medicalresearch.com: medical research exclusive interviews june 26 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]

June 25 2015

For Informational Purposes Only: Not for Specific Medical Advice.

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Placenta-on-a-Chip Technology Enhances Study Of Fetal CirculationMedicalResearch.com Interview with:Dan Dongeun Huh, Ph.D.Wilf Family Term Chair & Assistant ProfessorDepartment of BioengineeringUniversity of Pennsylvania

Philadelphia, PA 19104

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

Response: The placenta is a temporary organ central to pregnancy and serves as a major interface that tightly regulates transport of various endogenous and exogenous materials between mother and fetus. The placental barrier consisting of the closely apposed trophoblast epithelium and fetal capillary endothelium is responsible for maintaining this critical physiological function, and its dysfunction leads to adverse pregnancy outcomes. Despite its importance, barrier function of the placenta has been extremely challenging to study due to a lack of surrogate models that faithfully recapitulate the key features of the placental barrier in humans. Our study aims to directly address this long-standing technical challenge by providing a microengineered in vitro system that replicates architecture, microenvironment, and physiological function of the human placenta barrier. This “placenta-on-a-chip” device consists of microfabricated upper and lower cell culture chambers separated by a thin semipermeable membrane, and the placental barrier is generated by culturing human trophoblasts and fetal endothelial cells on either side of the membrane with steady flows of culture media in both chambers. This microfluidic cell culture condition allowed the cells to form confluent monolayers on the membrane surface and to create a bi-layer tissue that resembled the placental barrier in vivo. Moreover, the microengineered barrier enabled transport of glucose from the maternal chamber to the fetal compartment at physiological rates.

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

http://medicalresearch.com/author-interviews/placenta-on-a-chip-technology-enhances-study-of-fetal-circulation/15214/
















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?

• Response: This study suggests an exciting possibility to utilize microengineering technologies to address major limitations of existing placenta models based on traditional cell culture, perfused whole placenta, and animals. Our placenta-on-a-chip system provides unprecedented capabilities to simulate, visualize, and quantitatively analyze the placental barrier and its critical transport functions. We believe that our model holds great potential as a novel enabling platform for the study of placental barrier function and other important physiological processes in the placenta.





















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

• Response: It is exciting to think about the possibility of using our microengineered model and other similar platforms not only for the study of placental biology but also for drug screening applications. Our approach allows for continuous monitoring and quantitative analysis of drug transport from the intervillous space to the fetal circulation, and this new capability can be leveraged in understanding fetal exposure to drugs or exploring drug dosing for prenatal treatment. Another exciting possibility for future research is to use our ability to precisely control and manipulate cells and their microenvironment to develop disease models and study placental dysfunction in various pathological contexts.

• Citation:• Ji Soo Lee, Roberto Romero, Yu Mi Han, Hee Chan Kim, Chong Jai Kim, Joon-Seok Hong,

Dongeun Huh. Placenta-on-a-chip: a novel platform to study the biology of the human placenta. The Journal of Maternal-Fetal & Neonatal Medicine, 2015; 1 DOI: 10.3109/14767058.2015.1038518














http://dx.doi.org/10.3109/14767058.2015.1038518






Pre-Labor C-Section Affects Newborn’s Immune SystemMedicalResearch.com Interview with:Hans Bisgaard, DMScProfessor of PaediatricsUniversity of Copenhagen and Head of the Danish Pediatric Asthma Centre

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

Prof. Bisgaard: Programming of the immune response in perinatal life seems to contribute to the increased prevalence of immune-mediated diseases

• We hypothesized that initiation of labor could affect the developing newborn immune system.

• Medical Research: What are the main findings?• Prof. Bisgaard: Pre-labor cesarean section is associated with a distinct and gestational age-

related distribution of circulating immune cells in newborns suggesting that changes in specific immune compartments occur during the approach of labor.


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
















Pre-Labor C-Section Affects Newborn’s Immune SystemMedicalResearch.com Interview with:Hans Bisgaard, DMScProfessor of PaediatricsUniversity of Copenhagen and Head of the Danish Pediatric Asthma Centre

• Medical Research: What should clinicians and patients take away from your report?• Prof. Bisgaard: This is research attempting to understand factors influencing early immune

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

this study?• Prof. Bisgaar: Replication in a larger cohort.• Citation:• Prelabor cesarean section bypasses natural immune cell maturation• Thysen, Anna Hammerich et al.• Journal of Allergy and Clinical Immunology

Published Online: June 17, 2015DOI: http://dx.doi.org/10.1016/j.jaci.2015.04.044













http://dx.doi.org/10.1016/j.jaci.2015.04.044






Some Melanoma Cells Hide From BRAF Inhibitor TherapyMedicalResearch.com Interview with:Keiran Smalley, PhD. Scientific DirectorThe Comprehensive Melanoma Research Center Associate ProfessorThe Moffitt Cancer Center & Research Institute,

Tampa, FL


Dr. Smalley: The major finding of this study is that some melanomas (those which are BRAF mutant and PTEN null) can evade BRAF inhibitor therapy by remodeling their environment. Essentially the cells make a protective niche that allows them to escape from the drug. By attaching to this newly synthesized extracellular matrix the melanoma cells generate their own survival signals.


http://medicalresearch.com/author-interviews/some-melanoma-cells-hide-from-braf-inhibitor-therapy/15212/




















Tampa, FL

• Medical Research: What should clinicians and patients take away from your report?• Dr. Smalley: This work has uncovered another mechanism by which melanoma cells can

“hide” from therapy. Developing strategies that target these adaptations will prove critical if we ever want to achieve cures for cancer. This is particularly important for an aggressive cancers like melanoma where as little as one cell can repopulate the tumor.
















http://medicalresearch.com/author-interviews/neutrophil-to-lymphocyte-ratio-may-identify-melanoma-patients-likely-to-benefit-from-ipilimumab/14986/







Tampa, FL


• Dr. Smalley: New strategies need to be developed that target both the tumor and its mechanisms of adaptation to therapy.

• Citation:• I V Fedorenko, E V Abel, J M Koomen, B Fang, E R Wood, Y A Chen, K J Fisher, S Iyengar, K B

Dahlman, J A Wargo, K T Flaherty, J A Sosman, V K Sondak, J L Messina, G T Gibney, K S M Smalley. Fibronectin induction abrogates the BRAF inhibitor response of BRAF V600E/PTEN-null melanoma cells. Oncogene, 2015; DOI: 10.1038/onc.2015.188
















http://dx.doi.org/10.1038/onc.2015.188






Arrhythmia Risk Increased By Post-Operative Antinausea-Steroid CombinationMedicalResearch.com Interview with:Dr. Andrea Tricco Ph.DDalla Lana School of Public HealthUniversity of Toronto

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

Dr. Tricco: We were commissioned by Health Canada to assess the safety and effectiveness of serotonin (5-HT3) receptor antagonists in patients undergoing surgery. In order to examine this research question, we conducted a systematic review and network meta-analysis including >450 studies.

• We found that more patients receiving granisetron plus dexamethasone experienced arrhythmia compared to all other interventions and placebo. No differences were observed regarding mortality and QT prolongation in meta analysis; no studies reported on PR ‐prolongation or sudden cardiac death. Granisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine. We found that ondansetron plus droperidol intravenous (IV) was also a highly effective antiemetic for decreasing the risk of vomiting and post-operative nausea and vomiting (PONV).


http://medicalresearch.com/author-interviews/arrhythmia-risk-increased-by-post-operative-antinausea-steroid-combination/15207/



















• Medical Research: What should clinicians and patients take away from your report?• Dr. Tricco: Although granisetron plus dexamethasone was ranked highly effective across the

vomiting, nausea, and PONV outcomes, it was associated with an increased risk of arrhythmia. Patients and clinicians can use our results to tailor antiemetic treatment for those undergoing surgery.






















• Dr. Tricco: We are currently accounting for the dosages of the medications in a separate analysis, as well as conducting a similar study on patients undergoing chemotherapy and taking these drugs.

• Citation: BMC Med. 2015 Jun 18;13:142. doi: 10.1186/s12916-015-0379-3.• Comparative safety of serotonin (5-HT3) receptor antagonists in patients undergoing surgery:

a systematic review and network meta-analysis.• Tricco AC1,2, Soobiah C3,4, Blondal E5, Veroniki AA6, Khan PA7, Vafaei A8, Ivory J9, Strifler L10

, Ashoor H11, MacDonald H12, Reynen E13, Robson R14, Ho J15, Ng C16, Antony J17, Mrklas K18,19

, Hutton B20, Hemmelgarn BR21, Moher D22, Straus SE23,24.















http://www.ncbi.nlm.nih.gov/pubmed/26084332?dopt=Abstract&holding=f1000,f1000m,isrctn

















































Profound Educational Disparities in Obesity Widens Over Three DecadesMedicalResearch.com Interview with: Ruopeng An, PhDAssistant Professor, Department of Kinesiology and Community HealthCollege of Applied Health Sciences

University of Illinois at Urbana-ChampaignChampaign, IL 61820


Response: Health disparity is a particular type of health difference that is closely linked with social, economic and environmental disadvantage. One fundamental goal in the Healthy People 2020 is to “achieve health equity, eliminate disparities, and improve the health of all groups”. Obesity is a leading risk factor for many adverse health outcomes such as type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, and certain types of cancer. Sweeping across the nation during the past 3 decades, the prevalence of obesity increased from 15% in 1980 to 35% in 2012 among U.S. adults. The obesity epidemic is marked by salient demographic and socioeconomic disparities pertaining to gender, race/ethnicity, education, income and geographic location.


http://medicalresearch.com/weight-research/educational-disparities-in-obesity/15218/












http://medicalresearch.com/weight-research/obesity-largely-driving-health-care-and-societal-burden/15164/








In this study, we examined the annual trends in educational disparity in obesity among U.S. adults 18 years and older from 1984 to 2013 using data from a nationally-representative health survey. We found that the obesity prevalence among people with primary school or lower education increased from 17.46% or 3.41 times the prevalence among college graduates (5.12%) in 1984 to 36.16% or 1.73 times the prevalence among college graduates (20.94%) in 2013. In any given year, the obesity prevalence increased monotonically with lower education level. The obesity prevalence across education subgroups without a college degree gradually converged since early 2000s, whereas that between those subgroups and college graduates diverged since late 1980s. Absolute educational disparity in obesity widened by 60.84% to 61.14% during 1984-2013 based on the Absolute Concentration Index and the Slope Index of Inequality, respectively; meanwhile, relative educational disparity narrowed by 52.06% to 52.15% based on the Relative Index of Inequality and the Relative Concentration Index, respectively. The trends in educational disparity in obesity differed substantially by gender, race/ethnicity, age group, and obesity severity.





















