study using health insurance database with pharmacy database would produce better results.

• Citation:• Shin Ju-Young, Park Mi-Ju, Lee Shin Haeng, Choi So-Hyun, Kim Mi-Hee, Choi Nam-Kyong et al.

Risk of intracranial haemorrhage in antidepressant users with concurrent use of non-steroidal anti-inflammatory drugs: nationwide propensity score matched study 2015; 351 :h3517











http://medicalresearch.com/pain-research/nsaids-after-heart-attack-increase-risks-of-bleeding-and-further-attacks/12138/

http://www.bmj.com/content/351/bmj.h3517








Study Finds Increased Hospitalizations Near Marcellus Shale Fracking WellsMedicalResearch.com Interview with:Reynold A. Panettieri, Jr., M.D.Robert L. Mayock and David A. Cooper Professor of MedicinePulmonary, Allergy & Critical Care

Division Director, Airways Biology InitiativeDeputy Director, Center of Excellence in Environmental Toxicology

• Medical Research: What is the background for this study? What are the main findings?• Dr. Panettieri: Over the past ten years in the US, unconventional gas and oil drilling (hydraulic

fracturing) to generate natural gas has markedly increased. In areas with hydraulic fracturing, there is a large increase in truck traffic, noise and potential air and water pollution. Accordingly, residents may experience health consequences from such exposures. We questioned whether proximity to active wells increases hospitalization rates in residents. To address this question, we reviewed all hospitalizations in two counties in Pennsylvania, namely, Bradford and Susquehanna Counties, that experienced a meteoric increase in active wells. In comparison, Wayne County, where there is a moratorium on hydraulic fracturing, is demographically identical to Bradford and Susquehanna Counties and served as a control population. Having examined the 25 most common reasons for admission to the hospital, we determined that cardiovascular hospitalizations as well as neurologic, dermatologic and cancer hospitalizations were associated with living closer to active wells. These data represent some of the first studies to associate active well drilling with hospitalizations in the United States.


http://medicalresearch.com/author-interviews/study-finds-increased-hospitalizations-near-marcellus-shale-fracking-wells/15836/

























• Medical Research: What should clinicians and patients take away from your report?• Dr. Panettieri: Our data supports the concept that hydraulic fracturing and proximity to active

wells may increase the risk for hospitalization for cardiovascular and other diseases. Although our study can only associate active well density with hospitalizations, we posit that air, water and noise pollution as well as aberrant stress responses may contribute to the health consequences. Further, the economic value of hydraulic fracturing should account for the potential of increased hospitalizations and health care associated with this activity.




























• Dr. Panettieri: Since this study can only associate active well drilling with hospitalizations, further studies are necessary to identify the specific diseases that are manifested with proximity to active well drilling. Other studies should examine whether emergency department and outpatient visits also correlate with proximity to active wells to understand the comprehensive consequences of hydraulic fracturing on health care utilization.

• Citation:• Thomas Jemielita, George L. Gerton, Matthew Neidell, Steven Chillrud, Beizhan Yan, Martin

Stute, Marilyn Howarth, Pouné Saberi, Nicholas Fausti, Trevor M. Penning, Jason Roy, Kathleen J. Propert, Reynold A. Panettieri Jr. Unconventional Gas and Oil Drilling Is Associated with Increased Hospital Utilization Rates. PLoS One, 2015 DOI: 10.1371/journal.pone.0131093




















http://dx.doi.org/10.1371/journal.pone.0131093






Patients With Lower Health Literacy May Find Electronic Health Care Portals ChallengingMedicalResearch.com Interview with:Dr. Courtney Lyles Ph.D.Assistant ProfessorUCSF School of Medicine


Dr. Lyles: In our commentary (http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001852), we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs). This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider. Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now. Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits. Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients. Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations.


http://medicalresearch.com/author-interviews/patients-with-lower-health-literacy-may-find-electronic-health-care-portals-challenging/15706/







http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001852

http://medicalresearch.com/author-interviews/should-hospitalized-patients-have-access-to-their-electronic-medical-record/12405/







However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites. There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites. There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency. Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access.















• Medical Research: What should clinicians and patients take away from your report?• Dr. Lyles: Hopefully clinicians and patients can read our paper and think about the utility of

the existing portal websites in their setting, and come up with recommendations for better design and functionality. Delivering health data to patients is a goal that most providers and patients agree is critical to delivering truly patient-centered care. But providing data that is not always easily accessed, understood, or acted upon is not ideal.









http://medicalresearch.com/author-interviews/acos-find-engaging-chronically-patients-is-challenging-work/15161/








• Dr. Lyles: We put forth several recommendations in the paper for next steps. From a research perspective, we believe it is critical to produce generalizable health communication knowledge about the best ways to display and communication complex health information for patients with a spectrum of literacy, numeracy, and English language skills. Making information clearer will benefit not only those with communication challenges, but for all patients looking to best comprehend and actively manage their healthcare treatment decisions.

• Citation:• Connecting the Dots: Health Information Technology Expansion and Health Disparities• Courtney Lyles , Dean Schillinger, Urmimala Sarkar • Published: July 14, 2015• DOI: 10.1371/journal.pmed.1001852









http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001852









Atrial Fibrillation Increases Risk of Stroke After TAVRMedical Research Interview with:Prof. Johan BosmansInterventional cardiologistUniversity Hospital Antwerp, Wilrijkstraat 10, 2650,Edegem, Belgium

• MedicalResearch: What is the background for this study? What are the main findings?• Prof. Bosmans : Transcatheter aortic valve replacement (TAVR) has become standard of care

for patients who cannot undergo surgery. With this, it is important to ensure that the risks associated with TAVR be fully understood, and if possible prevented. Even at this stage of the adoption of TAVR, large trials continue to provide information to the clinician about how to select the right patients to ensure the best possible outcomes. The ADVANCE Study is a prospective, multicenter study that evaluated the use of TAVR in 1015 patients at 44 experienced TAVR centers, which was designed to reflect routine clinical practice.

• We know that the risk of serious adverse events, such as stroke or transient ischemic attack (TIA), in post-TAVR patients can vary based on the timing before and after the procedure. A patient’s baseline demographics and medical history can affect their risk of procedure-related events as well as long-term outcomes. The manipulations required crossing the aortic valve and appropriately positioning any type of TAV has been thought to be related to procedural stroke events. Therefore, we performed a multivariable analysis looking for predictors of stroke – or stroke and TIA at 3 unique time periods (periprocedural, early and late) following TAVR.


http://medicalresearch.com/heart-disease/atrial-fibrillation-increases-risk-of-stroke-after-tavr/15843/











http://medicalresearch.com/heart-disease/tavr-2/3842/







The most striking result from our analyses was that we were not able to identify any predictors of periprocedural (either during the procedure or on the day after) stroke, illustrating this very multifactorial etiology. We were able to show that being female, experiencing acute kidney injury or a major vascular complication positively predicted stroke during the early (2-30 days post procedure) time period. When we combined the outcome of stroke or TIA, we found that a history of prior atrial fibrillation (AF) was also a predictor. The only late predictor (day 31-730 post-procedure) of stroke was a history of coronary artery bypass grafting, which could reflect the patients’ risk of vascular disease.



















• MedicalResearch: What should clinicians and patients take away from your report? • Prof. Bosmans : We identified predictors of stroke, or stroke or TIA that can aid the clinician

in their screening and assessment of patients with symptomatic aortic stenosis that may benefit from TAVR. Early predictors included both medical history and procedural outcomes as predictors. It is common knowledge that the presence of Atrial Fibrillation is associated with increased stroke risk; therefore this outcome only supports common clinical practice. The procedural predictors can be managed by optimizing renal status and ensuring that vascular access is well managed, or by using newer, lower profile TAV systems. Since approximately 40% of patients treated with TAVR had a history of CABG, additional testing could be performed to ensure the patients cerebrovascular status is optimal for the procedure.













http://medicalresearch.com/heart-disease/atrial-fibrillation-increase-leading-to-more-hospitalizations-and-higher-costs/15608/







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

• Prof. Bosmans : Our results are based on TAVR procedures performed at experienced sites, as each center was required to have performed at least 40 procedures before being allowed to participate in the study. What could be interesting would be to apply a similar predictor model, with the different inputs for the different time periods, to other studies of similar patients based on risk profiles, and without the limitation of the experience requirement.

