medicalresearch.com medical research news and interviews september 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]

Sept 26 2015

For Informational Purposes Only: Not for Specific Medical Advice.

Read the rest of the interviews on MedicalResearch.com. NOT an

endorsement of efficacy or as medical advice.

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Cell Death Biomarker May Help Predict Melanoma PD-1 RespondersMedicalResearch.com Interview with:Dr. Roxana S. Dronca, M.D Assistant

Professor of OncologyAssistant Program Director of Hematology-Oncology FellowshipMayo Clinic College of MedicineRochester, Minnesota

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

• Dr. Dronca: We previously showed that Bim (BCL-2-interacting mediator of cell death ) is a downstream signaling molecule of PD-1 pathway reflecting the degree of PD-1 interaction with its ligand PD-L1 (unpublished data).

• In the current study we found that patients who experienced clinical benefit (CR/PR/SD) after 4 cycles of anti-PD1 therapy had higher frequency of Bim+ PD-1+ T-killer cells in the peripheral blood at baseline compared to patients with radiographic progression, likely reflecting an abundant PD-1 interaction with its tumor-associated ligand PD-L1 (B7-H1). In addition, the frequencies of Bim+ PD-1+ CD8 T cells decreased significantly after the first 3 months of treatment in responders compared to nonresponders, indicating tumor regression and therefore less PD-1 engagement with tumor-associated PD-L1.



http://medicalresearch.com/author-interviews/cell-death-biomarker-may-help-predict-melanoma-pd-1-responders/17611/

















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

• Dr. Dronca: Our findings could help physicians select patients with melanoma (and possibly other malignancies) who are most likely to benefit from PD-1 blockade, follow patients during treatment identify those who have late responses or are acquiring resistance to these agents during the course of treatment, thereby exposing fewer patients to inadequate treatments and their associated toxicities and costs. A great advantage of our approach lies in the ease of serial peripheral blood testing as compared to repeated invasive tissue biopsies.




















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

• Dr. Dronca: We are planning to validate these results on a larger prospective cohort on patients with melanoma and also lung cancer. We are also testing this marker in patients with other cancers such as chronic lymphocytic leukemia.

• Citation: Abstract presented at:• CRI-CIMT-EATI-AACR – The Inaugural International Cancer

Immunotherapy Conference:• Translating Science into Survival• September 16 – 19, 2015 • Sheraton New York Times Square Hotel •

New York, NY• A007 Bim as a predictive T cell biomarker for response to anti-PD-1

therapy in metastatic melanoma (MM). Roxana S Dronca, Svetomir N Markovic, Lisa A Kottschade, Wendy Nevala, Haidong Dong.


















Plain Soap Does The Job Just As Well As Antibacterial Soap for Hand WashingMedicalResearch.com Interview with:Min Suk Rhee, Ph.D.Professor Department of Biotechnology Department

of Food Bioscience & TechnologyCollege of Life Sciences & BiotechnologyKorea University Seoul Korea


• Dr. Min Suk Rhee: In December 2013, the US FDA (United States Food and Drug Administration) proposed an amendment that manufacturers of antibacterial hand soaps intended for use with water must demonstrate that they are safer and more effective than plain soap. As triclosan is the most common active antiseptic ingredient used in soap and its potential risk remains controversial, we investigated the effectiveness of antibacterial soap containing triclosan 0.3% from in vitro and in vivo experiment.

• The main finding of this study is that presence of antiseptic ingredients (in this case, triclosan) in soap does not always guarantee higher antimicrobial efficacy during hand washing.



http://medicalresearch.com/author-interviews/plain-soap-does-the-job-just-as-well-as-antibacterial-soap-for-handwashing/17615/









Plain Soap Does The Job Just As Well As Antibacterial Soap for Hand WashingMedicalResearch.com Interview with:Min Suk Rhee, Ph.D.Professor Department of Biotechnology Department

of Food Bioscience & TechnologyCollege of Life Sciences & BiotechnologyKorea University Seoul Korea


• Dr. Min Suk Rhee: We’d like to suggest that it is more important for people to wash their hands correctly and frequently rather than to use the antibacterial soaps containing triclosan. Clinicians have to notice the recommended standard method of hand washing to patients.


• Dr. Min Suk Rhee: It might be helpful to investigate the effectiveness of other antiseptic ingredients in soap.