• Medical Research: What should clinicians and patients take away from your report?• Response: Using 3 decades of data from a uniquely large nationally-representative survey,

this study documented the profound educational disparity in obesity and its long-term trajectory among U.S. adults. At any given point in time, lower education level was associated with noticeably higher obesity rate. The obesity prevalence across education subgroups without a college degree gradually converged whereas that between those subgroups and college graduates diverged, resulting in the widening of absolute educational disparity in obesity over the past 3 decades. The trends in educational disparity in obesity differed noticeably by population subgroups and obesity severity.






















• Response: Future research should explore the underlining driving forces that lead to sustained educational disparities in obesity, and design effective population-level interventions to address such disparities.

• Citation:• Educational disparity in obesity among U.S. adults, 1984-2013• An, Ruopeng Annals of Epidemiology

DOI: http://dx.doi.org/10.1016/j.annepidem.2015.06.004














http://dx.doi.org/10.1016/j.annepidem.2015.06.004






ICD Implantation Rates Too Low In ElderlyMedicalResearch.com Interview with:Sean D. Pokorney, MD, MBADivision of Cardiology, Duke University Medical CenterDuke Clinical Research Institute, Durham, North Carolina

Medical Research: What is the background for this study?

Dr. Pokorney: About 350,000 people die of sudden cardiac death in the US each year. Patients who have weakened heart function, particularly those with heart muscle damage as a result of a heart attack, are more likely to experience sudden cardiac death. Defibrillators have been around since the 1980s, and have prolonged countless lives. A previous study showed that 87% of patients who had a cardiac arrest were eligible for an implantable-cardioverter defibrillator (ICD) beforehand but did not get an ICD implanted prior to their arrest. The timing of ICD implantation is critical, as studies have not found a benefit to ICD implantation early after myocardial infarction (MI). Guidelines recommend primary prevention ICD implantation in patients with an EF ≤ 35% despite being treated with optimal medical therapy for at least 40 days after an MI. Given the need to wait for at least 40 days after an MI, ICD consideration is susceptible to errors of omission during the transition of post-MI care between inpatient and outpatient care teams. Also, the benefit of ICDs remains controversial among older patients, as these patients were underrepresented in clinical trials.


http://medicalresearch.com/heart-disease/icd-implantation-rates-too-low-in-elderly/15205/









http://medicalresearch.com/heart-disease/icd-implantation-and-cardiac-perforation-risk/1704/







• Medical Research: What are the main findings?• Dr. Pokorney: We looked at Medicare patients discharged from US hospitals after a heart

attack between 2007 and 2010. We focused on those patients who had weak heart function, and this left us with a little over 10,300 patients from 441 hospitals for our study. This was an older patient population with a median age of 78 years. We looked to see how many of these patients got an ICD within the first year after MI, and how many patients survived to 2 years after their heart attack. Only 8% of patients received an ICD within 1 year of their heart attack. ICD implantation was associated with a third lower risk of death within 2 years after a heart attack, and this was consistent with the benefit that were seen in the randomized clinical trials. Importantly, 44% of the patients in our study were over 80 years old, and we found that the relationship between ICD use and mortality was the same for patients over and under age 80 years. Increased patient contact with the health care system through early cardiology follow-up or re-hospitalization for heart failure or MI was associated with higher likelihood of ICD implantation. Rates of ICD implantation remained around 1 in 10 patients within 1 year of MI even among patients with the largest heart attacks and the weakest hearts (lowest ejection fractions), who were least likely to have improvement in their heart function over time. Similarly, even after excluding patients at highest risk for non-arrhythmic death (prior cancer, prior stroke, and end stage renal disease), ICD implantation rates remained around 1 in 10 patients.











http://medicalresearch.com/author-interviews/patient_safety_indicators_likely_to_change_under_new_icd10/7535/







• Medical Research: What should clinicians and patients take away from your report?• Dr. Pokorney: The post-MI care transition is a point of vulnerability, since there is an obligate

40-day waiting period between the inpatient MI and when the patient is eligible for the therapy. Our results found that in an older patient population ICDs were associated with the same amount of benefit as was seen in patients in the randomized trials with average ages in their 60s. This emphasizes that age alone should not be a contraindication to ICD implantation, and current rates of ICD use in patients after MI are too low. The decision to implant an ICD certainly needs to be individualized based on a patient’s quality of life, treatment goals, and preferences, but it is important for providers to engage older patients in a shared decision making process. Patients need to take an active role in their care by ensuring that they schedule and attend outpatient appointments, as well as making sure that their providers are aware of what happened to them during recent hospitalizations.











http://medicalresearch.com/heart-disease/icd-implantation-and-cardiac-perforation-risk/1704/








• Dr. Pokorney: Health system interventions that encourage close outpatient follow-up, improved communication and implementation of longitudinal care plans, and better patient education should be studied to assess whether they can effectively optimize ICD consideration and use. Better models are needed to be able to predict the patients at highest risk of arrhythmic death, who would benefit from an ICD, compared to patients at risk for non-arrhythmic death, who would be less likely to benefit from an ICD. This would help providers refine patient selection towards those patients who are most likely to benefit from an ICD. Finally, further research is needed to better understand individualized patient risk tolerance, as well as how patients think through the trade-offs associated with ICD therapy. Better insight into these issues would allow providers to assist with the shared decision-making process regarding ICD implantation.

• Citation:• Pokorney SD, Miller AL, Chen AY, et al. Implantable Cardioverter-Defibrillator Use Among Med

icare Patients With Low Ejection Fraction After Acute Myocardial Infarction. JAMA. 2015;313(24):2433-2440. doi:10.1001/jama.2015.6409.











http://medicalresearch.com/heart-disease/implantable_defibrillators_demonstrate_decrease_in_mortality_in_heart_failure_patients/6976/

http://jama.jamanetwork.com/article.aspx?articleid=2338252









Larger Study Finds No Link Between Melanoma and ViagraMedicalResearch.com Interview with:Dr. Stacy Loeb, MD, MScDepartment of Urology, Population Health, and Laura and Isaac Perlmutter Cancer CenterNew York University, New York


Dr. Loeb: A paper published last year suggested a relationship between use of sildenafil (Viagra) and melanoma. That study had only 142 cases of melanoma, and of these men 14 had used sildenafil. This study got a lot of publicity leading numerous patients to express concern over whether erectile dysfunction drugs could cause melanoma.

• Our goal was to look more closely at this issue in a larger population from Sweden (including 4065 melanoma cases of whom 435 used any type of erectile dysfunction drug- Viagra, as well as Levitra and Cialis). Sweden has a national health system so we were able to access prescription records for men across the entire country, which we linked to the national registries for melanoma and basal cell skin cancer.


http://medicalresearch.com/author-interviews/larger-study-finds-no-link-between-melanoma-and-viagra/15178/










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







• Medical Research: What are the main findings?

• Dr. Loeb: Although there is an association between erectile dysfunction medications with melanoma, a closer look at the data suggests that this relationship is unlikely to be causal.

• If erectile dysfunction drugs caused melanoma, you’d expect that the more prescriptions a man had, the greater the risk of melanoma. However, this was not the case- more prescriptions was not associated with an increased risk of melanoma.

• You would also expect that the drugs with a longer half life (in the body longer) would have greater risk of melanoma and this was not the case.

• If the drugs promote melanoma, you might also expect to see a relationship with more aggressive disease. However, we did not find a relationship between erectile dysfunction medications with advanced melanoma.

• Also, if it was a causal relationship due to a melanoma pathway,you would not expect to see a relationship between the drugs with basal cell skin cancer- however, we found a similar increased risk of basal cell skin cancer in men taking erectile dysfunction drugs.












http://medicalresearch.com/cancer-_-oncology/melanoma-women-have-survival-advantage/974/

http://medicalresearch.com/cancer-_-oncology/melanoma-women-have-survival-advantage/974/







• Medical Research: What should patients and clinicians take away from this report?• Response: Although it is unlikely that erectile dysfunction medications cause melanoma and

other skin cancers, the same men who take these medicines are still at risk for skin cancer. Avoiding blistering sunburn, using sunscreen and other protective wear are important to reduce the risk of skin cancer.