• Our study suggests that a history of Atrial Fibrillation may be an important risk factor for neurological events (stroke/TIA) early after TAVR. These results strongly suggest that, in order to reduce neurological complications after TAVR, anticoagulation therapy should be started immediately after diagnosis of the AF episode and continued for several months. No clear guidelines actually exist on anticoagulation therapy following short episodes of postoperative AF. However, patients undergoing TAVR are at high risk for thromboembolism in case of atrial arrhythmia and a more aggressive antithrombotic treatment should probably be implemented in these cases. Although dual antiplatelet therapy with aspirin and clopidogrel has been empirically recommended following TAVR, future randomized studies will have to evaluate the more appropriate antithrombotic treatment following these procedures and the potential role for systematic anticoagulant therapy either with warfarin or direct thrombin inhibitors in this setting.

• Citation:• Bosmans J, Bleiziffer S, Gerckens U, et al. The Incidence and Predictors of Early- and Mid-Term Clinic

ally Relevant Neurological Events After Transcatheter Aortic Valve Replacement in Real-World Patients. J Am Coll Cardiol. 2015;66(3):209-217. doi:10.1016/j.jacc.2015.05.025. Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.












http://medicalresearch.com/general-medicine/tavr/3709/

http://medicalresearch.com/heart-disease/most-patients-with-atrial-fibrillation-symptomatic-and-have-impaired-quality-of-life/14880/

http://medicalresearch.com/heart-disease/unpredictable_anticoagulation_with_warfarin/9788/

http://content.onlinejacc.org/article.aspx?articleID=2396369










RNA in Sperm Could Be Biomarkers of Male FertilityMedicalResearch.com Interview with: Stephen A. Krawetz, Ph.D.Associate Director C.S. Mott Center for Human Growth and Development,

Charlotte B. Failing Professor of Fetal Therapy and Diagnosis,Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics,Wayne State University School of Medicine,


Dr. Krawetz: The current study developed over approximately the past 20 years of work in my laboratory. In the mid 1990s, along with David Miller, we independently discovered that sperm contain RNA. This was followed by our joint publication in The Lancet that began to describe the RNAs in normal fertile males along with our paper in Nature that showed that RNA was delivered to the oocyte at fertilization. Following these studies we assessed the ability of RNAs to be used as markers of morphologically abnormal sperm (teratozoospermia). My laboratory then had the opportunity to explore the complexity of the population of sperm RNAs using Next Generation Sequencing. We recently began the translation of this work from the bench to bedside which takes us to the current paper in Science Translational Medicine that was a multi-institutional collaborative effort. Members of the team include Dr. Meritxell Jodar, Edward Sendler, Robert Goodrich, from my laboratory, along with Dr. Clifford L. Librach, Dr. Sergey I. Moskovtsev, and Sonja Swanson – CReATe Fertility Center, University of Toronto; Dr. Russ Hauser -Harvard University and Dr. Michael P. Diamond, Georgia Regents University. Here we tackled the issue of idiopathic infertility, that is, unknown infertility, since the couple appears normal in all respects. We specifically framed our study as the contribution of the male and female as a couple towards the birth of a healthy child focusing on male idiopathic infertility within the setting of a Reproductive Clinic. Representative publications from my laboratory that outline this part of my research program appear below.


http://medicalresearch.com/genetic-research/rna-in-sperm-could-be-biomarkers-of-male-fertility/15749/














http://medicalresearch.com/genetic-research/ivf_preimplantation_genetic_screening_improved_with_ngs/5616/








• 1) Jodar, M., Sendler, E., Moskovtsev, S. Librach, C., Goodrich, R., Swanson, S., Hauser, R., Diamond, M. and Krawetz, S.A. (2015) Absence of sperm RNA elements correlates with idiopathic male infertility. Science Translational Medicine, 7(295):295re6.

• 2) Sendler, E., Johnson, G.D., Mao, S., Goodrich, R.J., Diamond, M.P., Hauser, R., and Krawetz, S.A. (2013) Stability, Delivery and Functions of Human Sperm RNAs at Fertilization. Nucleic Acids Research 41:4104-4117. PMID: 23471003

• 3) Platts, A.E., Dix, D. J., Chemes, H.E., Thompson, K.E., Goodrich, R., Rockett, J. C., Rawe, V.Y., Quintana, S., Diamond, M.P., Strader, L.F. and Krawetz, S.A. (2007) Success and failure in human spermatogenesis as revealed by teratozoospermic RNAs. Human Molecular Genetics. 16:763-773. PMID: 17327269

• 4) Ostermeier, G.C., Miller, D., Huntriss, J.D., Diamond, M.P. and Krawetz, S.A. (2004) Delivering spermatozoan RNA to the oocyte. Nature 429:154. PMID: 15141202

• 5) Ostermeier, G.C., Dix, D.J., Miller, D., Khatri, P. and Krawetz, S.A. (2002) Spermatozoal RNA profiles of normal fertile men. The Lancet. 360:773-777. PMID: 12241836























Medical Research: What are the main findings?

Dr. Krawetz: With the use of RNA-Seq (RNA sequencing) we defined a series of 648 RNA elements in a series of males from couples presenting with idiopathic infertility (both the male and female appear normal but sought reproductive care) – yet within the first spermatogenic cycle successfully conceived, resulting in the birth of a healthy child. These RNAs correspond to exon-sized regions of the genome that we have termed elements. Using this set of elements we were then able to identify two groups. The first in which all the elements were present and the second in which at least one element was absent. When all the elements were present the birth of a healthy child could most often be achieved with minimal intervention. When at least one element was absent the use of ART (Assisted Reproductive Technology) was required to achieve the birth of a healthy child. This suggested that the elements we defined could serve as biomarkers for male fecundity.























• How this may help couples trying to conceive and have a baby:• Dr. Krawetz: It is our goal to use this technology to reduce both the time to live birth of a

healthy child and cost when couples seek infertility treatment so as to reduce the stress on the couple. It is our hope that by identifying the extent of Dad’s contribution, the responsibility for setting the course for the birth of a healthy child can now be more equally shared. Upon validation this discovery may help to identify those couples who may benefit from ART and those couples who may be successful with minimal intervention.
























• Dr. Krawetz: At present the test is experimental since sperm RNA analysis is technically challenging. It is being automated so that in the next short while it may become part of a routine examination as we move towards Personalized and Precision Medicine. The next step before we can make this test generally available is to secure the necessary funding so that we may expand this study to a prospective blinded trial.

• Citation:• Jodar, E. Sendler, S. I. Moskovtsev, C. L. Librach, R. Goodrich, S. Swanson, R. Hauser, M. P.

Diamond, S. A. Krawetz. Absence of sperm RNA elements correlates with idiopathic male infertility. Science Translational Medicine, 2015; 7 (295): 295re6 DOI: 10.1126/scitranslmed.aab1287
















http://dx.doi.org/10.1126/scitranslmed.aab1287






Gene Therapy May Stop Blindness From Retinitis PigmentosaMedicalResearch.com Interview with:Professor Robert E MacLaren MB ChB DPhil FRCOphth FRCSNuffield Laboratory of OphthalmologyNuffield Department of Clinical Neurosciences

Oxford Biomedical Research Centre, University of Oxford,


Prof. MacLaren: The study shows that gene therapy can be used to release a protein in the eye that arrests the development of retinitis pigmentosa, a blinding disease caused by degeneration of the retina. The study was performed in mice which had a similar genetic defect to that found in humans with the disease. The mice also had fluorescent green “glow in the dark” light sensing cells known as cones, which we could see and count by looking into the eye – like counting stars in the night sky. By counting the green fluorescent cones we were able to work out the exact dose of gene therapy needed to keep these cells alive indefinitely. The study was funded by Fight for Sight, a UK charity that supports finding cures for eye diseases.


http://medicalresearch.com/genetic-research/gene-therapy-may-stop-blindness-from-retinitis-pigmentosa/15850/

















Gene Therapy May Stop Blindness From Retinitis PigmentosaMedicalResearch.com Interview with:Professor Robert E MacLaren MB ChB DPhil FRCOphth FRCSNuffield Laboratory of OphthalmologyNuffield Department of Clinical Neurosciences

Oxford Biomedical Research Centre, University of Oxford,

• Medical Research: What should clinicians and patients take away from your report?• Prof. MacLaren: Gene therapy has great promise in treating retinitis pigmentosa but we are

only just entering clinical trials and there is a lot more to do before it becomes an approved treatment.