• Citation:• A. Kim, H. Moon, K. Lee and M.S. Rhee. Bactericidal effects of

triclosan in soap both in vitro and in vivo. Journal of Antimicrobial Chemotherapy, September 2015 DOI: 10.1093/jac/dkv275












Patient Centered Medical Home Model Adds Big Expense To Primary Care PracticesMedicalResearch.com Interview with:Michael K. Magill, MDProfessor and Chairman, Family and Preventive Medicine University

of Utah School of MedicineSalt Lake City, UT 84108


• Dr. Magill: The Patient Centered Medical Home (PCMH) model of primary care is becoming more common. The model focuses on team delivery of care with other medical staff joining the primary care provider/clinician to provide for all patients’ healthcare needs. However, the cost of sustaining PCMH functions is not well understood. This study assessed direct personnel cost of delivering PCMH services in 20 diverse primary care practices in Utah and Colorado. The main finding is that PCMH services cost on average around $105,000 per clinician FTE per year, or around $4.00 per member per month for an imputed panel size of 2000 patients per FTE clinician.



http://medicalresearch.com/author-interviews/patient-centered-medical-home-model-adds-big-expense-to-primary-care-practice/17619/











• Dr. Magill: Delivery of enhanced primary care services through the Patient Centered Medical Home model adds significant expense to the practices. However, studies of the benefits of PCMH to reduce overall cost of care may outweigh this cost by a factor of 10 or more to one.














• Dr. Magill: Future research should focus on the relationship between cost, staffing models, and outcomes such as patient and provider satisfaction, quality of care, and total cost of care. Payment reform should cover these costs based on the value of outcomes achieved.

• Email *

• Citation:• Michael K. Magill, David Ehrenberger, Debra L. Scammon, Julie Day,Tatiana

Allen, Andreu J. Reall, Rhonda W. Sides, and Jaewhan Kim• The Cost of Sustaining a Patient-Centered Medical Home: Experience From

2 StatesAnn Fam Med September/October 2015 13:429-435;doi:10.1370/afm.1851

• Read the rest of the interviews on MedicalResearch.com. NOT an










PET Scan Using Tagged Fibrin Can Detect Hidden Blood ClotsMedicalResearch.com Interview with: Peter Caravan, PhDCo-Director, Institute for Innovation in Imaging (I3)Martinos Center for Biomedical Imaging Massachusetts

General HospitalAssociate Professor of RadiologyHarvard Medical School


• Dr. Caravan: The motivation for this work was to develop a technique that would allow the detection of thrombus (clot) anywhere in the body after injection of a molecular probe called 64Cu-FBP8. Current techniques for thrombus detection are limited to specific vascular territories. In instances where the location of the thrombus is unknown or if there is suspicion of multiple thrombi, then multiple imaging tests must be performed. We sought to develop a test that could be used to find clots anywhere: brain, thorax, abdomen, legs and in arteries, veins, or the cardiac chambers. In addition to whole body thrombus detection, we sought a technique that could address some of the limitations with current thrombus imaging techniques. For example computed tomography (CT), which is used to detect pulmonary emboli, requires a contrast agent that cannot be used in patients with poor kidney function. Transesophageal echocardiography used to identify thrombus in the chambers of the heart requires that the patient be sedated.



http://medicalresearch.com/medical-imaging/pet-scan-using-tagged-fibrin-can-detect-hidden-blood-clots/17630/














• Our approach is to use a small peptide that recognizes the protein fibrin, which is a key component of blood clots. We tagged the peptide with an isotope of copper, Cu-64, that allows the peptide to be detected by positron emission tomography (PET). 64Cu-FBP8 binds specifically to fibrin but not to other proteins in the blood and this means that the uptake in the clot is high while background signal is very low. We combined PET imaging which finds the clot with CT imaging or magnetic resonance imaging (MRI). By overlaying the PET image with the CT or MRI image, we could precisely localize the clot within the We were interested to see if the age of the clot impacted our ability to detect it. We imaged animals with a total of 42 arterial or venous clots and then the images were analyzed by two reviewers who had no prior knowledge of the location of the clot. Overall the accuracy was 98% for detection.

















• Another key finding was that the uptake of 64Cu-FBP8 strongly correlated with the amount of fibrin in the clot and that younger, fresher clots had more fibrin than older clots. This could be very useful in distinguishing newer clots which may be the source of cardiovascular events from older, clots that may pose less risk.

• We also showed using combined PET-MRI that we could detect multiple blood clots in the animal in a single whole body scan. The procedure involves a single intravenous administration of 64Cu-FBP8 and clots in the deep veins of the legs or in the carotid arteries were readily detected.


