• Citation:• Loeb S, Folkvaljon Y, Lambe M, et al. Use of Phosphodiesterase Type 5 Inhibitors for Erectile D

ysfunction and Risk of Malignant Melanoma. JAMA. 2015;313(24):2449-2455. doi:10.1001/jama.2015.6604.












http://medicalresearch.com/cancer-_-oncology/prostate-cancer/does_cialis_work_for_ed_in_men_after_prostate_cancer_radiation/4518/

http://researchblogging.org/citation/markup









Choice of Kidney Function Equation Important In Risk Evaluation Prior To Stent SurgeryMedicalResearch.com Interview with:Jessica Parsh MDHitinder Gurm MBBSDepartment of Internal MedicinebUniversity of Michigan Health System


Response: Chronic kidney disease (CKD) is associated with adverse events after percutaneous coronary interventions (PCI). Estimated glomerular filtration rate (eGFR) is used for CKD stage classification and there are several widely used eGFR equations, including the Cockcroft-Gault, CKD-EPI, and MDRD. Others have shown that the CKD-EPI equation is more accurate, more precise and less bias. The current Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend the use of CKD-EPI. Even so, there remains wide variability among equation choice between different institutions as well as between different health care providers (physicians, pharmacists, etc). In addition, in a recent survey, up to 12% of providers were “unsure” of which equation they used. Furthermore, the FDA has no clear guidelines regarding equation selection for pharmacokinetic studies of novel medications and the equation used for development of a particular drug is not always clearly labeled on package inserts.


http://medicalresearch.com/heart-disease/choice-of-kidney-function-equation-important-in-risk-evaluation-prior-to-stent-surgery/15166/




















Using data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium for almost 130,000 patients who underwent PCI, we investigated whether use of different eGFR equations would lead to discrepant eGFR output, how this would lead to CKD stage reclassification and whether CKD stage reclassification by a certain equation led to improved risk prognostication for adverse events. We also studied how calculation of eGFR by various equations would affect drug dosing recommendations for common renally-dosed antiplatelet and antithrombotic medications. We found that there was wide discrepancy among the eGFR output of the various equations and this led to significant CKD stage reclassification (with agreement on stage classification as low as 56% for CKD-EPI and Cockcroft-Gault). Further, our data from receiver operating characteristic analysis and net reclassification index analysis support CKD-EPI as superior for risk prognostication for renal adverse outcomes of acute kidney injury and new requirement for dialysis. In regards to drug dosing, agreement between all three equations on dosing adjustment was as low as 34% (bivalirudin with eGFR cutoff < 30 ml/min/1.732).
















http://medicalresearch.com/heart-disease/risk-statification-of-stent-pci-surgery-outlines/10870/







• Medical Research: What should clinicians and patients take away from your report?• Response: Our study demonstrates that eGFR equation selection is important since the

various equations lead to very discrepant eGFR values and CKD stage classification. Further, for renal adverse outcomes of acute kidney injury and new requirement for dialysis, the use of CKD-EPI leads to improved risk prognostication. These findings compliment many other studies which have demonstrated the superiority of the CKD-EPI equation in terms of accuracy, precision and bias. Therefore, our study supports increased awareness of equation selection by providers and the use of CKD-EPI for risk stratification for patients undergoing PCI.

• Given the potential for harm with inappropriate drug dosing in patients with CKD, our findings that various eGFR equations lead to large discrepancies in drug dosing recommendations is concerning. When possible, providers should review package labeling and dose medications using the same eGFR equation used in the original pharmacokinetic design.
















http://medicalresearch.com/heart-disease/large-study-evaluates-predictors-of-long-term-pci-outcomes/12778/








• Response: Future research investigating the potential harm related to inaccurate drug dosing secondary to inappropriate eGFR equation selection is needed. From there, investigations into whether pursuing a standardized eGFR equation selection approach for new drug pharmacokinetic design would lead to a decrease in harm from drug dosing inaccuracies will be an important next step to improve the safety of patients living with CKD.

• Citation:• Parsh J, Seth M, Aronow H, et al. Choice of Estimated Glomerular Filtration Rate Equation Imp

acts Drug-Dosing Recommendations and Risk Stratification in Patients With Chronic Kidney Disease Undergoing Percutaneous Coronary Interventions. J Am Coll Cardiol. 2015;65(25):2714-2723. doi:10.1016/j.jacc.2015.04.037.
















http://medicalresearch.com/heart-disease/patients_with_atrial_fibrillation_recurrence_more_likely_to_have_kidney_function_decline/8255/

http://content.onlinejacc.org/article.aspx?articleid=2337417










Hispanics Have High Prevalence of Hyperlipidemia, but Low Awareness and TreatmentMedicalResearch.com Interview with:Carlos J. Rodriguez, MD, MPHDivision of Public Health SciencesDepartment of Medicine Wake Forest School of Medicine

Winston Salem, NC 27152‐

MedicalResearch: What prompted you to study cholesterol in the Latino population? Please explain in detail.

Dr. Rodriguez: Early in my career I noted that there were race-ethnic differences in the cholesterol profile between hispanics, african americans and non-hispanic whites. Hispanics are the largest ethnic minority group in the us yet prior studies of cholesterol in hispanics were relatively small, lacked adequate representation of diverse hispanic background groups for comparisons, and were not necessarily representative of nor generalizable to the hispanic population. The hispanic/latino adults in the hispanic community health study / study of latinos helped filled this critical gap.


http://medicalresearch.com/author-interviews/hispanics-have-high-prevalence-of-hyperlipidemia-but-low-awareness-and-treatment/15223/








http://medicalresearch.com/heart-disease/comorbidities-increase-mortality-risk-of-atrial-fibrillation-in-blacks-and-hispanics/15168/








• MedicalResearch: What do you think are the most significant findings from your study? What could have the greatest clinical implications and applications?

• Dr. Rodriguez: Several findings are important: less than half of those with high cholesterol were aware of their condition; less than a third of those with high cholesterol were being treated; and among those receiving treatment, only two-thirds had cholesterol concentrations that were adequately controlled.

• MedicalResearch: Why do you think Latinos have this high risk for hyperlipidemia? Is it diet? Genes? A mix? Please explain in detail.

• Dr. Rodriguez: Hispanics have a high prevalence of high cholesterol (approximately 45%) due probably a mix of genes and diet. What is more surprising is the lack of awareness, treatment and control that needs to change since awareness is the first step in prevention; one cannot actively prevent what one is not aware of.

















• MedicalResearch: Half reported not being aware of their condition, meaning that a healthcare professional never informed them of their elevated cholesterol. Do you think this reflects a problem in the US healthcare industry or do you think this was an issue with recall? Please explain in detail.

• Dr. Rodriguez: Of course some component may be recall bias but I don’t think that’s the major component to this finding. When such a large percentage of the population has not had a health professional tell them about high cholesterol, I think that is a problem on several levels with the health care system including issues with access to care and patient-provider difficulties such as language barriers or cultural insensitivity.










http://medicalresearch.com/author-interviews/underserved-patients-minority-physicians-role/3498/








• MedicalResearch: WHY do you think younger people, women and undereducated an underinsured were less likely to have their cholesterol controlled? And why do you think certain groups such as Puerto Ricans had better treatment that Mexicans? What’s driving these disparities and how could they be corrected?

• Dr. Rodriguez: I think much of it is access to care related where certain groups such as young hispanics and latinas may be falling through the cracks in the health care system but some of the reason is also physician inertia where one may be reluctant or just more slow to uptitrate or intensify treatment in certain patients. Patient adherence is also a significant factor low due to lack of understanding, lack of resources to get their medications or patient provider relationship difficulties such as language barriers or cultural insensitivity.

















• MedicalResearch: You studied primarily urban communities. Do you think the same would hold true for rural communities or perhaps be even worse? Please explain in detail.

• Dr. Rodriguez: Yes. Rural communities would do possibly worse or similar.• MedicalResearch: What do you think is the most important take-away message to people

reading your study?• Dr. Rodriguez: An important message is that no population can be left behind if we are to

improve the health of the nation. Our study highlights that the hispanic population needs attention with regards to cholesterol awareness, treatment and control.










http://medicalresearch.com/author-interviews/hispanic-and-uninsured-adults-may-experience-barriers-to-blood-pressure-control/12670/








• MedicalResearch: Based on these findings, what do you plan to study next?• Dr. Rodriguez: I think further studies on how acculturation impacts health are needed. This is

important primarily for immigrant populations such as hispanics. I also think more studies that can pilot an intervention to address improving health literacy, cultural competency, and assessing how these interventions impact physician inertia or patient adherence. Also we need to evaluate if more widespread acceptance of the affordable care act across all states helps alleviate any of the findings from this study.

• Citation:• High Cholesterol Awareness, Treatment, and Control Among Hispanic/Latinos: Results From t

he Hispanic Community Health Study/Study of Latinos• Carlos J. Rodriguez, Jianwen Cai, Katrina Swett, Hector M. González, Gregory A. Talavera, Lisa

M. Wruck, Sylvia Wassertheil Smoller, Donald Lloyd Jones, Robert Kaplan, and Martha L. Davi‐ ‐glus

• J Am Heart Assoc. 2015;4:e001867, originally published June 24, 2015, doi:10.1161/JAHA.115.001867










http://jaha.ahajournals.org/content/4/7/e001867.abstract












Trial of JAK Inhibitor Fedratinib For Blood Cancer DiscontinuedMedicalResearch.com Interview with:Dr. Ayalew Tefferi, M.D.Department of Medicine,Mayo ClinicRochester, Minnesota

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Tefferi: William Vainchenker discovered and reported an activating JAK2 mutation

(JAK2V617F) in myelofibrosis and related myeloproliferative neoplasms in 2005 (Nature. 2005;434:1144-1148). This seminal observation led to the recognition of activated JAK-STAT as the potential disease-driving pathway in myeloproliferative neoplasms and development of several JAK inhibitors, including fedratinib, ruxolitinib and momelotinib, for treatment of myelofibrosis. In phase 2 studies, these JAK inhibitors showed similar activity in alleviating constitutional symptoms and reducing spleen size. However, none of them were able to induce complete or partial remissions or reversal of bone marrow fibrosis or significant lowering of JAK2 mutant allele burden. A subsequent phase 3 study provided the information required for FDA approval of ruxolitinib and the current phase 3 study was meant to do the same for fedratinib.


http://medicalresearch.com/cancer-_-oncology/trial-of-jak-inhibitor-fedratinib-for-blood-cancer-discontinued/15131/




















• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Tefferi: The study was positive in terms of the activity of fedratinib in reducing spleen size

and alleviating constitutional symptoms. A little more than one-third of the study patients experienced a spleen response defined by MRI or CT documented decrease in spleen volume of over 35% and a similar proportion achieved symptoms relief defined by 50% or more reduction in total symptom score, at both dose levels of 400 and 500 mg daily. These outcome results were significantly better than those seen in patients receiving placebo. Adverse events previously noted in phase 2 studies, including anemia, gastrointestinal symptoms, liver and pancreatic enzyme abnormalities, were also seen in the phase 3 study. However, an unexpected and serious neurotoxicity, clinically consistent with Wernicke encephalopathy, was also seen in 4 women receiving the drug at the higher dose level of 500 mg daily. This led to a unilateral decision from the sponsor to discontinue further development of the drug.






