• Prof. MacLaren: We need to know more about how the protein induced by the gene therapy works. The protein is known as ciliary neurotrophic factor (CNTF) and has been in clinical trials before but some toxic effects were seen. It may be more stable when delivered at a lower dose using gene therapy, or the route of administration may be critical to the success with retinitis pigmentosa. We now have sufficient data to start designing a clinical trial.

• Citation:• Mol Ther. 2015 Apr 21. doi: 10.1038/mt.2015.68. [Epub ahead of print]• CNTF Gene Therapy Confers Lifelong Neuroprotection in a Mouse Model of Human Retinitis P

igmentosa.• Lipinski DM1, Barnard AR2, Singh MS2, Martin C3, Lee EJ4, Davies WI5, MacLaren RE6.














http://medicalresearch.com/ophthalmology/sildenafil_may_cause_visual_problems_in_genetically_predisposed/8006/
























Increased Leisure Time Sitting Raises Cancer RiskMedicalResearch.com Interview with:Alpa Patel, PHDStrategic Director, CPS-3American Cancer Society, Inc.Atlanta, GA 30303


Dr. Patel: Using information from more than 146,000 men and women (69,260 men and 77,462 women) who were cancer-free and enrolled in the American Cancer Society Cancer Prevention Study II Nutrition Cohort, we examined the association between leisure time spent sitting and cancer risk. Study participants were followed from 1992 through 2009, during which time 18,555 men and 12,236 women were diagnosed with cancer. We found longer leisure-time spent sitting was associated with a 10 percent higher risk of cancer in women after adjustment for physical activity, BMI, and other factors. The association in women was primarily due to invasive breast cancer, ovarian cancer, and multiple myeloma. No association was apparent in men.


http://medicalresearch.com/cancer-_-oncology/increased-leisure-time-sitting-raises-cancer-risk/15854/









http://medicalresearch.com/menopause/all-cause-mortality-decreased-in-post-menopausal-women-who-reduce-sedentary-time/14346/






Increased Leisure Time Sitting Raises Cancer RiskMedicalResearch.com Interview with:Alpa Patel, PHDStrategic Director, CPS-3American Cancer Society, Inc.Atlanta, GA 30303

• Medical Research: What should clinicians and patients take away from your report?• Dr. Patel: These findings add to the growing body of scientific evidence that prolonged sitting

is harmful to your overall health. Given the high rate of sedentary time in the U.S. any efforts to decrease sitting time can have broad public health benefit.


• Dr. Patel: American Cancer Society guidelines for cancer prevention currently recommend reducing sitting time when possible. We need to conduct additional research to better understand the differences in associations between men and women as well as to quantify how much (or little) individuals should sit to prevent these negative health effects.

• Citation:• Leisure-time spent sitting and site-specific cancer incidence in a large US cohort

Alpa V. Patel, Janet S. Hildebrand, Peter T. Campbell, Lauren R. Teras, Lynette L Craft, Marjorie L. McCullough, and Susan M. Gapstur

• Cancer Epidemiol Biomarkers Prev cebp.0237.2015; Published OnlineFirst June 30, 2015; doi:10.1158/1055-9965.EPI-15-0237











http://medicalresearch.com/exercise-fitness/increased-sitting-time-linked-disability/3864/

http://medicalresearch.com/exercise-fitness/sitting-time-linked-to-increased-heart-diease-and-cancer-mortality/10652/

http://cebp.aacrjournals.org/citmgr?gca=cebp;1055-9965.EPI-15-0237v1










Why Do Dilute Bleach Baths Improve Atopic Dermatitis?MedicalResearch.com Interview with:Adam Friedman, MD, FAADAssociate Professor of Dermatology Residency Program DirectorDirector of Translational ResearchDepartment of Dermatology

• Medical Research: What is the background for this study? What are the main findings?• Dr. Friedman: Given pruritus is not only a hallmark symptom of atopic dermatitis, and in fact

is even part of the diagnostic criteria, we sought to evaluate whether factors known to cause itch or inhibit said pruritogens in other disease states are over or under expressed in skin from patients diagnosed with atopic dermatitis. Over the past 10 years considerable attention has been paid to the complexity of the immune dysregulation and plethora of inflammatory and neurogenic factors involved in the activity and progression of this disease. Our study showed significant differences between atopic dermatitis skin and normal skin. Specifically, we found significantly elevated levels of several well-known components of both the inflammatory and pruritus cascade including interleukin-2, BLT1 (the receptor for leukotriene B4, recently implicated in atopic dermatitis), 5-lipoxygenase and Matrix Metalloproteinase-7. Interestingly, for the first time to our knowledge, α-2 macroglobulin, a ubiquitous protein found in the skin that binds a host of proteases, growth factors (TGF-b, PDGF, b-NGF) and inflammatory cytokines (TNF-α, IL-1b, IL-2, IL-6, IL-8), was found to be significant unregulated in atopic skin. Because it has a known an important role in the modulation of inflammation, as its binding acts to inhibit the majority of these mediators, this overexpression may in fact be a compensatory mechanism for ongoing disease. Importantly, when activated through chloramination by, for example, bleach, it can very effeectively scavenge these pro-inflammatory mediators. Thus leading to the second goal of this study.


http://medicalresearch.com/author-interviews/why-do-dilute-bleach-baths-improve-atopic-dermatitis/15858/
















One of the driving forces for selecting the various “itch or anti-itch factors” is that all can be augmented by hypochlorous acid, which is what bleach disassociates into when mixed with water. Bleach baths have been used for years as an adjuvant to treatment in atopic dermatitis. When mixed with water, sodium hypochlorite (NaOCL) produces hypochlorous acid (HOCl), a compound stable between pH 3 and 6. HOCl is known to have antimicrobial properties, and therefore it was believed that bleach baths lowered bacterial burden on the skin and prevented and treated localized skin infections and colonization by organisms such as Staphylococcus aureus. Recent studies have found that HOCl intact has potent anti-inflammatory properties, and therefore we sought to expand this data by evaluating whether factors augmented by HOCl are overexposed in atopic dermatitis skin, giving some insight into how bleach bathes or HOCl products may aid in disease and symptom management.












http://medicalresearch.com/infections/staph-aureus-colonization-linked-to-asthma-symptoms-in-children-and-young-adults/11412/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Friedman: I hope these findings encourage and give physicians confidence to utilize

bleach bathes and HOCl products in their management of atopic dermatitis. It is but one part of our armament, one which has significant data supporting its use. When used correctly, meaning the correct concentration and pH, HOCl may have a potent effect on itch through its interference with the studied factors as well as activation of α-2 macroglobulin.



















• Dr. Friedman: I think this study is hopefully a stimulus for prospective clinical trials. Further research may elucidate the intricacies of HOCl and other oxidative substances’ role in these pathways, and therapeutic strategies for minimizing their pruritogenic potential. Atopic dermatitis (AD) is a chronic dermatologic disorder affecting 10-20% of children in the first decade of life, with about two-thirds having persistent disease into adulthood – it’s not going anywhere and therefore we need better and more innovative ways to manage it

• Citation:• Identifying new biologic targets in atopic dermatitis (AD): A retrospective histologic analysis• Angelo Landriscina, BAJamie Rosen, BA Joseph Albanese, MD Bijal Amin, MD Adam J. Friedma

n, MD• DOI: http://dx.doi.org/10.1016/j.jaad.2015.06.036• JAAD Published Online: July 10, 2015












http://www.jaad.org/article/S0190-9622(15)01815-0/abstract










Evaluating Liver Fat On Cardiac CT Helps Predict Risk vs Benefit of Statin TherapyMedicalResearch.com Interview with:Venkatesh L. Murthy, MD, PhD, FACC, FASNCUniversity of Michiganand Dr. Ravi Shah MDBeth Israel Deaconess Medical Center

• MedicalResearch: What is the background for this study?