• Dr. Caravan: These results are very promising and have the potential to impact patient care. For instance, translating this to patients would not require the need for patient sedation and it would not involve a potentially nephrotoxic contrast agent. The ability to detect clots in different anatomical regions could be very useful in contexts where the clinician is concerned about the presence of thrombus in different and/or unknown areas. For instance pulmonary embolism arises from a clot breaking off from a larger clot in the deep veins of the legs and traveling to the lungs. A study where both the lungs and the legs could be evaluated in a single session would speed patient throughput and minimize the number of procedures that the patients must undergo.

















• Another example is in searching for the cause of a stroke. Most strokes are caused by a piece of clot breaking off from a larger clot in the carotid arteries, the aortic arch, the left atrium of the heart, or in some cases from the deep veins of the legs, and then traveling to the brain to stop blood flow. Despite best clinical practice, about 30-40% of strokes are termed “cryptogenic” in that the clinician does not know the source of the stroke. Where the stroke originated is very important because location dictates the type of treatment that will be given to prevent a second stroke. If source thrombus remains, there is a high risk of secondary stroke. The ability to noninvasively search multiple anatomical regions for clot would be very valuable in this context. A related example is transient ischemic attack (TIA) which is similar to a stroke but the effect is temporary and resolves without long term damage. However having a TIA puts a patient at extremely high risk for a stroke, and so having the ability to scan TIA patients for the underlying source thrombus could also be extremely valuable.


















• Dr. Caravan: This study was performed in rats, but the results are so compelling that we are planning to perform human studies in the near future. That involves demonstrating to the FDA that 64Cu-FBP8 is safe for taking forward and we are in the process of submitting that documentation. Then will come studies in patients to first test how accurate 64Cu-FBP8 PET scanning is for detection of clot. Should these studies prove effective, it may be possible to gain regulatory approval for widespread clinical use of this technique.

• Citation: Francesco Blasi, Bruno L. Oliveira, Tyson A. Rietz, Nicholas J. Rotile, Pratap C. Naha, David P. Cormode, David Izquierdo-Garcia, Ciprian Catana, Peter Caravan. Multisite Thrombus Imaging and Fibrin Content Estimation With a Single Whole-Body PET Scan in Rats.Arteriosclerosis, Thrombosis, and Vascular Biology, 2015; ATVBAHA.115.306055 DOI: 10.1161/ATVBAHA.115.306055















Sugar Sweetened Beverages Linked To Overall Unhealthy DietMedicalResearch.com Interview with:Louise Brunkwall Nutritionist, MPH and Phd-studentDiabetes and Cardiovascular Disease, Genetic Epidemiology Lund

University, Clinical SciencesMalmö, Sweden


• Response: There has been a huge interest for sugar sweetened beverages (SSB) the last years and SSB has been associated with various diseases like type 2 diabetes and obesity, while juice for example which have approximately the same amount of energy have not. We find this very interesting and wanted to know more about who the people were that consumed a lot of these different beverages. We started of by looking at diet and found that the different beverages were associated with different dietary patterns. Sugar sweetened beverages were associated with a more unhealthy diet while juice was associated with a more healthy diet. We see the same for tea which is a beverage previously associated with a lower risk of several diseases, that it is associated with an overall very healthy diet. Therefore we draw the conclusions that beverages are a part of the overall diet which might contribute to the previous findings of associations with different diseases. This also tells us that it is of great importance to know more about the overall diet than just consumption of a single product when investigating beverages-dieases association studies.



http://medicalresearch.com/author-interviews/sugar-sweetened-beverages-linked-to-overall-unhealthy-diet/17564/
















• Response: The most important thing is that you should be careful when interpreting studies that have looked at a single product and the association with a disease because that single product is a part of an overall diet which may also be important for the association. Secondly our study suggest that if you only change or take away the beverage lets say sugar sweetened beverages you will not get as good of a results as if you would to change or improve the overall diet.



















• Response: – Our study highlight the need for good dietary data when studying food-disease associations. We will never be able to adjust for the overall diet, however it is of importance to have the knowledge about the overall diet and the total energy intake in the populations, in which you are studying the associations, to be able to interpret your results.

• Citation:• EASD 2015• Overall dietary characteristics of individuals with high consumption

of beverages previously associated with risk of type 2 diabetes L. Brunkwall, S. Hellstrand, M. Orho-Melander, U. Ericson; Diabetes and Cardiovascular Disease, Genetic Epidemiology, Lund University, Clinical Sciences, Malmö, Sweden.
