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

• Dr. Tefferi: The value and limitations of JAK inhibitors in myeloproliferative neoplasms are now clear; they are capable of alleviating symptoms and reducing spleen size in about a third of patients but this activity is not durable (average duration of response is one to two years) and the drugs have not shown convincing evidence of disease-modifying activity. It is unlikely that additional JAK inhibitors (e.g. momelotinib) are going to do any better in the latter regard but might provide a better toxicity profile in some (e.g. anemia) but not in other (e.g. peripheral neuropathy) regard. There continues to be unmet need for patients with myelofibrosis and other myeloproliferative neoplasms in terms of disease-modifying drugs and patients might be best served by participating in clinical trials with drugs that might be capable of achieving this important goal.

• Citation:• Pardanani A, Harrison C, Cortes JE, et al. Safety and Efficacy of Fedratinib in Patients With Pri

mary or Secondary Myelofibrosis: A Randomized Clinical Trial. JAMA Oncol. Published online June 18, 2015. doi:10.1001/jamaoncol.2015.1590.
















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

http://oncology.jamanetwork.com/article.aspx?articleid=2330618









Placement of Hand Sanitizer Dispensers Important For Staff ComplianceMedicalResearch.com Interview with:Laila Cure, Ph.D.Assistant ProfessorDept. of Industrial and Manufacturing EngineeringWichita State University


Response: It is widely known that healthcare work, particularly inpatient care work, is mostly knowledge-based. Healthcare workers are constantly assessing the clinical state of their patients and making decisions that affect their workflow. This type of work is difficult to study and organize as a whole using traditional work design techniques, which are mostly designed for routine, repetitive work. Nevertheless, there are components of inpatient work that can be improved using basic workstation design principles. Hand hygiene is one of them.




Hand hygiene is still the single most important intervention to prevent infection in hospitals. Guidelines state that health care workers should clean their hands before touching a patient, before an aseptic procedure, after body fluid exposure, after touching a patient, after touching patient surroundings. Hand sanitizer dispensers are practical resources to support hand hygiene because they can be placed almost anywhere throughout hospital units. This study aimed at determining whether “good” placement of sanitizer dispensers correlates with compliance of staff in using the sanitizer. “Good placement” was defined in terms of usability characteristics extracted from hand hygiene literature recommendations. Of the usability characteristics included in the study, visibility and accessibility had some statistical influence on improving compliance.


http://medicalresearch.com/infections/improving_hand_hygiene_compliance_with_red_flashing_lights/6889/



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

• Response: From the point of view of the work system, the hand sanitizer is a resource needed during any type of inpatient care work that involves the patient. Hand hygiene is one of the very few repetitive steps of health care delivery and should become almost automatic. The environment of care should be designed to support this automation by having the hand hygiene resources in the appropriate place. Our study suggests that place should be mainly visible and easily accessible upon entry.

• In general, there may be other routine components of inpatient care for which the environment should be designed to support healthcare providers. Human factors and work design methodologies can be used to identify these components and improve their associated work systems.


http://medicalresearch.com/infections/norovirus-and-rotovirus-may-be-resistant-to-alcohol-based-hand-disinfectants/13649/




• Response: The limitations of the current study are mostly related to the data. In principle, hand hygiene compliance is difficult to measure through observation due to the Hawthorne effect and patient privacy concerns. The current main priority for hand hygiene researchers is to find practical ways to reliably assess compliance. The study could perhaps be replicated using other sources of compliance data such as the consumption of cleaning agent.

• Involving different healthcare organizations in the study could also help identify if the significant usability factors are organization specific or if they are generalizable to the whole healthcare industry.


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



• Finally, the compliance data used had been originally collected for general quality improvement purposes but with no specific use in mind other than assessing hospital- and unit- wide compliance rates. Some rooms had very few observations and we had to exclude them from the study. So we suggest designing the study to make sure that all applicable locations and usability characteristics are included in the analysis with an appropriate sample size.

• In general, collecting compliance data is costly and time consuming. Such data should support quality improvement not only by assessing key performance metrics, but also helping identify root causes. Our recommendation for researchers and quality managers is to collaborate with each other so that quality improvement data collection efforts can actually support the improvement of healthcare delivery through incorporating state-of-the art research finding.

• Citation:• Effect of hand sanitizer location on hand hygiene compliance• Cure, Laila et al.• American Journal of Infection Control

DOI: http://dx.doi.org/10.1016/j.ajic.2015.05.013


http://www.ajicjournal.org/article/S0196-6553(15)00536-2/abstract





Robotic-Assisted Cardiac Surgery: Higher Cost But Shorter Hospital StayMedicalResearch.com Interview with:Vanita Ahuja, MD, MPH Department of General SurgeryYork Hospital, York, Pennsylvania

• MedicalResearch: What is the background for this study? What are the main findings?• Dr. Ahuja: Robotic-assisted surgery has been slowly accepted within the medical community.

Felger et al. (1999), Falk et al. (2000), and Loumet et al. (2000) state that specific to cardiac surgery, the advantages of the robot in coronary artery bypass grafting (CABG) and valvular operations were demonstrated with increased visualization, ease of harvest, and quality of vascular anastomoses as early as 1999. However, Giulianotti, et al. (2003), Morgan et al. (2005), and Barbash et al. (2010) suggest that although safety and efficacy are supported, it is not conclusive yet that robot-assisted surgery is cost-effective, given the high cost of the robot itself, longer operating times, and the short life of the robotic instruments. The purpose of our paper was to compare outcomes of complications, length of stay (LOS), actual cost, and mortality between non-robotic and robotic-assisted cardiac surgery.


http://medicalresearch.com/author-interviews/robotic-assisted-cardiac-surgery-higher-cost-but-shorter-hospital-stay/15220/
















• In general surgery and subspecialties, the use of the robot has increased significantly over the past few years. It has been noted that robotic surgery improves on laparoscopic surgery by providing increased intra-cavity articulation, increased degrees of freedom, and downscaling of motion amplitude that may reduce the strain on the surgeon.

• The biggest growth in robotic surgery has been seen in the fields of gynecology and urology. Recently, Wright et al. reported an increase in robotic assisted hysterectomy from 0.5 percent of the procedures in 2007 compared to 9.5 percent in 2010 for benign disease. In their study, robotic assisted surgery had similar outcomes to laparoscopic surgery but higher total cost of $2,189 more per case. In urologic surgery, Leddy et al. reported in 2010 that radical prostatectomy remains the biggest utilization of robotic assisted surgery in urology with 1% in 2001 to 40% of all cases in 2006 performed in the United States.


















Utilizing a nationwide database from 2008-2011, subjects were propensity matched by 14 patient characteristics to reduce selection bias in a retrospective study. The patients were then divided into three groups by operation types: valves, vessels and other type. Univariate analysis revealed that robotic-assisted surgery, compared to non-robotic surgery, had higher cost ($39,030 vs. $36,340), but lower LOS (5 vs. 6 days) and mortality (1% vs. 1.9%, all p<0.001). For those who had one or more complications, robotic-assisted cardiac surgery had fewer complications (27.2%) to non-robotic cardiac surgery (30.3%, p < .001).


















• MedicalResearch: What should clinicians and patients take away from your report?• Dr. Ahuja: Robotic-assisted cardiac surgery increased by 600% from 0.06% to .4% over four

year period. Robotic-assisted cardiac surgery appears to have reduced mortality and complications compared to similar matched characteristics non-robotic surgery patients, helping to offset upfront costs. Robotic-assisted cardiac surgery has lower length of stay than non-robotic surgery. Results of this study suggest robotic-assisted cardiac surgery may be as safe as non-robotic surgery and offer the surgeon an additional technique for performing cardiac surgery.


















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

• Dr. Ahuja: Further studies need to be done to show long-term benefits including quality of life and pain scores. Further research may also consider the use of The Society of Thoracic Surgeons (STS) database which allows 30 day follow-up post-operative, has further information on patient’s other co-morbidities and surgeon training.

• Citation:• Yanagawa F, Perez M, Bell T, Grim R, Martin J, Ahuja V. Critical Outcomes in Nonrobotic vs Rob

otic-Assisted Cardiac Surgery. JAMA Surg. Published online June 17, 2015. doi:10.1001/jamasurg.2015.1098.












http://archsurg.jamanetwork.com/article.aspx?articleid=2322834








Caesarean Section Linked to Increased Autism RateMedicalResearch.com Interview with:Ali S. Khashan, Ph.D.Irish Centre for Fetal and Neonatal Translational Research (INFANT)Cork, Ireland


Dr. Khashan: The Caesarean section rate is increasing worldwide reaching 30% in some western countries and 50% in China and Brazil. As a result, it is becoming increasingly important to understand the long-term effects this procedure may have on both mother and child. Previously, our group conducted a systematic review and meta-analysis of published literature and found birth by Caesarean to be associated with approximately 20% increased risk of autism spectrum disorder (ASD), compared to birth by vaginal delivery. This means if the risk of ASD in children born by vaginal delivery were 1%, and the association was causal, the risk of autism spectrum disorder in children born by Caesarean section is 1.2% i.e. two additional ASD cases per 1000 births. However, studies were limited, and we were unable to determine what was driving this association. In our new study, now published in JAMA Psychiatry, we investigated this issue further with the largest study on this subject to date, including all children born in Sweden between 1982 and 2010.