• Response: Recent changes recommend statin therapy for cardiovascular risk reduction in an increasingly large number of Americans. Conversely, a number of studies have identified an increased risk of diabetes with statin treatment. Thus, there is increasing need for tools to target statin therapy to those with a favorable risk-benefit profile.


http://medicalresearch.com/diabetes/evaluating-liver-fat-on-cardiac-ct-helps-predict-risk-vs-benefit-of-statin-therapy/15870/












http://medicalresearch.com/heart-disease/putting-more-people-on-statins-would-be-cost-effective-and-improve-heart-health/15715/







• • MedicalResearch: What are the main findings?• Response: In our study, we analyzed data from 3,153 individuals from the Multi-Ethnic Study of

Atherosclerosis who underwent CT scanning at baseline for assessment of calcium score. The CT scans were analyzed to assess liver attenuation as a measure of the amount of liver fat. We demonstrated that high liver fat doubled the risk of diabetes over a median of 9 years of follow-up. Importantly, statin therapy also doubled the risk of diabetes. The two together had an additive effect, even after adjusting for BMI, age, gender, family history of diabetes, waist circumference, lipids, hsCRP and exercise habits. As in prior studies, the risk of cardiovascular disease (CVD) events increased with increasing calcium score, as has previously been shown in MESA and in other studies.

• We then divided the cohort into six groups based on calcium score (0, 1-100 and >100) and liver fat (low/high). Using published data from meta-analyses of statin trials, we computed the number needed to treat to prevent one hard CVD event for statin therapy. Using data from our study, we computed the number needed to harm to cause one additional case of diabetes from statin therapy. The numbers needed to treat with ranged from 29-40 for calcium score of >100 to 218-252 for calcium score of 0. Conversely, the numbers needed to harm were approximately 63-68 for those with low liver fat versus 22-24 for those with high liver fat. Thus the combination of calcium score and liver fat assessment, from a single standard calcium score scan, allows for physicians to provide better assessment of risk and benefit of statins in discussion with their patients.














http://medicalresearch.com/weight-research/epicardial-fat-fatty-liver-linked/2447/







• MedicalResearch: What should clinicians and patients take away from your report?• Response: While it is well established that calcium score scans can help personalize CVD risk

assessment and select optimal patients for statin therapy based on identifying those with greatest potential for benefit, a simple evaluation of the portion of the liver which is seen at the edges of the scan can help physicians assess the risks of statin therapy as well. Although not every patient needs this type of scan, when a calcium score is ordered, assessment of liver fat may be a no or low cost additional assessment with additional clinically important information.














http://medicalresearch.com/heart-disease/calcium-scores-predictive-heart-disease-death-even-low-risk-adults/4891/








• Response: Exploration of the mechanisms whereby statins and liver fat may contribute to diabetes remains a very active area of investigation. We also do not yet have definitive evidence that a strategy of using calcium score combined with liver fat will optimize the balance of cardiovascular and diabetes risks or is cost effective.

• Citation:• Liver Fat, Statin Use, and Incident Diabetes: The Multi-Ethnic Study of Atherosclerosis• AtherosclerosisIn Press, Accepted Manuscript, Available online 15 July 2015• Ravi V. Shah, Matthew A. Allison, Joao A.C. Lima, David A. Bluemke, Siddique A. Abbasi, Pamel

a Ouyang, Michael Jerosch-Herold, Jingzhong Ding, Matthew J. Budoff, Venkatesh L. Murthy














http://medicalresearch.com/general-medicine/statins-elderly/8963/

http://www.atherosclerosis-journal.com/article/S0021-9150(15)30038-1/abstract?rss=yes












Genetic Risk Score Did Not Predict Recurring Events After Myocardial InfarctionMedicalResearch.com Interview with:Christopher Labos MD CM, MSc FRCPCDivision of Epidemiology, Biostatistics and Occupational HealthMcGill University Montreal

, QuebecCanada


Response: There have been great advances in the field of genetics in recent years. Especially in cardiology, a number of genetic variants have been identified that are associated with cardiovascular disease. But it is not clear how useful these variants are in terms of predicting future evens in patients that have already suffered a myocardial infarction. What we found in our study is that a genetic risk score composed of the 30 most common genetic variants associated with cardiovascular diseases was not useful in predicting recurrent events in the first year after a patient suffered a myocardial infarction.


http://medicalresearch.com/genetic-research/genetic-risk-score-did-not-predict-recurring-events-after-myocardial-infarction/15880/












http://medicalresearch.com/heart-disease/majority-of-myocardial-infarction-patients-did-not-achieve-risk-factor-control/13904/







, QuebecCanada

• Medical Research: What should clinicians and patients take away from your report?• Response: While genetics is clearly important for the development of atherosclerosis over the

long-term, ordering a genetic panel in patients after an myocardial infarction is not likely to provide any new useful information in the short-term beyond what physicians can get from asking about standard risk factors in the post-ACS setting. So a genetic risk score would not necessarily change treatment approaches in the early post-ACS setting for the patient.




















, QuebecCanada


• Response: It will be interesting to see if other researchers can find utility for using a genetic risk score in certain subgroups of patients or in longer follow-up periods where the mechanism of disease may be different. A recent study suggests that people with a high genetic risk score may have more benefit from lipid-lowering from statins which, if replicated by other groups, would have important clinical implications for using a genetic profile after an ACS. It will also be important to re-examine the issue as new genetic variants are discovered in the future that may provide additional predictive capacity.

• Citation:• Utility of a Genetic Risk Score to Predict Recurrent Cardiovascular Events 1 Year After an Acut

e Coronary Syndrome: A Pooled Analysis of the RISCA, PRAXY, and TRIUMPH Cohorts• Atherosclerosis Available online 17 July 2015• Christopher Labos, Sara C. Martinez, Rui Hao Leo Wang, Petra A. Lenzini, Louise Pilote, Peter

Bogaty, James M. Brophy, James C. Engert, Sharon Cresci, George Thanassoulis















http://www.sciencedirect.com/science/article/pii/S0021915015300496

http://www.sciencedirect.com/science/article/pii/S0021915015300496

http://www.sciencedirect.com/science/journal/00219150







• MedicalResearch: What is the background for this study? • Response: Recent changes recommend statin therapy for cardiovascular risk reduction in an

increasingly large number of Americans. Conversely, a number of studies have identified an increased risk of diabetes with statin treatment. Thus, there is increasing need for tools to target statin therapy to those with a favorable risk-benefit profile.





















• MedicalResearch: What are the main findings?• Response: In our study, we analyzed data from 3,153 individuals from the Multi-Ethnic Study

of Atherosclerosis who underwent CT scanning at baseline for assessment of calcium score. The CT scans were analyzed to assess liver attenuation as a measure of the amount of liver fat. We demonstrated that high liver fat doubled the risk of diabetes over a median of 9 years of follow-up. Importantly, statin therapy also doubled the risk of diabetes. The two together had an additive effect, even after adjusting for BMI, age, gender, family history of diabetes, waist circumference, lipids, hsCRP and exercise habits. As in prior studies, the risk of cardiovascular disease (CVD) events increased with increasing calcium score, as has previously been shown in MESA and in other studies.

• We then divided the cohort into six groups based on calcium score (0, 1-100 and >100) and liver fat (low/high). Using published data from meta-analyses of statin trials, we computed the number needed to treat to prevent one hard CVD event for statin therapy. Using data from our study, we computed the number needed to harm to cause one additional case of diabetes from statin therapy. The numbers needed to treat with ranged from 29-40 for calcium score of >100 to 218-252 for calcium score of 0. Conversely, the numbers needed to harm were approximately 63-68 for those with low liver fat versus 22-24 for those with high liver fat. Thus the combination of calcium score and liver fat assessment, from a single standard calcium score scan, allows for physicians to provide better assessment of risk and benefit of statins in discussion with their patients.














http://medicalresearch.com/weight-research/epicardial-fat-fatty-liver-linked/2447/







• MedicalResearch: What should clinicians and patients take away from your report?• Response: While it is well established that calcium score scans can help personalize CVD risk

assessment and select optimal patients for statin therapy based on identifying those with greatest potential for benefit, a simple evaluation of the portion of the liver which is seen at the edges of the scan can help physicians assess the risks of statin therapy as well. Although not every patient needs this type of scan, when a calcium score is ordered, assessment of liver fat may be a no or low cost additional assessment with additional clinically important information.














http://medicalresearch.com/heart-disease/calcium-scores-predictive-heart-disease-death-even-low-risk-adults/4891/








• Response: Exploration of the mechanisms whereby statins and liver fat may contribute to diabetes remains a very active area of investigation. We also do not yet have definitive evidence that a strategy of using calcium score combined with liver fat will optimize the balance of cardiovascular and diabetes risks or is cost effective.