Lowering Hospital Bed Occupancy Associated With Reduced Patient MortalityMedicalResearch.com Interview with:Dr Daniel BodenEmergency Medicine ConsultantDerby Hospitals NHS Foundation Trust


• Dr. Boden: The overall objective was to evaluate whether there is an association between an intervention to reduce medical bed occupancy and both performance on the 4-hour target and hospital mortality.

• We undertook a before-and-after study in Derby teaching Hospitals NHS Foundation Trust (a large UK District General Hospital) over a 32 month period. A range of interventions were undertaken to reduce medical bed occupancy within the Trust. Performance on the four-hour target and hospital mortality (HSMR, SHMI and Crude Mortality) were compared before, and after, intervention. Daily data on medical bed occupancy and percentage of patients meeting the four-hour target was collected from hospital records. Segmented regression analysis of interrupted time-series method was used to estimate the changes in levels and trends in average medical bed occupancy, monthly performance on the target and monthly mortality measures (HSMR, SHMI and crude mortality) that followed the intervention.



http://medicalresearch.com/author-interviews/lowering-hospital-bed-occupancy-associated-with-reduced-patient-mortality/17595/









• Medical Research: What are the main findings?

• Dr. Boden:• Mean medical bed occupancy decreased significantly from 93.7% to

90.2% (p=0.02).• The trend change in 95% target performance, when comparing pre- and

post-intervention, revealed a significant improvement (p=0.019).• The intervention was associated with a mean reduction in all markers of

mortality (range 4.5% – 4.8%). SHMI (p=0.02) and Crude Mortality (p=0.018) showed significant trend changes after intervention.

• Our conclusion is that lowering medical bed occupancy is associated with reduced patient mortality and improved ability of the acute Trust to achieve the 95% four hour target. Whole system transformation is required to create lower average medical bed occupancy.













• Dr. Boden: There are a number of things we feel should be taken away from this study:

• There is growing evidence of the harm caused by “crowding” in the Emergency Department and “Exit Block” This study reveals one potential solution to this problem. If medical bed occupancy is reduced then patient “flow” is facilitated in their in-patient journey. This, in conjunction with improved ward-based care, results in less harm to patients (reduced mortality) as well as improvement in performance against the 95% 4 hour target.

• Whole system transformation is required to facilitate this.• Association does not imply causation. It is important to be aware of

potential confounding factors.













• Dr. Boden: I will be seeking further advice on this. A multicentre study (ideally a cluster RCT) would be a big challenge. A more realistic alternative may involve an opportunistic observational study making use of changes in bed occupancy occurring at a number of hospitals that could be compared to controls that make no such intervention.

• Citation:• Lowering levels of bed occupancy is associated with decreased inhospital

mortality and improved performance on the 4-hour target in a UK District General Hospital

• D G Boden, A Agarwal, T Hussain, S J Martin, N Radford, M S Riyat, K So, Y Su, A Turvey,C I Whale

• Emerg Med J emermed-2014-204479Published Online First: 17 September 2015doi:10.1136/[email protected]











Poor Lifestyle Linked to Acute Coronary Syndrome, Even After EventMedicalResearch.com Interview with: Sylvie S.L. Leung Yinko, MSc, RDDivision of Clinical EpidemiologyLouise Pilote, MD, MPH, PhD

Professor of Medicine McGill University andDirector of the Division of General Internal MedicineMcGill University Health Centre


• Response: Patients with premature acute coronary syndrome (ACS) are a vulnerable population of young or middle-aged adults at risk for future cardiovascular events. However, while health behaviors such as diet, physical activity, smoking, alcohol consumption and recreational drug use are important lifestyle factors that can influence cardiovascular risk, there is limited information about health behaviors in this population group. Additionally, there is indication in the literature regarding sex and age differences in health behaviors, but whether such differences exist in patients with premature acute coronary syndrome remained to be explored.

• Using data from GENESIS-PRAXY (GENdEr and Sex determInantS of Cardiovascular Disease from bench to beyond in PRemature Acute Coronary Syndrome), a large-scale prospective cohort study across Canada, US and Switzerland, we explored the health behavior profile of patients with premature ACS. As well, we examined whether there is a change in health behaviors 1 year post-ACS and assessed sex differences.



http://medicalresearch.com/heart-disease/poor-lifestyle-linked-to-acute-coronary-syndrome-even-after-event/17598/


















• Our results showed that the health behavior profile of men and women with premature Acute Coronary Syndrome are worse than that of the general population. We found a high prevalence of poor health behaviors in a young population with only modest changes after Acute Coronary Syndrome. Health behaviors remained suboptimal and worse than the general population, especially with regards to diet, smoking and recreational drug use. Sex differences existed in the prevalence of these behaviors at baseline and 1 year post-ACS but not in the magnitude of change after the ACS event.






