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















Our study included data on over 2.9 million people and accounted for variety of factors known to be associated with both Caesarean section and autism spectrum disorder. After controlling for known confounders, such as maternal age and psychiatric history as well as various other perinatal and socio-demographic factors, we confirmed our previous findings that birth by Caesarean was associated with approximately 20% increased risk of autism spectrum disorder, compared to birth by vaginal delivery. However, with this analysis it remained unclear whether the increased risk was due to the Caesarean section itself, or some genetic or environmental factor that we were unable to measure.











http://medicalresearch.com/mental-health-research/autism/preeclampsia_raises_risk_of_autism-spectrum-disorder/9570/







• • To determine if it was birth by Caesarean section or another unknown factor which led to an

increased risk of ASD, we compared children with autism spectrum disorder to their non-diagnosed brothers and sisters. In other words, we analysed pairs of siblings in which one was diagnosed with ASD and one was not, to determine if birth by Caesarean was associated with increased risk of ASD within families. In this way, we attempted to indirectly account for genetic and family environment factors that are shared by siblings but we were unable to measure in the general population. In this analysis, which included data on over 13,000 sibling pairs, there was no longer any association between birth by Caesarean section and ASD.











http://medicalresearch.com/mental-health-research/autism/autism-spectrum-disorders-bacterial-infections-pregnancy-increased-risk/3290/







• • Overall, these results indicate that though birth by Caesarean section may be associated with

an increased risk of ASD, it is likely due to family factors such as genetics or environment, rather than the Caesarean section itself. These findings are more informative than many previous studies as we had the largest sample size on this topic to date and estimated the association between Caesarean section and the risk of autism spectrum disorder while comparing siblings born by different methods of delivery. This allowed us to control for many factors that other studies did not.


















• Dr. Khashan: Professor Louise Kenny, Consultant Obstetrician and Gynaecologist at Cork University Maternity Hospital said, “the overall risk of autism spectrum disorder is very small and this most recent work suggests that most, if not all, the risk is not to do with the Caesarean section at all, which reassuring for parents. Anyone concerned about their pregnancy or their baby should speak to their health care provider”.











http://medicalresearch.com/mental-health-research/syngap1-gene-mutation-linked-intellectual-disability-schizophrenia-autism/10936/







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

this study?• Dr. Khashan: Although our study is the largest and most comprehensive, to date, on the

association between Caesarean section and autism spectrum disorder, these findings should be replicated using population-based data from other countries. Considering the rising Caesarean section rates worldwide, it is important to conduct more research to understand the association between Caesarean section and other short and long term health outcomes in the children.

• Citation:• Please find my answers to your questions below. If you need any more information please

send an email or call me on +353 863 235 935. My answer to the first question may be long and I am not sure whether you would like to edit it. If you edit significantly, I am happy to have another look at it. For the second question, I requested a quote from my colleague and co-author Prof. Kenny. This is the link of the earlier systematic review that I mention in the first paragraph (http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12351/abstract;jsessionid=ECE0C5FFF4BE28343E65639131DA7AAE.f03t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false).











http://medicalresearch.com/mental-health-research/autism/rise_in_autism_rates_largely_due_to_changes_in_diagnostic_criteria/8678/

http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12351/abstract;jsessionid=ECE0C5FFF4BE28343E65639131DA7AAE.f03t02?deniedAccessCustomisedMessage=&userIsAuthenticated=false








New Blood Biomarker Panel May Detect Melanoma Micro-MetastasesMedicalResearch.com Interview with:Mitchell S. StarkSenior Research Assistant/PhD StudentOncogenomics GroupQIMR Berghofer Medical Research InstituteHerston

, Brisbane, Australia

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

Response: Melanomas are among the most commonly occurring cancers with the number of new cases rising each year. Melanoma is currently is listed as the 4th and 6th most common cancer in Australia and the USA with >11,000 and >76,000 news diagnoses each year. The overall 5-year survival for melanoma is 91%, which is largely due to curative surgery for early stage disease. However, cure rates are <15% if distant metastasis occurs (stage IV). We now have evidence that current therapeutic options for late stage disease are more effective if the disease is treated with a lower disease burden. 2010). Hence, melanoma must be treated in earlier stages to maximize the chances of patient survival. Therefore, the ability to identify signs of melanoma progression sooner would be a valuable clinical tool.


http://medicalresearch.com/author-interviews/new-blood-biomarker-panel-may-detect-melanoma-micro-metastases/15294/




















The use of melanoma progression markers have been used for many years however it is clear from the survival rates that melanoma must be detected before disease progresses thus highlighting that the current methods of progression detection are inadequate. We have identified a seven-microRNA panel (MELmiR-7) that has the ability to detect the presence of melanoma with high sensitivity and specificity which is superior to currently used markers for melanoma progression, recurrence, and survival. This panel may enable more precise measurement of disease progression and may herald an increase in overall survival.























• Medical Research: What should clinicians and patients take away from your report?• Response: In a few years time melanoma could be monitored more precisely with this panel

of microRNAs (miRNAs) as part of a patients routine follow-up to complement their CT and MRI scans. If the blood tests gives a positive result and the scans are negative, then this may indicate there is underlying micro-metastases present and the patient should therefore for monitored more frequently for signs of recurrence.















http://medicalresearch.com/author-interviews/jak1-inhibitors-may-be-new-option-to-treat-resistant-melanoma/14561/









• Response: Given the current data presented in this study and with further validation in larger cohorts of patients, future melanoma treatment regimens should consider the utility of miRNAs as a prognostic aid in the clinical setting.

• Citation:• The Prognostic and Predictive Value of Melanoma-related MicroRNAs Using Tissue and Serum

: A MicroRNA Expression Analysis • Mitchell S. Starka, b, , ,Kerenaftali Kleinc, d,Benjamin Weidee,Lauren E. Hayduf, g

,Annette Pflugfeldere, h,Yue Hang Tangi,Jane M. Palmera,David C. Whitemanj,Richard A. Scolyerf, g,Graham J. Mannf, g,John F. Thompsonf, g,Georgina V. Longf, g,Andrew P. Barbouri

,H. Peter Soyerh,Claus Garbee

,Adrian Herington Pamela M. Pollock Nicholas K. Hayward EBioMedicine• Available online 12 May 2015















http://www.sciencedirect.com/science/article/pii/S2352396415300189







































Opioids and Barbituates Commonly Prescribed For HeadachesMedicalResearch.com Interview with:Dr. Mia T. Minen, MD, MPHDirector, Headache ServicesNYU Langone Medical CenterAssistant professor, Department of Neurology


Dr. Minen: We conducted a survey on opioid and barbiturate use among patients visiting a headache center to find out which medications they were receiving for treatment. There’s limited evidence that long-term use of these medications can help treat headaches or migraines, and even short-term use in small quantities can cause medication overuse headache. It is important to determine which providers start these medications so that educational interventions can be tailored to these physician specialties to try to prevent situations such as incorrect prescribing practices and medication overuse.

• In this sample of patients from a specialty headache center, approximately 20 percent of patients — or 1 in 5 — were using opioids or barbiturates, and about half had been prescribed these medications at some point in the past for their headaches. These findings show that opioids and barbiturates are commonly prescribed to patients with headaches. While two-thirds of patients found opioids or barbiturates helpful, many did not like them, were limited by side effects or did not find them to be helpful. Emergency department physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent prescribers of barbiturate-containing medications. Primary care physicians were also identified as frequent first prescribers of these medications.


http://medicalresearch.com/pain-research/opioids-and-barbituates-commonly-prescribed-for-headaches/15302/














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








• Dr. Minen: These data provide a snapshot of the wide variety of physician specialties that might benefit from additional education about the appropriate use of opioids and barbiturate-containing medications in patients with headache. Physicians are often put in a tough position when patients come in with headaches and ask for these medications. These physicians may benefit from learning more about the evidence-based treatment guidelines from the American Academy of Neurology and American Headache Society. Patients can address with their doctors their medication regimen and the frequency at which they use these medications.
















http://medicalresearch.com/author-interviews/pharmacy-shopping-and-overlapping-prescriptions-linked-to-opioid-overdose/11910/








• Dr. Minen: More research is needed to develop educational interventions targeted to physician specialties with higher opioid and barbiturate prescribing rates for headache, and determine these initiatives’ effectiveness.

• Citation:• Abstract presented at the 2015 American Headache Society June 2015:• Survey”of”opioid”and”barbiturate”use”among”patients”evaluated”in”a”headache”clinic”
















http://medicalresearch.com/pain-research/us-surgery-patients-report-more-pain-receive-more-opioids/14566/

http://www.americanheadachesociety.org/57th_annual_scientific_meeting/






No Knee-Jerk Antibiotics Campaign Aims To Reduce Antibiotic OverusageMedicalResearch.com Interview with:Barbara W. Trautner, MD, PhDHouston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey

Veterans Affairs Medical Center


Dr. Trautner: Reducing antimicrobial overuse, or antimicrobial stewardship, is a national imperative. If we fail to optimize and limit use of these precious resources, we may lose effective antimicrobial therapy in the future. CDC estimates that more than $1 billion is spent on unnecessary antibiotics annually, and that drug-resistant pathogens cause 2 million illnesses and 23,000 deaths in the U.S. each year. The use of antibiotics to treat asymptomatic bacteriuria (ASB) is a significant contributor to antibiotic overuse in hospitalized and nursing home patients, especially among patients with urinary catheters. In catheterized patients, ASB is very often misdiagnosed and treated as catheter-associated urinary tract infection (CAUTI). Therefore, we designed the “Kicking CAUTI: The No Knee-Jerk Antibiotics Campaign intervention” to reduce overtreatment of ASB and to reduce the confusion about distinguishing CAUTI from asymptomatic bacteriuria.


http://medicalresearch.com/infections/urinary-tract-infections/no-knee-jerk-antibiotics-campaign-aims-to-reduce-antibiotic-overusage/15233/










http://medicalresearch.com/infections/urinary-catheter-infections-clinical-assessment-vs-national-safety-network-definition/1881/

http://medicalresearch.com/infections/urinary_tract_infections/3978/








This study evaluated the effectiveness of the Kicking CAUTI intervention in two VAMCs between July 2010 and June 2013. The primary outcomes were urine cultures ordered per 1,000 bed-days (inappropriate screening for ASB) and cases of ASB receiving antibiotics (overtreatment). The study included 289,754 total bed days, with 170,345 at the intervention site and 119,409 at the comparison site. Through this campaign, researchers were able to dramatically decrease the number of urine cultures ordered. At the intervention site, the total number of urine cultures ordered decreased by 71 percent over the course of the intervention. Antibiotic treatment of asymptomatic bacteriuria decreased by more than 75 percent during the study. No significant changes occurred at the comparison site over the same time period. Failure to treat catheter-associated urinary tract infection when indicated did not increase at either site.



