• Citation:• Liver Fat, Statin Use, and Incident Diabetes: The Multi-Ethnic Study of Atherosclerosis• AtherosclerosisIn Press, Accepted Manuscript, Available online 15 July 2015• Ravi V. Shah, Matthew A. Allison, Joao A.C. Lima, David A. Bluemke, Siddique A. Abbasi, Pamel

a Ouyang, Michael Jerosch-Herold, Jingzhong Ding, Matthew J. Budoff, Venkatesh L. Murthy














http://medicalresearch.com/general-medicine/statins-elderly/8963/













Why do Asian Americans Live So Much Longer Than Other Ethnic Groups?MedicalResearch.com Interview with:Francesco AcciaiDepartment of SociologyPennsylvania State UniversityUniversity Park, PA

• MedicalResearch: What is the background for this study? • Response : Life expectancy in the United States varies greatly by race. Asian–Americans enjoy

the greatest longevity, with a nearly 8 year mortality advantage on whites• Response : Life expectancy in the United States varies greatly by race. Asian–Americans enjoy

the greatest longevity, with a nearly 8 year mortality advantage on whites. This advantage can derive from two separate processes. One, from a more favorable allocation of causes of death (incidence effect); i.e. from the fact that Asians tend to die of causes that strike on average at older ages while avoiding causes of death that afflict the young. Two, they can die of the same causes of death, but at an older age (age effect). By using the age-incidence decomposition method we are able to distinguish and quantify these contributions to the 7.8 year gap in life expectancy between Asians and whites.


http://medicalresearch.com/author-interviews/why-do-asian-americans-live-so-much-longer-than-other-ethnic-groups/15884/















• MedicalResearch: What are the main findings?• Response: Nearly 90% (or 6.9 years) of this gap is attributable to the fact that Asians tend to

outlive whites regardless of the cause of death (age effect). The causes that contribute the most to the gap are heart disease (24%) and cancers (18%). The incidence effect accounts for the remaining 0.9 years of the Asian-white gap in life expectancy. Moreover, sex-specific analyses show that men contribute somewhat more to the gap than women do (55% vs 45%), primarily because Asian–white differences in mortality are greater among men than among women with respect to suicide, traffic accidents and accidental poisoning.


















•Response: Since Asians and whites generally succumb to the same causes of death, researchers can focus on why Asian victims tend to outlive white victims. Are there any individual (e.g. health behaviors) or contextual (e.g. family network) factors that contribute to the Asian mortality advantage? Is the onset of disease delayed for Asians, or do they live longer while in poor health? Studies of mortality gaps, then, need to be juxtaposed with studies of morbidity gaps. Future research should also make use of the heterogeneity of Asian-Americans themselves (their country of origin, generation, length of time in the USA and so on) as leverage for understanding the exceptional life expectancy of Asian-Americans. Lastly, nativity data should be routinely transferred from death certificates to data archives to permit the comparison of US-born and foreign-born Asians. The best studies will compare those data with data from countries of origin to test more directly the idea that Asians live longer in America because of self-selection, that is, the Asians who move to America tend to be healthier than those who do not migrate.











http://medicalresearch.com/cancer-_-oncology/more-asians-and-hispanics-developing-non-melanoma-skin-cancer/12961/

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







• MedicalResearch: What should clinicians and patients take away from your report?• Response : The fact that Asians in America live so much longer than other Americans suggests

that the longevity of other groups can be increased. Clinicians should be aware of this difference, and they should be especially alert to differences in the life style and habits of Asians that might account for their longer lifespans. Once researchers and clinicians have a better understanding of the protective factors that contribute to Asian longevity, clinicians should disseminate this knowledge so that patients know not only that living a longer (and healthier) life is possible, but also the actions that are most likely to help them achieve this goal.

• Citation:• Pinpointing the sources of the Asian mortality advantage in the USA• Francesco Acciai, Aggie J Noah, Glenn Firebaugh• J Epidemiol Community Health jech-2015-205623Published Online First: 1 June 2015 doi:10.11

36/jech-2015-205623











http://jech.bmj.com/citmgr?gca=jech;jech-2015-205623v1









Small Subset of Cells Make HER2+ Breast Cancer Resistant To TreatmentMedicalResearch.com Interview with:Niels de Jonge, Ph.DHead of the Innovative Electron Microscopy groupGerman Cancer Research Center (DKFZ) in Heidelberg

University of Freiburg


Response: HER2 membrane proteins play a special role in certain types of breast cancer: amplified levels of HER2 drive unrestricted cell growth. HER2-tailored antibody-based therapeutics aim to prevent cancer cell growth. However, two-thirds of HER2 positive breast cancer patients develop resistance against HER2-targeting drugs. The reason for this is not yet understood. We now found out, that HER2 dimers appeared to be absent from a small sub-population of resting SKBR3 breast cancer cells. This small subpopulation may have self-renewing properties that are resistant to HER2-antibody therapy and thus able to seed new tumor growth.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/small-subset-of-cells-make-her2-breast-cancer-resistant-to-treatment/15892/












http://medicalresearch.com/cancer-_-oncology/breast-cancer/her2-positive-breast-cancer-adjuvant-chemotherapy/2779/








• Medical Research: What should clinicians and patients take away from your report?• Response: With our new analytical capabilities to study the functional state of HER2 at he

sub-cellular level, we provide a novel approach to study the functioning of HER2 proteins and obtained data not discovered before with existing methods. Possibly, research on the effect of HER2-targeting drugs using this new method, will lead to a better understanding of the causes of drug resistance. The effect of medication can now be examined in a new way, which may possible result in a better therapy with less drug resistance against breast cancer.














http://medicalresearch.com/cancer-_-oncology/breast-cancer/genes-identified-that-may-be-new-drug-targets-in-her2-breast-cancer/13996/









• Response: We aim to study the effect of HER2-targeting drugs on breast cancer cells, and in particular plan to examine small sub-populations of cells, for example, cancer stem cells. As found in our published study, small sub-populations of cells exist with a different behavior of HER2. An exciting question is thus if small sub-populations also exhibit a different response to these drugs.

• Citation:• B. Peckys, U. Korf, N. de Jonge. Local variations of HER2 dimerization in breast cancer cells

discovered by correlative fluorescence and liquid electron microscopy. Science Advances, 2015; 1 (6): e1500165 DOI: 10.1126/sciadv.1500165














http://medicalresearch.com/cancer-_-oncology/breast-cancer/improved-survival-combination-therapy-her2-positive-metastatic-breast-cancer/11713/

http://dx.doi.org/10.1126/sciadv.1500165






Unhealthy Weight Linked To Poor Pregnancy OutcomesMedicalResearch.com Interview with:Maya Tabet, MS Graduate Research AssistantSaint Louis UniversityCollege for Public Health and Social Justice

Department of Epidemiology St. Louis, MO 63104

• MedicalResearch: What is the background for this study? • Response: The majority of women in the U.S. have an unhealthy weight before they start

pregnancy, most of them being overweight or obese. It is well-known that having an unhealthy weight before pregnancy increases the likelihood of having adverse outcomes for the mother and baby. However, this study is the first to examine the likelihood of adverse outcomes in a second pregnancy among women who had an unhealthy weight before a first pregnancy that had no complications.


http://medicalresearch.com/weight-research/unhealthy-weight-linked-to-poor-pregnancy-outcomes/15896/



















• MedicalResearch: What are the main findings?• Response: Our study involved 121,049 women in Missouri who delivered their first 2

singleton pregnancies between 1989 and 2005. Findings revealed that women who were underweight before a first uncomplicated pregnancy had a 20% increased likelihood of having a shorter gestation and a 40% increased likelihood of having a small baby for gestational age in the second pregnancy, as compared to women who had a healthy weight before their first pregnancy.

• Also, women who were obese before a first uncomplicated pregnancy had a 55% increased likelihood of having a large baby for gestational age, a 156% increased likelihood of having preeclampsia, and an 85% increased likelihood of having a cesarean delivery. Babies born to these women also had a 37% increased likelihood of dying in the first 28 days of their life.














http://medicalresearch.com/cancer-_-oncology/higher-birthweight-linked-to-increased-childhood-cancer-risk/11259/








• MedicalResearch: What should clinicians and patients take away from your report?• Response: Second-time mothers who had an unhealthy weight when they started their first

pregnancy have an increased likelihood of poor pregnancy outcomes even when their first pregnancy was uncomplicated. In addition, some of the risk remains even if they reached a normal weight by their second pregnancy.