• Response: Men and women with premature acute coronary syndrome have suboptimal lifestyle behaviors. There are only small and modest improvements after the ACS event. Certain health behaviors, such as dietary habits and smoking, seem harder to improve. There appears to be sex differences with men generally having poorer health behaviors than women. However, the extent to which the health behaviors change appears to depend more the type of behavior itself rather than differ by sex.






















• Response: Future interventions aiming at improving the health behaviors of patients with premature acute coronary syndrome may require a sex-based approach to ensure successful improvements. As well, it is important to understand the barriers to improved health behaviors in this population.

• Citation:• Sex differences in health behavior change after premature acute coronary

syndrome• Sylvie S.L. Leung Yinko, RD, MSc Janane Maheswaran, BSc Roxanne Pelletier,

PhD Simon L. Bacon, PhD Stella S. Daskalopoulou, MD, MSc, PhD Nadia A. Khan, MD, MSc Mark J. Eisenberg, MD, MPH Igor Karp, MD, MPH, PhD Kim L. Lavoie, PhD Hassan Behlouli, PhD Louise Pilote, MD, MPH, PhD for the GENESIS-PRAXY investigatorsl

• Received: JAHA December 23, 2014; Accepted: April 12, 2015; Published Online: April 18, 2015



















MedicalResearch.com Interview with:Dr. Xiaohu Xia Ph.D. Assistant ProfessorDepartment of ChemistryMichigan Technological UniversityHoughton, MI 49931


• Dr. Xia: Peroxidases, a family of enzymes that catalyze the oxidation of certain compounds with peroxides, have found widespread use in areas such as biomedicine and environmental protection. Over the past several years, researchers have found that certain inorganic nanomaterials (such as nanoparticles made of metal, metal oxides, and carbon) possess intrinsic peroxidase-like activities. As the major advantage over their natural counterparts, these peroxidase mimics are much more stable because they are less vulnerable to denaturation and protease digestion. In spite of the superior stability of the mimics, improvement in their catalytic efficiency has been met with limited success. The catalytic efficiencies for most of the previously reported peroxidase mimics with sizes 1-100 nm are limited to the range of 101-104 s-1 in terms of catalytic constant (Kcat, which measures the maximum number of chemical conversions of substrate molecules per second per enzyme/mimic).



http://medicalresearch.com/accidents-violence/nanotechnology-can-improve-psa-sensitivity-and-efficiency/17634/









• Our research team have recently developed a new type of peroxidase mimic with a record high efficiency that was engineered by coating ~18 nm palladium (Pd) nanocubes with ultrathin iridium (Ir) skins of a few atomic layers (i.e., Pd-Ir core-shell cubes, see Figure). The catalytic efficiency of our Pd-Ir cubes could reach a level of Kcat = 106 s-1.

• In view of the substantially enhanced efficiency, we applied our Pd-Ir cubes to the colorimetric enzyme-linked immunosorbent assay (ELISA) of human prostate surface antigen (PSA) by functionalizing their surface with antibodies. The detection limit of the Pd-Ir cubes-based ELISA of PSA was determined to be 0.67 pg/mL, which is over 100-fold lower than that of the conventional horseradish peroxidase(HRP)-based ELISA using the same set of antibodies and the same procedure (see Figure).













• Dr. Xia: PSA test measures the level of PSA in a man’s blood, which is done to help diagnose and follow prostate cancer. In particular, for patients who have undergone radical prostatectomy, it is vital to monitor minute concentration of PSA at the earliest stage possible to improve their survival rates. Therefore, sensitive and simple techniques of PSA test are urgently needed, especially for health systems in resource-limited areas.












• Our Pd-Ir cube-based ELISA offers several advantages compared to existing techniques of PSA test:

• i) High sensitivity. Its detection limit (sub-pg/mL) is 2 orders of magnitude lower than the commercially available in-clinic ELISA kit, rivaling the limits of sophisticated equipment-based techniques;

• ii) Simple procedure. The entire test could be completed within 3 hours with the aid of a simple and low-cost microplate reader which is available in most clinic laboratories;

• iii) Reliable performance. Since Pd-Ir nanocrystals are made of inert noble metals with excellent stabilities, the Pd-Ir ELISA could survive harsh environments and provide reliable test results.