• Medical Research: What should clinicians and patients take away from your report?• Dr. Trautner: Antibiotic stewardship is every person’s responsibility, patient and providers

alike. Providers need to recognize the harms of indiscriminant use of antimicrobials and stop and think before treating a patient for a CAUTI that may or may not exist. Patients likewise can help by recognizing that antibiotics are not any more effective for treating asymptomatic bacteriuria than they are for treating the common cold.












http://medicalresearch.com/infections/travelers-may-spread-antibiotic-resistance/10983/









• Dr. Trautner: Our next step is to implement our intervention in other VA hospitals nation-wide. For this purpose we have joined forces with several VA operational partners to initiate the VA Choosing Wisely Campaign for UTI. The antimicrobial stewardship lessons learned from Kicking CAUTI have also helped inform the antimicrobial stewardship components of the AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs, another national project.

• Citation:• Trautner BW, Grigoryan L, Petersen NJ, et al. Effectiveness of an Antimicrobial Stewardship Ap

proach for Urinary Catheter Associated Asymptomatic Bacteriuria. JAMA Intern Med. Published online May 26, 2015. doi:10.1001/jamainternmed.2015.1878.












http://archinte.jamanetwork.com/article.aspx?articleid=2296017








Patient Controlled Medication Found Effective For Abdominal Pain In ERMedicalResearch.com Interview with:Prof. Jason SmithConsultant in Emergency Medicine, Derriford Hospital, Plymouth, UKRoyal College of Emergency Medicine Professor

• Medical Research: What is the background for this study?• Prof. Smith: Patients commonly present to emergency departments in pain. When patients

are asked about their emergency department experience, they often say that more could have been done to manage their pain.

• Routine care for patients in moderate or severe pain who present to emergency departments usually involves intravenous (IV) morphine, delivered by a nurse. There may be a delay when patients are admitted to a hospital ward before they are reviewed by the admitting medical team, when their pain needs are reassessed.

• Patient controlled analgesia (PCA) is used to good effect elsewhere in the hospital.The aim of this study was to compare PCA with routine care in patients presenting to emergency departments with either traumatic injuries or non-traumatic abdominal pain, who require admission to hospital.


http://medicalresearch.com/pain-research/patient-controlled-medication-found-effective-for-abdominal-pain-in-er/15241/















• Medical Research: What are the main findings?• Prof. Smith: We found that significant reductions in pain were possible using patient

controlled analgesia in patients with abdominal pain. Patients spent significantly less time in moderate or severe pain, and were more likely to be very or perfectly satisfied with their pain management.

• In patients with traumatic injuries, a modest (but non-significant) reduction in pain was seen in patients allocated to the PCA group compared with the routine care group. Patients in the PCA group were more likely to be very or perfectly satisfied with their pain management.

















• Medical Research: What should clinicians and patients take away from your report?• Prof. Smith: Multimodal analgesia including opiates is effective at managing pain in

emergency patients, but significant improvements can be gained by using patient controlled analgesia in some groups. Patient controlled analgesia should be considered as an option when dealing with patients in pain, particularly those in whom repeated doses of intravenous opiates are required.


















• Prof. Smith: Patient controlled analgesia may be useful in other groups that have not yet been studied in the emergency setting, such as children. Novel methods of dealing with patients in pain in emergency departments need to be investigated. This may involve novel methods of drug delivery (intranasal, buccal, inhaled) or drugs.

• http://www.bmj.com/content/350/bmj.h2988andhttp://www.bmj.com/content/350/bmj.h3147

• Citation:• Smith Jason E, Rockett Mark, Creanor Siobhan, Squire Rosalyn, Hayward Chris, Ewings Paul et

al. PAin SoluTions In the Emergency Setting (PASTIES)—patient controlled analgesia versus routine care in emergency department patients with non-traumatic abdominal pain: randomised trial 2015; 350 :h3147











http://www.bmj.com/content/350/bmj.h2988











Many US Infants Found To Be Vitamin D DeficientMedicalResearch.com Interview with:Katherine Ahrens Ph.D. MPHNational Center for Health StatisticsCenters for Disease Control and PreventionHyattsville, MD

• Medical Research: What is the background for this study? • Dr. Ahrens: In 2008, the American Academy of Pediatrics (AAP) revised their recommended

minimum daily intake of vitamin D for infants and children to 400 IU.• Medical Research: What are the main findings?

Dr. Ahrens: Approximately one quarter of US infants aged 0 to 11 months met the 2008 AAP vitamin D recommendations on a given day in 2009 to 2012. Fewer than 1 in 5 breastfed infants met the vitamin D recommendations compared to nearly 1 in 3 non-breastfed infants.


http://medicalresearch.com/vitamin-d/many-us-infants-found-to-be-vitamin-d-deficient/15285/








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






Many US Infants Found To Be Vitamin D DeficientMedicalResearch.com Interview with:Katherine Ahrens Ph.D. MPHNational Center for Health StatisticsCenters for Disease Control and PreventionHyattsville, MD

• Medical Research: What should clinicians and patients take away from your report?• Dr. Ahrens: The findings from our study show a gap between current vitamin D intake and the

2008 AAP vitamin D recommendations for US infants, particularly for breastfed infants.• Medical Research: What recommendations do you have for future research as a result of

this study?• Dr. Ahrens: Future research could include ascertaining reasons for low vitamin D

supplementation among US infants.• Citation:• Clin Pediatr (Phila). 2015 Jun 7. pii: 0009922815589916. [Epub ahead of print]• Adherence to Vitamin D Recommendations Among US Infants Aged 0 to 11 Months, NHANES,

2009 to 2012.• Ahrens KA1, Rossen LM2, Simon AE2.










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

http://www.ncbi.nlm.nih.gov/pubmed/26054780?dopt=Abstract















Consciousness May Arise UnconsciouslyMedicalResearch.com Interview with:Ezequiel Morsella, Ph.D.Associate Professor of NeuroscienceDepartment of Psychology San Francisco State UniversityAssistant Adjunct Professor Department of NeurologyUniversity of California, San Francisco


Dr. Morsella: The theoretical framework, Passive Frame Theory, builds on an action-based, theoretical project that first appeared in Psychological Review, in 2015.

• The framework is a synthesis of hypotheses from disparate fields. It reveals that consciousness serves as a frame that constrains and directs skeletal muscle output, thereby yielding adaptive behavior. From this unique, action-based perspective, consciousness is in the service of the somatic nervous system. How consciousness achieves this is more counterintuitive, ‘low level,’ and passive than the kinds of functions that theorists have attributed to consciousness.


http://medicalresearch.com/mental-health-research/consciousness-may-arise-unconsciously/15287/


















• Medical Research: What should clinicians and patients take away from your report?• Dr. Morsella: The framework may shed light on why many conscious thoughts, urges, and

inclinations arise even though they are undesired by the actor. For instance, the mechanism that generates an urge that is experienced consciously does not “know,” in a sense, that the urge is not adaptive in the current context.





















• Dr. Morsella: The research also suggests that, to learn more about the neural correlatesof conscious processing, investigators should focus on the long neglected olfactory system. More specifically, the mechanisms that link conscious olfactory processing to skeletomotor control (e.g., in “voluntary” action) might reveal a great deal about the neural correlates of conscious processing.

• Citation:• Ezequiel Morsella, Christine A. Godwin, Tiffany K. Jantz, Stephen C. Krieger, Adam Gazzaley.

Homing in on Consciousness in the Nervous System: An Action-Based Synthesis. Behavioral and Brain Sciences, 2015; 1 DOI: 10.1017/S0140525X15000643














http://dx.doi.org/10.1017/S0140525X15000643






Intense Education Shortens Arrival Time To ER For Stroke PatientsMedicalResearch.com Interview with:Dr. Bernadette Boden-Albala MPH, DrPHAssociate Dean of Program DevelopmentNYU’s College of Global Public Health


Response: Stroke is a leading cause of morbidity and mortality globally and in the US. The US Food and Drug Administration has approved tissue plasminogen activator (tPA) as treatment for acute ischemic strokes within 3 hours of the onset of stroke symptoms. However, less than 25% of eligible stroke patients arrive to an emergency department (ED) in time to receive treatment with tPA. Our study, the Stroke Warning Information and Faster Treatment (SWIFT), compares the effect of an interactive intervention (II) with enhanced educational (EE) materials on recurrent stroke arrival times.

• The II group included in-hospital interactive group sessions consisting of a community placed preparedness PowerPoint presentation; a stroke survivor preparedness narrative video; and the use of role-playing techniques to describe stroke symptoms. Both groups received standardized educational materials focused on being prepared to recognize and react to stroke symptoms plus a medical alert bracelet so medical professionals would recognize them as SWIFT participants.


http://medicalresearch.com/author-interviews/intense-education-shortens-arrival-time-to-er-for-stroke-patients/15290/










http://medicalresearch.com/stroke/states-with-stroke-legislation-have-more-certified-stroke-centers/15098/







We found that at follow-up, 42 percent of these patients arrived to the emergency room within 3 hours compared to only 28 percent at baseline, a 49 percent increase in the proportion of all patients arriving within three hours of symptom onset. Among Hispanics, there was a 63 percent increase. While there was no difference in the proportion arriving within 3 hours between intervention groups, the intensive intervention appeared to be more beneficial in those with early recurrent events within the first 30 days.


