• Health professionals should counsel women of reproductive age on the potential pregnancy complications that an unhealthy weight may engender. Women who had a suboptimal weight before their first pregnancy should be monitored for complications in their subsequent pregnancies even if they had no complications in their first pregnancy or if they reached a healthy weight by their second pregnancy.














http://medicalresearch.com/diabetes/diabetes_in_pregnancy_lower_hbaic_threshold_improves_detection/7509/









• Response: Our finding that starting pregnancy with an unhealthy weight could pose problems in subsequent pregnancies carries considerable public health implications and is of great clinical significance.

• Future research should explore the mechanism by which an unhealthy weight in a first uncomplicated pregnancy may increase the risk of adverse outcomes in a second pregnancy.

• Citation:• Am J Obstet Gynecol. 2015 Jun 20. pii: S0002-9378(15)00631-6. doi: 10.1016/j.ajog.2015.06.0

31. [Epub ahead of print]• Prepregnancy body mass index in a first uncomplicated pregnancy and outcomes of a second

pregnancy.• Tabet M1, Flick LH2, Tuuli MG3, Macones GA3, Chang JJ2.














http://medicalresearch.com/weight-research/diet-and-supervised-exercise-may-be-helpful-in-preventing-excessive-pregnancy-weight-gain/14969/





















Soda Linked To Higher Risk of Diabetes, Regardless of Obesity StatusMedicalResearch.com Interview with: Dr. Fumiaki Imamura Ph.D.MRC Epidemiology UnitUniversity of Cambridge


Dr. Imamura: Soft drink consumption is associated with risk of diabetes, but whether or not the association persists after controlling for obesity status is not known. Diet drinks and fruit juice may be good alternatives to soft drinks. However, while obese individuals may consume diet drinks or fruit juice instead of sugar-sweetened soft drinks, evidence was weak to determine whether or not consuming these beverages is associated with risk of diabetes.


http://medicalresearch.com/weight-research/soda-linked-to-higher-risk-of-diabetes-regardless-of-obesity-status/15905/






http://medicalresearch.com/weight-research/much-sugary-drink-tax-reduce-obesity/2477/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Imamura: Consumption of soft drinks appeared to be associated with higher risk of diabetes,

regardless of obesity status. Although causality of the association remains unknown, it is reasonable to avoid it, based on the findings and known clinical evidence about soft drinks. If the association is causal and everyone takes maximal action to reduce the consumption, a sizable number of diabetes cases would be prevented, eg 4-13% of cases in US. Thus, although an individual benefit may be small, the population benefit can be substantial.

• Diet drinks may be candidate alternatives to soft drinks. Although they may be good to reduce caloric intake as shown by some clinical trials, these beverages themselves may not merit primary prevention of diabetes. Fruit juice itself may not, either. It would be advisable to consider water, unsweetened coffee, or unsweetened tea to consume instead of any sweet beverages. Coffee and tea have been shown to be associated with lower risk of type 2 diabetes.

• The study did not assess beverage consumption and health outcomes among diabetes patients. Yet, based on the existing evidence, the above recommendation is generally reasonable.

• The proportion of diabetes cases attributable to soft drinks was estimated to be 4-13% in US and lesser in UK. This indicates that more than 80% of diabetes cases are related to other factors. As commonly noted, clinicians and patients should focus on other dietary and lifestyle factors, as well as consumption of soft drinks or sugar.








http://medicalresearch.com/diabetes/replacing-sugary-drinks-with-plain-coffee-or-tea-may-reduce-diabetes-risk/13863/

http://medicalresearch.com/pediatrics/sugar-sweetened-beverages-linked-to-earlier-puberty-in-girlsed-to-earlier-puberty-in-girls/11089/








• Dr. Imamura: Reducing soft drinks is recommended. But, we do not know what strategies are effective in terms of people’s preference, people’s health and social benefits. Effectiveness of different interventions is one of things to study. Research can include statistical simulation, clinical intervention, and community-based intervention.

• Evidence remained relatively limited for non-white populations: for example, people in Latino countries, China, and India: Latino countries have recorded the world highest sales of soft drinks; and China and India are becoming leading countries of diabetes epidemics.

• We have insufficient evidence for impact of sweet beverage consumption on vascular diseases, cancer, kidney function, liver diseases, bone health, neurodegenerative diseases, and other chronic conditions; and prognosis of any diseases. We should keep in mind that any social, population-wide intervention influence risks of any diseases. Thus, further research on different health conditions is warranted.

• Citation:• Consumption of sugar-sweetened beverages, artificially sweetened beverages, and fruit juice

and incidence of type 2 diabetes: a systematic review, meta-analysis, and estimation of population attributable fraction

• Imamura, Fumiaki; O’Connor, Laura; Ye, Zheng; Mursu, Jaakko; Hayashino, Yasuaki; Bhupathiraju, Shilpa N.; Forouhi, Nita G.

• URI: http://www.repository.cam.ac.uk/handle/1810/248741Read the rest of the interviews on MedicalResearch.comContent NOT an endorsement of efficacy and NOT intended as specific medical advice.







http://medicalresearch.com/medical-research-centers/nih/sugar_sweetened_beverage_sodabriety/4452/

https://www.repository.cam.ac.uk/handle/1810/248741



http://www.repository.cam.ac.uk/handle/1810/248741






Older Sexually Active Adults Report Better Quality of LifeMedicalResearch.com Interview with:Dr. Alan J. Gow PhD, CPsychol, CSci, AFBPsS, FHEAAssociate Professor in Psychology School of Life SciencesHeriot-Watt UniversityEdinburgh

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

Dr. Gow: We were interested in exploring how sexual behaviours might be associated with quality of life in older adults. Ms. Taylor-Jane Flynn, who led on the research, noted “There is an abundance of research identifying factors that predict better health and well-being in later life, but sex is one that is under researched.” We asked our participants to report the frequency with which they engaged in six sexual behaviours from touching or holding hands to sexual intercourse, and then to also rate how important the behaviours were to them. Our results suggested that how often older adults engaged in sexual behaviours was positively associated with the quality of their social relationships. Interestingly, the importance of these sexual behaviours was found to be positively associated with their psychological quality of life.


http://medicalresearch.com/author-interviews/older-sexually-active-adults-report-better-quality-of-life/15917/
























Our recently published research on how sexual behaviours are associated with quality of life in older adults grew from Taylor-Jane’s work with older adults. She reflected “I found my inspiration for this study while working as a Health Care Assistant caring for older adults. In recent years, many of those who opened up to me on a personal level expressed their need and want to have intimacy and companionship in their lives. However, sex has generally been seen as a taboo subject, especially among older adults. Despite this, older adults shared in our conversations that they miss and want to engage in sexual behaviours, whether that be a kiss to intercourse, and for many these behaviours remained an important element in their life.” We were therefore keen to use these anecdotal accounts as a foundation for studying sexual behaviours as one of the many and varied determinants of wellbeing.


























• Medical Research: What should clinicians and patients take away from your report?• Dr. Gow: It’s important to note we can’t say the behaviours influenced quality of life, as our

study was cross-sectional. We can only talk about how these things were associated. Our results suggested that how often older adults engaged in sexual behaviours was positively associated with the quality of their social relationships. Interestingly, the importance of these sexual behaviours was found to be positively associated with their psychological quality of life.



























• Dr. Gow: Ours was a relatively small study, so we weren’t able to explore the possible mechanisms through which sexual behaviours might influence quality of life, or indeed, vice versa. What we hope is that our current findings encourage other researchers interested in the determinants of health and wellbeing in older adults to also consider sexual behaviours. Taylor-Jane added, “In deciding to study how sexual behaviours might be associated with quality of life, it was interesting to see how little research existed in older adults. Previous work has, however, found that older adults continue to be sexually active and that sexual experiences have been associated with better health both physically and psychologically.”