• Dr. Xia: Our work demonstrated that the peroxidase-like activity could be enhanced by carefully engineering the structure and elemental composition of a mimic. Future fundamental studies on the catalytic mechanism will be helpful for researchers to gain more insight into the system and develop mimics with further enhanced efficiencies. On the other hand, clinical studies such as blood sample tests based on high-efficiency and stable peroxidase mimics are worth investigating in the near future.

• Citation:• Xiaohu Xia, Jingtuo Zhang, Ning Lu, Moon J. Kim, Kushal Ghale, Ye Xu, Erin

McKenzie, Jiabin Liu, Haihang Ye. Pd–Ir Core–Shell Nanocubes: A Type of Highly Efficient and Versatile Peroxidase Mimic. ACS Nano, 2015; 150910154147007 DOI: 10.1021/acsnano.5b03525











Investigating cellular HIV resistance to understand “Elite controllers”?MedicalResearch.com Interview with:Yong-Hui Zheng, Ph.D. Associate

ProfessorBiomedical Physical Science BuildingDepartment of Microbiology and Molecular GeneticsMichigan State University


• Dr. Zheng: Although HIV-1 has caused one of the most devastating pandemics by inducing AIDS, this virus failed to induce the disease in a small cohort of patients, who are known as “Elite controllers”. The secrete of the viral resistance in these individuals may point the direction of a cure for AIDS, which is still not available in the current antiretroviral therapies. We started to study HIV resistance using human CD4+ T cells as a model system, because these cells are primary targets for HIV-1 infection. We successfully identified a highly HIV-resistant cell line CEM.NKR, where HIV-1 replication is decreased by almost 1,000-fold. Understanding of the resistant mechanism has been the primary interest in our laboratory, and we have published a series of papers to elucidate how the HIV-1 replication is inhibited in these cells.



http://medicalresearch.com/infections/hiv/investigating-elite-controllers-to-understand-hiv-resistance/17664/


















• Our initial findings uncovered that HIV-1 is able to enter these cells, but fails to regenerate infectious virions. Further investigation showed that although the virus could make the other viral proteins, it fails to express the viral envelope (Env) glycoprotein. Most viruses have an envelope to cover their protein capsids, where viral spikes are anchored. These spikes are made from the Env glycoproteins, which are required for the virus to penetrate into cells and start infection. Thus, identifying the pathway that specifically inhibits the Env expression will open a new avenue for antiretroviral therapies.

• In the present paper, we found that the endoplasmic reticulum class I α-mannosidase (ERManI) initiates the Env inhibition process. ERManI is a host enzyme that is involved in protein N-glycosylation. When the ERManI expression is up-regulated, it targets Env to the ER-associated protein degradation (ERAD) pathway, resulting in Env degradation and inhibition of HIV-1 replication.






















• Dr. Zheng: These findings suggested that ERManI could contribute to the natural host resistance to HIV-1 infection. It would be interesting to further investigate the correlation between the ERManI expression levels and viral loads in HIV patients. An inverse correlation would further confirm its important role in the natural resistance.






















• Dr. Zheng: ERManI is an unstable protein and expressed at low levels in mammalian cells. We are planning to develop a technology to boost the ERMani expression, and test whether HIV-1 replication could be eradicated by this technology.

• Citation:• Tao Zhou, Dylan A. Frabutt, Kelley W. Moremen, Yong-Hui Zheng.ERManI

(Endoplasmic Reticulum Class I α-Mannosidase) Is Required for HIV-1 Envelope Glycoprotein Degradation via Endoplasmic Reticulum-associated Protein Degradation Pathway. Journal of Biological Chemistry, 2015; 290 (36): 22184 DOI:10.1074/jbc.M115.675207

• Related links:• http://msutoday.msu.edu/news/2010/msu-professor-probes-hiv-immunity/• http://msutoday.msu.edu/news/2015/international-team-discovers-natural-

defense-against-hiv/



















Kids Who Have Longer Lunch Periods Eat Healthier MealsMedicalResearch.com Interview with:Juliana F. W. Cohen, ScD, ScM Harvard

T. H Chan School of Public HealthAssistant Professor Department of Health Sciences School of Science and EngineeringDepartment of Health Sciences, Merrimack CollegeNorth Andover, MA


• Dr. Cohen: There is a substantial amount of variation in the amount of time students have to eat lunch because there are no national standards for lunch period lengths. This study found that when students had less than 20 minutes of seated time in the cafeteria, they were less likely to select a fruit and consumed significantly less of their entrees, milk and vegetables compared with students who had at least 25 minutes to eat their lunch.



http://medicalresearch.com/pediatrics/kids-who-have-longer-lunch-periods-eat-healthier-meals/17668/















• Dr. Cohen: Advocating for longer lunch periods for children in schools is important to help address this issue. However, not all schools will be able to extend the length of the lunch periods. Therefore, pushing for schools to implement strategies to get kids through the lunch line faster, such as more lunch lines and automated point of sales systems, may help.


