• Medical Research: What should clinicians and patients take away from your report?• Response: For clinicians, the continued low rate of arrival to the ED within three hours

suggests we may not be effectively disseminating stroke preparedness messages. Our findings suggest that at a minimum, clear, simple, preparedness-focused messages before hospital discharge – and possibly follow-up reinforcement – would result in a greater proportion of early emergency room arrivals. Moreover, culturally tailored, health literate educational materials may decrease racial disparities in stroke outcomes. This work is especially important for patients because it suggests that with the right information, patients and family members can take control of their health, recognize stroke symptoms and get to the emergency room more quickly.












http://medicalresearch.com/stroke/hospital-system-efficiently-uses-mri-to-screen-for-stroke-and-shorten-treatment-window/14186/








• Response: Further research is needed to identify the optimal way to deliver stroke preparedness messages. While we documented an unprecedented level of early ED arrival in our study, we know that stroke care, specifically recognition of a stroke event, comes from a patients care network. Thus, involvement of a patient’s care network or family may yield an even greater rate of early ED arrival.

• Citation:• Bernadette Boden-Albala, Joshua Stillman, Eric T. Roberts, Leigh W. Quarles, M. Maria

Glymour, Ji Chong, Harmon Moats, Veronica Torrico, and Michael C. Parides. Comparison of Acute Stroke Preparedness Strategies to Decrease Emergency Department Arrival Time in a Multiethnic Cohort: The Stroke Warning Information and Faster Treatment Study. Stroke, June 2015 DOI: 10.1161/STROKEAHA.114.008502












http://medicalresearch.com/author-interviews/skilled-team-work-required-for-endovascular-treatment-of-ischemic-stroke/12456/

http://dx.doi.org/10.1161/STROKEAHA.114.008502






Trial of First Fasting Mimicking Diet Safely Improves Biomarkers of AgingMedicalResearch.com Interview with:Todd Morgan, Ph.D.Chief Scientific OfficerL-Nutra, IncCulver City, CA 90232

Medical Research: What is the background for this study?

Dr. Longo: Despite health benefits, even short periods of fasting are difficult to maintain for most people, as it can lead to electrolyte abnormalities and malnutrition in at-risk individuals, such as the elderly. For over a decade the Longo lab at the University of Southern California has been studying effective approaches for achieving the beneficial effects of fasting while avoiding its shortcomings. We recently developed the first Fasting Mimicking Diet (FMD). Put in simple terms, this five-day meal replacement regimen nourishes the organism while the body thinks it is fasting. We tested this FMD in mice and in a pilot randomized human trial with generally healthy subjects and found impressive results around health optimization.




• Medical Research: What are the main findings?Dr. Longo: In pre-clinical trials, we provided mice with bi-weekly Fasting Mimicking Diet cycles that resulted in multi-system regeneration, increased longevity (11.2% median life extension), lowered visceral fat, lowered cancer incidence, rejuvenated immune system, and improved cognitive functions.

• The human clinical trial consisted of randomized cohorts who went through three cycles of this Fasting Mimicking Diet regimen (1 cycle per month for three months). The plant-based meal plan consisted of a variety of soups, bars, snacks, drinks and teas providing between 30-50% of normal calories. Subjects were not asked to change their lifestyle during the 25 remaining days of each month. Compliance was over 95% indicating that the Fasting Mimicking Diet regimen was safe, easy to follow and nourishing. Subjects who completed the 3-month trial showed remarkable, and long- lasting improvements in biomarkers/risk factors for aging, cancer, diabetes, and CVD.




• Specifically, there was a 3% reduction in body weight that remained lower at the completion of the study. Trunk fat percentage, measured by dual-energy X-ray absorptiometry, showed a trend for reduction after 3 Fasting Mimicking Diet cycles and one week of normal dieting, while the lean body mass adjusted for body weight was increased after completion of 3 cycles, indicating that fat loss accounts for most of the weight loss. A complete metabolic panel indicated no persistent metabolic changes. Together with the self-reported Common Terminology Criteria for Adverse Events, these results provide initial evidence that the periodic use of Fasting Mimicking Diet is generally safe and causes fat loss without reducing lean body mass.

• Fasting blood glucose levels were reduced by 11% and remained 6% lower than baseline levels after resuming the normal diet following the third FMD cycle. Serum ketone bodies increased almost 4-fold at the end of the FMD regimen and returned to baseline levels following normal food intake. Circulating IGF-I, a marker associated with increased mortality in humans, was reduced by ~24 % by the end of the FMD period and remained ~15 % lower after resuming the normal diet.




• The serum level of C-reactive protein (CRP) is a marker of inflammation and a risk factor for cardiovascular disease (CVD). CRP levels were reduced by the FMD cycles. Eight of the 19 FMD subjects had CRP levels in the moderate or high cardiovascular disease risk range (levels above 1.0 and 3 mg/L, respectively) at baseline. For 7 of them the levels returned to the normal range (levels below 1.0 mg/L), after 3 FMD cycles. For the 11 participants with CRP levels below 1.0 mg/L at baseline, no changes were observed at the completion of the trial. These results indicate that periodic FMD cycles promote anti-inflammatory effects and reduce at least one risk factor for CVD.

• Although not significant, the percentage of mesenchymal stem and progenitor cells (MSPC), which have been shown to have embryonic-like features, in the peripheral blood mono-nucleated cell population showed a trend to increase from nearly 10-fold at the end of the FMD cycle, with a subsequent return to baseline levels after return to normal diet.




• Medical Research: What should clinicians and patients take away from your report?• Dr. Longo: Our results indicate that FMD cycles induce long-lasting beneficial and/or

rejuvenating effects in markers for diseases and regeneration in humans. Although the clinical results will require confirmation by a larger randomized trial, the effects of FMD cycles on biomarkers/risk factors for aging, cancer, diabetes, and CVD, coupled with the very high compliance to the diet and its safety, indicate that this periodic dietary strategy has

• high potential to be effective in promoting human healthspan. Because prolonged FMD such as the one tested here are potent and broad-spectrum, they should only be considered for use under medical supervision.





• Dr. Longo: We are currently analyzing results from a larger clinical trial on 70-80 subjects that includes additional end points to further support the efficacy of our periodic FMD approach. Ultimately, we envision FMDs getting FDA approval.

• Citation:• A Periodic Diet that Mimics Fasting Promotes Multi-System Regeneration,

Enhanced Cognitive Performance, and Healthspan• Brandhorst, Sebastian et al.• Cell Metabolism• http://dx.doi.org/10.1016/j.cmet.2015.05.012


http://www.cell.com/cell-metabolism/abstract/S1550-4131(15)00224-7





Menopausal SSRIs Increases Risk of Bone FracturesMedicalResearch.com Interview with:Dr Matthew Millerand Yi-Han Sheu Department of EpidemiologyHarvard T.H. Chan School of Public HealthHarvard University Boston, Massachusetts


Response: Selective serotonin reuptake inhibitors (SSRIs) were recently approved by the FDA to treat vasomotor symptoms associated with menopause. No prior study has directly examined whether fracture risk is increased among perimenopausal women who initiate SSRIs or among a population of women without mental disorders more generally..

• Medical Research: What are the main findings?

Response: We found that SSRIs treatment for non-psychiatric conditions at doses customarily used to treat depression is, all else equal, associated with higher rates of fractures — an effect that first became evident several months after beginning treatment and, importantly, persisted over the five year study period.


http://medicalresearch.com/menopause/menopausal-ssris-increases-risk-of-bone-fractures/15318/



















Menopausal SSRIs Increases Risk of Bone FracturesMedicalResearch.com Interview with:Dr Matthew Millerand Yi-Han Sheu Department of EpidemiologyHarvard T.H. Chan School of Public HealthHarvard University Boston, Massachusetts

• Medical Research: What should clinicians and patients take away from your report?• Response: These findings suggest that shorter duration of treatment might mitigate the risk

of developing excess fractures. The extent to which our findings would manifest among women treated at lower doses is not certain


• Response: Future efforts should be made to examine how SSRI dose (cumulative, daily or both) might modify fracture risk over time.

• Citation:• SSRI use and risk of fractures among perimenopausal women without mental disorders • Yi-han Sheu, Amy Lanteigne, Til Stürmer, Virginia Pate, Deborah Azrael, Matthew Miller• Inj Prev injuryprev-2014-041483Published Online First: 25 June 2015 doi:10.1136/injuryprev-2

014-041483
















http://injuryprevention.bmj.com/content/early/2015/05/20/injuryprev-2014-041483









Electromagnetic Interference Between Smart Phones and Cardiac Devices Rare But PossibleMedicalResearch.com Interview with:Dr. Carsten LennerzDeutsches HerzzentrumMünchen

• Medical Research: What is the background for this study? What are the main findings?• Response: The number of cardiovascular implantable electronic devices (CIEDs) is increasing.

Worldwide more than 4 million people rely on an implanted pacemaker (PM) or implantable cardioverter defibrillator ICD. Sensing intrinsic cardiac electrical activity is the core principle of all CIED devices, however in case of electromagnetic interference (EMI) exogenous electric and magnetic fields can be picked up by the sensing circuit and mistakenly interpreted as a cardiac signal by the CIED. PM can respond to EMI with pacing-inhibition, leading to bradycardia or asystole and resulting in syncope. In ICDs EMI may be detected as a life threatening ventricular arrhythmia with the subsequent delivery of inappropriate shocks.

• Early studies on EMI, run more than 10 years ago, have identified mobile phones as a source of EMI with pacemakers. Based on these pacemaker studies the CIED manufacturer and the regulatory authorities (e.g. Food and Drug Administration [FDA]) currently recommend a safety distance, i.e. hold the phone to the contra-lateral ear and avoid placing a turned-on phone next to the generator pocket.


http://medicalresearch.com/heart-disease/electromagnetic-interference-between-smart-phones-and-cardiac-devices-rare-but-possible/15323/


















• In the meantime telecommunication and the CIED techniques have dramatically evolved. The classic mobile phone has been replaced by modern smartphones, furthermore the network standards have changed from GSM to UMTS (3G) and LTE (4G). New cardiac devices are now in use including more devices for cardiac resynchronisation therapy (CRT) or for the protection from sudden cardiac death (ICD); some of them are even compatible for MRI diagnostics.

• With the use of a hemertic titanium shell, new filtering properties of the feed-throughs, sense amplifiers and noise protection algorhythms as well as the predominant use of bipolar leads the CIED may be better shielded against external influences and adverse effects of EMI.