• Citation:• Examining associations between sexual behaviours and quality of life in older adults• Age Ageing first published online July 14, 2015Taylor-Jane Flynn and Alan J. Gow




















http://ageing.oxfordjournals.org/content/early/2015/07/14/ageing.afv083.full









Non-Psychotropic Cannabis Extract May Promote Bone HealingMedicalResearch.com Interview with:Yankel Gabet, DMD, PhDDepartment of Anatomy and AnthropologySackler Faculty of Medicine, Tel Aviv UniversityTel Aviv Israel


Dr. Gabet: Cannabis affects the body via specific components that are able to binding to receptors in the brain and other tissues. The components include the well-known Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), the major constituents of cannabis. The cannabinoid receptors in our body are activated by several molecules (‘endocannabinoids’) synthesized by different sorts of cells under specific conditions. These receptors can be activated by synthetic compounds (cannabinoid ligands) as well as by natural cannabis. The effect of endocannabinoids in bone metabolism has been studied before but this study is the first report on the actions of natural THC and CDB in bone fracture healing. This is particularly important in light of the high incidence of both cannabis use and bone fractures; it is likely that many patients suffering from bone fractures consume cannabis that may have beneficial or adverse effects on the healing process. Another important point is that the non-psychogenic CDB is enough to promote bone healing, so there is no need to be exposed to the euphoric effects of cannabis/THC to get the beneficial functions of CBD on bone.


http://medicalresearch.com/author-interviews/non-psychotropic-cannabis-extract-may-promote-bone-healing/15924/












http://medicalresearch.com/author-interviews/majority-of-medical-cannabis-products-found-to-be-mislabeled/15229/







• Medical Research: How does this change how scientists/people think about CBD and fracture-healing?

• Dr. Gabet: Cannabidiol has no psychoactivity (does not affect the brain, no euphoria…), and is primarily anti-inflammatory. Yet its receptor in the human body and the exact target cells are not known. As mentioned above, there was no report on any possible effect of cannabidiol in fracture healing before this article.

• Medical Research: What should clinicians and patients take away from your report? Might cannabidiol help heal fractures in humans?

• Dr. Gabet: So far, small rodents, such as mice and rats have proven reliable models for human skeletal biology. All the current clinical treatments for osteoporosis have been successfully tested in rodents prior to clinical settings. While there is no certainty, these findings hold promise for the potential clinical applicability of using cannabidiol for fracture healing in humans. The main limitation is that this is the very first study on the matter and results have been obtained in animals only. We also did not specifically assess side effects or long term effects. We also studied bone fracture healing, and not any other bone defect or disease.














http://medicalresearch.com/cancer-_-oncology/cannabis-extracts-enhance-anti-tumor-radiation-effects/9021/

http://medicalresearch.com/pain-research/marijuana-component-could-ease-pain-from-chemotherapy-drugs/246/







• Medical Research: Do one knows exactly how CBD is facilitating this process? What’s the mechanism?

• Dr. Gabet: As mentioned above, the receptor for cannabidiol in our body has not been characterized yet. However, the mechanism of action of CBD in fracture healing is quite outstanding. Most therapeutic approaches (clinically and experimentally) enhance the formation and/or mineralization of the fracture callus (the cartilaginous bridge immediately formed between the broken parts). Here we observed a strengthening of the fracture callus (using biomechanical testing), but not via increased in the mineralized component of the callus. Indeed all our microCT analyses showed that the dimensions and microarchitectural properties of both the mineralized and unmineralized parts of the callus, were similar with or without cannabidiol. However, we observed a significant effect in the formation of the organic matrix of the callus (the collagenous part that serve as a basis for the subsequent mineralization). CBD treatment resulted in a biomechanically stronger matrix by enhancing the crosslinks between the collagen molecules. Furthermore, we observed that this effect was linked to a direct stimulation of a crosslinking enzyme (PLOD1) in osteoblasts, the bone forming cells.





















• Dr. Gabet: Well, first, the exact mechanism of action should be carefully elucidated. Side effects, either on the short term on the long term on the skeleton and/or other organs should be studied in depth.

• Citation:• Journal of Bone and Mineral Research• Kogan, N. M., Melamed, E., Wasserman, E., Raphael, B., Breuer, A., Stok, K. S., Sondergaard, R

., Escudero, A. V., Baraghithy, S., Attar-Namdar, M., Friedlander-Barenboim, S., Mathavan, N., Isaksson, H., Mechoulam, R., Müller, R., Bajayo, A., Gabet, Y. and Bab, I. (2015), Cannabidiol, a Major Non-Psychotropic Cannabis Constituent Enhances Fracture Healing and Stimulates Lysyl Hydroxylase Activity in Osteoblasts. J Bone Miner Res. doi: 10.1002/jbmr.2513














http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2513/suppinfo











Family History of Lupus Is Strong Risk Factor For Lupus and Other Autoimmune DiseasesMedicalResearch.com Interview with: Dr. Changfu Kuo MD PhDDivision of Rheumatology, Orthopaedics, and Dermatology

School of Medicine, University of Nottingham, Nottingham, EnglandDivision of Rheumatology, Allergy, and ImmunologyChang Gung Memorial Hospital, Taoyuan, Taiwan


Dr. Kuo: Systemic lupus erythematosus (SLE) is a prototype of autoimmune disease with features like autoantibody production and multiple target organ damage. SLE can affect any part of the body and the course of the disease is highly diverse and unpredictable. SLE can occur at any age and affect both females and males with a sex ratio of 9 to 1.

• Familial predisposition has been recognised as a risk factor previously and heritability of SLE has been estimated to be 66%. However, previous reports are often based on less robust sampling strategies and case ascertainment which generally depend on hospital records, self-reported diagnosis and disease registries, therefore limiting generalisability. The previous estimates of heritability are overestimated, due to a lack of consideration of shared environmental contribution.


http://medicalresearch.com/genetic-research/family-history-of-lupus-is-strong-risk-factor-for-lupus-and-other-autoimmune-diseases/15805/

























This study utilised a unique health insurance database that provides information on the whole population of Taiwan and permits determination of spouse and first-degree relatives. Over 23 million people were included in this study. Furthermore, through inclusion of SLE status of the spouse in our analyses the study is also able to examine how much of familial clustering results from genetic versus shared environmental factors. Overall the familial relative risk is 16.92. The genetic contribution to SLE susceptibility is estimated to be 44%. In addition to SLE, other autoimmune diseases are also more prevalent in individuals with a family history of SLE.




















http://medicalresearch.com/author-interviews/minority-patients-with-lupus-kidney-disease-may-have-suboptimal-care/11814/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Kuo: Family history for SLE is a strong predictive risk factor for SLE and other related

autoimmune diseases. The heritability is high, but seems to be lower than previously thought. Despite high familial relative risk, the absolute risk is not high considering low background prevalence of SLE.


• Dr. Kuo: This study is purely based on a Asian population. Estimation of familial relative risks and heritability should be undertaken in other population with different ethnic background.

• Citation:• Kuo C, Grainge MJ, Valdes AM, et al. Familial Aggregation of Systemic Lupus Erythematosus a

nd Coaggregation of Autoimmune Diseases in Affected Families. JAMA Intern Med. Published online July 20, 2015. doi:10.1001/jamainternmed.2015.3528.




















http://medicalresearch.com/author-interviews/lupus-nephritis-susceptibility-genes-identified/1575/

http://archinte.jamanetwork.com/article.aspx?articleid=2397732









Aging Adults Benefit From Exposure To Green and Blue SpacesMedicalResearch.com Interview with:Jessica Finlay M.A.Department of Geography, Environment and SocietyUniversity of Minnesota MN


Response: Natural environments are known to promote physical, mental, and spiritual healing. People can attain health benefits by spending time outside, often in remote places to “get away from it all.” Now research conducted by a University of Minnesota graduate student with a team in Vancouver, B.C., shows that green and “blue” spaces (environments with running or still water) are especially beneficial for healthy aging in seniors. The research team interviewed older adults aged 65 – 86 years who lived in Vancouver, B.C., Canada. All study participants were low-income, represented 8 different self-identified racial and ethnic groups, and experienced a range of chronic conditions and health status.


http://medicalresearch.com/author-interviews/aging-adults-benefit-from-exposure-to-green-and-blue-spaces/15813/













Published in the journal Health and Place, the study – “Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older adults” – demonstrates that by incorporating smaller features, such as a koi pond or a bench with a view of flowers, public health and urban development strategies can optimize nature as a health resource for older adults. Throughout the research, green and blue spaces promoted feelings of renewal, restoration, and spiritual connectedness. They also provided places for multi-generational social interactions and engagement, including planned activities with friends and families, and impromptu gatherings with neighbors.















• Medical Research: What should clinicians and patients take away from your report?• Response: We zoomed in to everyday life for seniors between the ages of 65 and 86. We

discovered how a relatively mundane experience, such as hearing the sound of water or a bee buzzing among flowers, can have a tremendous impact on overall health. Accessibility to everyday green and blue spaces encourages seniors to simply get out the door. This in turn motivates them to be active physically, spiritually and socially, which can offset chronic illness, disability and isolation.