• Dr. Cohen: Future studies should also examine the role of students’ taste preferences for the foods offered as this likely impacts selection and consumption.

• Citation:• Amount of Time to Eat Lunch Is Associated with Children’s

Selection and Consumption of School Meal Entrée, Fruits, Vegetables, and Milk

• Cohen, Juliana F.W. et al. Published Online: September 11, 2015

• Journal of the Academy of Nutrition and Dietetics• DOI: http://dx.doi.org/10.1016/j.jand.2015.07.019















Mid-Day Nap May Be Good For Your Blood PressureMedicalResearch.com Interview with:Dr Manolis Kallistratos MD,PhD FESC,EHSCardiologist at Asklepieion Voula General HospitalAthens, Greece


• Dr Kallistratos: We all know that lifestyle changes represent the cornerstone of treatment of arterial hypertension. Lifestyle changes include restriction of salt and alcohol, physical activity, smoking cessation and weight loss. On the other hand, we know that many individuals especially the elders are sleeping at noon. Unfortunately there are few studies assessing mid-day sleep. A study in healthy individuals affirmed that sleeping at noon resulted in a decrease of 12% of the relative risk of coronary mortality in healthy subjects. So the question regarding this habit is: Is it only a custom, a behavioral adaptation or is it also beneficial? Should mid-day sleep be included in the life style changes suggested by the doctors in patients with arterial hypertension? because we all know that nowadays is almost a privilege for a few due to the “nine to five” working culture, and the intense daily routine.



http://medicalresearch.com/sleep-disorders/mid-day-nap-may-be-good-for-your-blood-pressure/17676/



















• For this purpose we prospectively studied 386 middle-aged patients (200 males and 186 females) from our outpatient hypertensive clinic. We observed that hypertensive patients that slept at noon presented lower pulse wave velocity levels (less stiff arteries), lower daytime and nighttime as well as average systolic blood pressure levels (24-hours SBP) . In general mid-day sleep decreased systolic blood pressure levels (during 24 hours) for approximately 6 mm of Hg. 60 minutes of mid-day sleep, decreased average SBP in our patients for about 4 mmHg. In addition, there was a trend, patients who slept at noon to be under fewer medications.























• Dr Kallistratos: Mid-day sleep decreases systolic blood pressure levels. Although the mean blood pressure decrease seems low, it has to be mentioned that reductions as small as 2 mmHg in systolic blood pressure can reduce the relative risk of cardiovascular events by up to 10%. However, a prolonged mid-day sleep period may not be beneficial, since usually reflects and is associated among other, with other probably less beneficial habits of patients.























• Dr Kallistratos: This was an observational and not a randomized study however, it’s difficult to randomize someone to sleep or not to sleep. Moreover, happens that those patients were well controlled in respect of their blood pressure levels. Probably untreated patients or patients with uncontrolled hypertension could present different results (probably higher drop of blood pressure levels). More studies with larger sample of patients could verify our results.

• Citation: Abstract presented at the European Society of Cardiology September 2015. “Midday naps associated with reduced blood pressure and fewer medications.”





















Psoriasis Elevates Risk of MigrainesMedicalResearch.com Interview with:Alexander Egeberg, MDDepartment of Cardiology Herlev and Gentofte HospitalHellerup, Denmark


• Dr. Egeberg: Psoriasis is a common chronic skin disease, with a strong inflammatory component. Within the last decade, our understanding of psoriasis have advanced significantly, and psoriasis is now widely regarded as a systemic disease, where the skin is a direct marker of disease activity. The inflammatory pathways in psoriasis have also been implicated in several central nervous system diseases such as depression, uveitis, and multiple sclerosis. Moreover, pain generation and sensitization can occur as a result of the pro-inflammatory mediators which are upregulated in psoriasis.

• In the present study, we investigated the association between psoriasis and psoriatic arthritis, and the risk of new-onset migraine. The main finding was a psoriasis-severity dependent increased risk of new-onset migraine, and patients with severe skin psoriasis, and psoriatic arthritis appeared to have the highest risk.



http://medicalresearch.com/pain-research/psoriasis-elevates-risk-of-migraines/17681/


















• Dr. Egeberg: Certain forms of migraine are associated with increased risk of stroke, and studies have shown that patients with psoriasis have increased risk of stroke. Focus on migraine in patients with psoriasis, including during cardiovascular risk assessments may be warranted.





