• In light of the above, the purpose of our study was to evaluate if previous precautions recommended to cardiovascular implantable electronic devices recipients are still up-to-date or if they can be abandoned. By today there are neither studies focusing on EMI between modern smartphones and modern CIEDs nor on newer mobile network standards (UMTS or LTE).




















• In a cross-sectional study we enrolled 308 patients and exposed them to the electromagnetic field of three smartphones (Samsung Galaxy 3, Nokia Lumia, HTC One XL) by placing the handhelds directly over the pulse generator. Installing an own base mobile network station we ensured that each smartphone went through a standardized protocol that included the entire calling process (connecting, ringing, talking), the handovers between all current network standards (GSM, UMTS, LTE where applicable) and operation at maximal transmission power.

• More than 3.400 tests on electromagnetic interference were performed. One out of 308 patients (0.3%) was repeatedly affected by EMI caused by smartphones. The patient’s MRI compatible CRT-defibrillator malfunctioned with short-term ventricular and atrial oversensing when exposed to Nokia or HTC smartphones operating at GSM and UMTS.




















• Medical Research: What should clinicians and patients take away from your report?• Response: In general the current recommendations on keeping a safety distance between

mobile phones or smartphones and cardiovascular implantable electronic devices should be upheld. Electromagnetic interference between smartphones and CIED is rare but still present in vivo. Furthermore the clinicians may become more aware that in our electrified, high tech world their patients are exposed to many potential sources of electromagnetic interference. The information about EMI and its potential sources should be an integral part of the treatment and follow up care of CIED-patients. Also the CIED patient may become more sensitized to the potential risk of EMI in daily life and especially are discouraged of careless handling of smartphones.





















• Response: As the electrification of the world is inexorably progressing and new technologies facilitate all areas of our lives, our patients are involuntarily exposed to various new sources of electromagnetic interference. Innovations often discussed with regard to the topic of electromagnetic interference are for example induction ovens or electric cars.

• Citation:• Electromagnetic interference between smartphones and current cardiac implantable electron

ic devices: rare but present• June 22 2015 presented at EHRA EUROPACE – CARDIOSTIM 2015 by Dr Carsten Lennerz, first

author and cardiology resident in the Clinic for Heart and Circulatory Diseases, German Heart Centre, Munich, Germany














http://www.escardio.org/The-ESC/Press-Office/Press-releases/Last-5-years/Cardiac-device-wearers-should-keep-distance-from-smartphones










JAK Inhibitors Offer Hope For VitiligoMedicalResearch.com Interview with:Brett King, M.D., Ph.D.Assistant Professor of DermatologyYale University School of Medicine


Dr. King: Treatment options for vitiligo are limited and often ineffective. This report highlights the possibility of targeted therapy of vitiligo using a relatively new class of medicines called Janus kinase (JAK) inhibitors. Based upon our understanding of vitiligo, JAK inhibition interrupts interferon gamma signaling, which perpetuates depigmentation.

• Medical Research: What should clinicians and patients take away from your report?• Dr. King: There is hope that effective treatments will soon be available for vitiligo.


http://medicalresearch.com/author-interviews/jak-inhibitors-offer-hope-for-vitiligo/15331/







http://medicalresearch.com/medical-research-centers/nih/study-examines-risk-alopecia-areata-vitiligo-stem-cell-recipients/7514/

http://medicalresearch.com/author-interviews/alopecia_areata_enbrel_may_improve_or_worsen_hair_loss/8385/






JAK Inhibitors Offer Hope For VitiligoMedicalResearch.com Interview with:Brett King, M.D., Ph.D.Assistant Professor of DermatologyYale University School of Medicine


• Dr. King: Clinical trials using different JAK inhibitors, both topically and orally, are needed. Also, we need to better understand how important JAK 1/2 vs JAK 1/3 inhibition is to repigmentation.

• Citation:• Craiglow BG, King BA. Tofacitinib Citrate for the Treatment of Vitiligo: A Pathogenesis-Directe

d Therapy. JAMA Dermatol. Published online June 24, 2015. doi:10.1001/jamadermatol.2015.1520.









http://archderm.jamanetwork.com/article.aspx?articleid=2323633









Drug Nanocarrier Helps Overcome Medication ResistanceMedicalResearch.com Interview with: Jose A. Garcia Salcedo, PhD.Unidad de Enfermedades Infecciosas Hospital Universitario San CecilioInstituto de Investigación Biosanitaria de Granada

Granada Spain

• Medical Research: What is the background for this study?• Response: Drug resistance is complicating the treatment of parasitic diseases including

African trypanosomiasis, a fatal disease if left untreated. Development of a vaccine is unlikely due to parasite antigenic variation. Current chemotherapy relies primarily on four drugs. Three of these drugs access the cell’s interior through surface transporters and resistance mechanisms are largely associated with loss-of-function mutations in the involved surface drug transporters.


http://medicalresearch.com/medication-research/drug-nanocarrier-helps-overcome-medication-resistance/15336/

































Granada Spain

• Medical Research: What are the main findings?• Response: We have developed a drug nanocarrier that consists of polymeric nanoparticles

coated with a single domain antibody that targets the trypanosome surface. This new formulation reduces the minimal curative dose and, most importantly, circumvents drug resistance in a resistant cell line as a result of mutations in the surface transporter that mediate drug uptake. This study presents a proof-of-concept of a novel technology for reversing transporter-related drug resistance with applications to other infectious diseases.



































Granada Spain


• Response: This study presents a proof-of-concept of a novel technology for reversing transporter-related drug resistance with applications to other diseases.

• Citation:• Juan D. Unciti-Broceta, José L. Arias, José Maceira, Miguel Soriano, Matilde Ortiz-González, Jo

sé Hernández-Quero, Manuel Muñóz-Torres, Harry P. de Koning, Stefan Magez, José A. Garcia-Salcedo

• Published: June 25, 2015• DOI: 10.1371/journal.ppat.1004942





























http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1004942










Gut Microbiome May Drive Colon CancerMedicalResearch.com Interview with:Michael B. Burns, Ph.D. HHMI Post-Doctoral FellowDept. of Genetics, Cell Biology and Development Dept. of Ecology, Evolution, and Behavior

Masonic Cancer Center Dept. of Biology Teaching and LearningUniversity of Minnesota, Twin Cities St. Paul, MN 55108

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

Dr. Burns: Recent technological advances have made it possible to survey all the of microbes that in, on, and around us. One of the surprising things is the sheer quantity and diversity of the bacteria in our environments and our microbiomes. Many researchers have begun the systematic characterization of the microbes that are associated with specific disease states, including cancer. With regard to colorectal cancer, there have been numerous studies that have identified specific bacteria that are linked to the presence of the disease. There have been many reports that have identified particular potentially important microbes that may be causing the cancer, driving the cancer, or some combination of the two. Among these microbes, one of the best studied so far is a group of bacteria called Fusobacterium.


http://medicalresearch.com/cancer-_-oncology/colon-cancer/gut-microbiome-may-drive-colon-cancer/15340/















http://medicalresearch.com/cancer-_-oncology/colon-cancer/genetic-fingerprint-may-lead-to-blood-test-for-colon-cancer/13072/








• • Medical Research: What are the main findings?

Dr. Burns: In our work, we set out to perform another characterization of the bacteria in the gut microbiome that are specifically associated with colorectal tumors. We used samples of normal colon tissue from the same individuals as controls, which allowed us to account for much of the variability in the different bacteria we found that might have been simply the result of, for instance, diet. In our analysis, we confirmed the previous results related to Fusobacterium, and additionally discovered a new potential culprit in colorectal cancer, a group of bacteria named Providencia.

• The finding of another new set of microbes that might be causing or driving cancer is not surprising. As indicated above, there are many groups who have found other potential candidate microbes that could be implicated in the disease. Our next question was to determine if there was some reason why there might be so many different bacteria that are linked with the disease and what it might be able to tell us about what these bacteria are doing. To that end, we used computational approaches to assess what these two groups of bacteria might be doing at a functional level and if there were any similarities. We found that there was a great deal in common between Fusobacterium and Providencia, including a finding that one of the common functions was related to a large group of virulence genes.

















http://medicalresearch.com/infections/c-difficile/fecal-microbiota-transplantation-may-normalize-intestinal-microbiome/13193/








• Medical Research: What should clinicians and patients take away from your report? What recommendations do you have for future research as a result of this study?

• Dr. Burns: Our findings indicate that there are likely several different groups of bacteria that might be causing or driving colorectal cancer. Despite this diversity of microbes, our analysis indicates that at least some of these bacteria are likely behaving in functionally similar manners. We propose that future work focus on identifying as many of the different potentially pathogenic microbes associated with cancer as possible and also, and this is important, assessing what these bacteria ace actually doing in the gut. It may be far easier to design a treatment that specifically targets a single common process that the bacteria use to interact with the tumor than it would be to attempt to design drugs to target the multitude of potentially virulent bacteria.
























• Moving forward, we are working to perform additional experiments to determine how we can apply our findings in a clinical setting. We envisage that we should be able to analyze the microbes in patient stool samples for the specific bacteria found in our study as well as for the enrichment of virulence-associated genes as a way of both 1) detecting the presence of a tumor and 2) identifying potential therapeutic targets based on the specific functions of the virulence genes found to be enriched.

• While we have found clear correlations between the microbiome and colorectal cancer, further work is required to allow us to fully understand what the direct interactions are between these microbes and the tumors. For instance, are these bacteria causing the cancer to form? Perhaps they are only important once the tumor has formed at which point they drive the tumor to expand? Answering these questions will move the research on this topic forward and provide critically important information to clinicians with the potential to improve patient outcomes.

• Citation:• Michael B. Burns, Joshua Lynch, Timothy K. Starr, Dan Knights, Ran Blekhman. Virulence

genes are a signature of the microbiome in the colorectal tumor microenv

















http://medicalresearch.com/author-interviews/gut-microbiome-may-influence-our-behavior-and-long-term-memory/15237/






medicalresearch.com: medical research exclusive interviews june 26 2015

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