• While younger generations may use green and blue spaces more to escape and rejuvenate from their busy work life, our participants used nature to be active physically, spiritually, and socially in later life. Many overcame barriers due to chronic illness, disability, and progressing old age to connect regularly with green and blue spaces.















Natural environments enable older adults to uphold daily structure in retirement and provide opportunities for diverse activities outside the home. This is important to quality of later life by decreasing boredom, isolation, and loneliness; as well as boosting one’s sense of purpose and accomplishment. Blue space in particular provides opportunities for non-weight bearing physical activity and physiotherapy (e.g. wading, water walking, swimming). Waterfront areas are comforting sites for spiritual connectedness with deceased loved ones, and relaxing places to escape the strains of later life.
















• Response: While our research may seem intuitive, it creates conversations on how to build communities that serve people across their entire lifetime. We don’t just need a playground for children, we also need sheltered benches for the grandparents to watch them. This research is more than anecdotal; it gives credence to some small but significant elements of everyday later life. Hopefully it will help urban planners and developers build communities that span a lifetime.

• Citation:• Therapeutic landscapes and wellbeing in later life: Impacts of blue and green spaces for older

adults• Health Place. 2015 Jul;34:97-106. doi: 10.1016/j.healthplace.2015.05.001. Epub 2015 May 18.• Finlay J1, Franke T2, McKay H3, Sims-Gould J4.


























Peripheral Nerve Stimulation Improves Motor Nerve Function After Spinal Cord InjuryMedicalResearch.com Interview with:Dr Michael Lee PhD MPhty MChiro BScDiscipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney

Clinical Neurophysiologist, The Brain & Mind Research Institute, The University of Sydney

Medical Research: What is the background for this study?

Dr. Lee: Our research team at the University of Sydney has previously shown that the functioning of peripheral nerves deteriorate following spinal cord injury (SCI). Using novel, non-invasive electrophysiological techniques (nerve excitability testing), we showed in this study that peripheral nerves below the level of spinal cord injury underwent dramatic functional reorganization. Peripheral nerve dysfunction will not only contribute to a number of undesirable medical complications including peripheral neuropathy and pain, it exacerbates muscle atrophy and can potentially limit the effectiveness of rehabilitative therapies that drive central plasticity. In this study, we were interested to see whether this secondary peripheral nerve dysfunction could be reversed with a short-term targeted peripheral nerve stimulation therapy.


http://medicalresearch.com/neurological-disorders/peripheral-nerve-stimulation-improves-motor-nerve-function-after-spinal-cord-injury/15943/





















Medical Research: What are the main findings?

Dr. Lee: We studied peripheral nerve function in both the upper (median nerve at the wrist) and lower limbs (peroneal nerve near the fibular head) in 22 patients with acute spinal cord injury (all within 6 months of injury). We then randomly assigned one upper limb and one lower limb nerve to a daily regimen of 30-min peripheral nerve stimulation for 6 week. All study participants continued with standard rehabilitation. The results from our nerve excitability studies showed that 6-weeks of daily stimulation reversed a number of nerve excitability abnormalities secondary to spinal cord injury, and in some cases normalized it to a level comparable to healthy age-matched subjects. The peripheral nerves in the opposite limbs remained dysfunctional over the 6-week period. The results of our study showed convincingly that the addition of peripheral nerve stimulation in the early stages of spinal cord injury is beneficial by ameliorating the downstream effects of spinal cord injury.
















http://medicalresearch.com/neurological-disorders/stepping-closer-nerve-regeneration-spinal-cord-injury/10120/








• Medical Research: What should clinicians and patients take away from your report?• Dr. Lee: The take home message is that the addition of peripheral nerve stimulation is clearly

beneficial for improving motor nerve function in patients with spinal cord injury. We don’t believe peripheral nerve stimulation alone was responsible for this improvement, in fact we hypothesize that repetitive stimulation of the nerves improved the biophysical properties of axonal membrane by normalizing various energy-dependent processes and this in turns enhanced the responsiveness of the motor axons to concurrent rehabilitation therapies.

• This type of stimulation was tolerated well by all of our study participants. There was no drop out nor report of any adverse reaction. One of our study participants chose to continue the same stimulation regimen after the trial ended for another 18 months, and upon reassessment, the improvement in peripheral nerve function was maintained over the 18 months period.

• Our study also highlighted the importance of screening for peripheral nerve dysfunction following spinal cord injury, particularly in patients who developed new motor weakness or sensory loss.
















http://medicalresearch.com/medical-imaging/spinal-cord-injury-nerve-degeneration-occurs-within-months/986/









• Dr. Lee: We will need to trial this type of peripheral nerve stimulation therapy on a larger cohort of spinal cord injury patients and perform long-term follow ups to properly evaluate its clinical benefits. Also, as the study was conducted in patients with recent spinal cord injury, future studies which evaluate its effectiveness in patients with chronic SCI will be necessary.

• Citation:• Short-term peripheral nerve stimulation ameliorates axonal dysfunction after spinal cord injur

y• Michael Lee, Matthew C Kiernan, Vaughan G. Macefield, Bonne B. Lee, Cindy S-Y Lin• Journal of Neurophysiology Published 18 March 2015 Vol. no. , DOI: 10.1152/jn.00839.2014
















http://jn.physiology.org/content/early/2015/03/13/jn.00839.2014









Despite Notification, Most High Risk Patients Do Not Seek Further Breast Cancer EvaluationMedicalResearch.com Interview with: Alison L. Chetlen, D.O.Associate Professor, Department of RadiologyPenn State Milton S. Hershey Medical Center

Hershey, PA 17033

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

Dr. Chetlen: Breast cancer risk assessment provides a means of identifying women who are at risk for development of this disease. Identifying individuals at high risk for breast cancer allows for genetic testing, supplemental breast cancer screening, possibly prophylactic surgery or chemoprevention in hopes of decreasing mortality from breast cancer. Despite the advantages of cancer genetic risk assessment and testing, most individuals in the general population who would benefit from such services currently do not receive them.

• Medical Research: What are the main findings?

Dr. Chetlen: After implementation of a specific high-risk recommendation within our standardized mammography report along with a letter written in “lay” language informing patients of their high-risk status, the number of referrals to our high-risk clinic increased only modestly. Despite these specific recommendations to both physicians and patients, over 85% of high risk patients did not consult a high-risk provider regarding their elevated lifetime risk of breast cancer.


http://medicalresearch.com/cancer-_-oncology/breast-cancer/despite-notification-most-high-risk-patients-do-not-seek-further-breast-cancer-evaluation/15947/










http://medicalresearch.com/cancer-_-oncology/breast-cancer/family-history-alone-does-not-affect-breast-cancer-recurrence/14364/






Despite Notification, Most High Risk Patients Do Not Seek Further Breast Cancer EvaluationMedicalResearch.com Interview with: Alison L. Chetlen, D.O.Associate Professor, Department of RadiologyPenn State Milton S. Hershey Medical Center

Hershey, PA 17033

• Medical Research: What should clinicians and patients take away from your report?• Dr. Chetlen: Patients should understand the significance of an increased familial cancer risk to

increase the likelihood that they will follow through on consulting such a provider. Recognition of high risk by primary care providers and communication of this risk to patients is not currently optimized. Increased collaboration between primary care physicians and breast radiologists through educational programs and community outreach programs may allow for improved care of the population of women at high risk for breast cancer.

• Medical Research: What recommendations do you have for future research as a result of this study?• Dr. Chetlen: The process of risk assessment and referral, evaluation by genetic counselors, genetic

testing, and use of intensive screening is clearly complex and must include shared decision making with patients. Further research is needed to determine the effects of enhanced education for referring providers and for patients, in addition to the mammogram letter, to ensure that patients at high risk for breast cancer receive adequate personal counseling, supplemental screening, and preventive therapies.

• Citation:• Does a High-Risk Recommendation in Mammography Reports Increase Attendance at a Breast Cancer

Risk Assessment Clinic?• Vaidya, Ankur M. et al.• Journal of the American College of Radiology• DOI: http://dx.doi.org/10.1016/j.jacr.2015.04.024• Published Online: July 14, 2015












http://medicalresearch.com/cancer-_-oncology/breast-cancer/prevention-breast-cancer-high-risk-postmenopausal-women/5914/

http://www.jacr.org/article/S1546-1440(15)00328-2/abstract




http://dx.doi.org/10.1016/j.jacr.2015.04.024






medicalresearch.com: medical research exclusive interviews july 20 2015

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