• Dr. Egeberg: Future studies of the cerebrovascular risk in patients with psoriasis should include migraine, and studies are warranted to examine if other central nervous system diseases occur more frequently in patients with psoriasis.

• Citation:• Increased risk of migraine in patients with psoriasis: A Danish

nationwide cohort study, Capsule Summary• Alexander Egeberg, Lotus Mallbris, Gunnar Hilmar Gislason, Lone

Skov, Peter Riis Hansen• Publication stage: In Press Corrected Proof• Journal of the American Academy of Dermatology• Accepted: August 20, 2015; Published Online: September 16, 2015



















Intermittent Androgen Deprivation May Improve QoL in Prostate CancerMedicalResearch.com Interview with:Sindy Magnan, MD, MSc, FRCPCDivision of Radiation Oncology, Department of MedicineCHU de Québe Université

LavalQuébec City, Québec, Canada


• Dr. Magnan : Androgen deprivation is the standard therapy for patients with advanced or recurrent prostate cancer. Intermittent administration of this treatment could offer several advantages over the standard continuous administration by delaying the development of castration-resistant disease and by reducing the drugs’ adverse effects. However, this mode of administration remains controversial. We thus conducted a systematic review with meta-analysis of randomized controlled trials to compare the effectiveness and tolerability of intermittent versus continuous androgen deprivation. Intermittent therapy was non-inferior to continuous therapy with respect to overall survival. No major difference in global quality of life was observed between the two interventions, but some quality-of-life criteria, mainly in relation with physical and sexual functioning, seemed improved with intermittent therapy.



http://medicalresearch.com/cancer-_-oncology/prostate-cancer/intermittent-androgen-deprivation-may-improve-qol-in-prostate-cancer/17689/


















• Dr. Magnan : Intermittent androgen deprivation can be considered as an alternative therapeutic option in patients with prostate cancer. However, further research is needed before it becomes the standard of care.





















• Dr. Magnan : Future research should focus on assessing the impact of disease stage on treatment efficacy, particularly in the sub-group of patients with metastatic disease, and clarifying the optimal approach to the duration of on and off-treatment periods.

• Citation:• Magnan S, Zarychanski R, Pilote L, et al. Intermittent vs

Continuous Androgen Deprivation Therapy for Prostate Cancer: A Systematic Review and Meta-analysis. JAMA Oncol. Published online September 17, 2015. doi:10.1001/jamaoncol.2015.2895.


















Chronic Loud Noise Exposure Raises Risk of Heart DiseaseMedicalResearch.com Interview with:Wenqi Gan, MD, PhD Assistant ProfessorDepartment of Preventive Medicine and Environmental Health University

of Kentucky College of Public HealthLexington, KY 40536

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

• Dr. Wenqi Gan: In epidemiologic studies on health effects of noise exposure, community noise is typically assessed using noise prediction models, occupational noise is assessed using self-reports or historical records. These methods are able to estimate community noise exposure in residential areas and occupational noise exposure in the workplace; however, these methods are not able to accurately reflect actual personal noise exposure in the home and workplace. The lack of personal noise exposure information is a major limitation of previous studies, which could cause underestimations of the true health effects of noise exposure. Bilateral high-frequency hearing loss, an objective indicator for long-term exposure to loud noise, may be used to investigate health effects of noise exposure.



http://medicalresearch.com/heart-disease/chronic-loud-noise-exposure-raises-risk-of-heart-disease/17626/


















• Dr. Wenqi Gan: This study includes 5223 people aged 20-69 years who participated in the US National Health and Nutrition Examination Survey 1999-2004. Compared with people with normal high-frequency hearing, people with bilateral high-frequency hearing loss were approximately two times more likely to have coronary heart disease. This association was particularly striking for people who were chronically exposed to loud noise in the workplace or leisure time. For example, for currently employed workers with occupational noise exposure history, the possibility of having coronary heart disease increased more than four times. This study confirms that chronic exposure to loud noise is associated with increased risk of coronary heart disease.





















• Dr. Wenqi Gan: Accumulating evidence suggests that exposure to loud noise can increase the risk of coronary heart disease. However, this risk can be prevented by eliminating or reducing excessive noise exposure in the home and workplace. Using earmuffs and earplugs is able to reduce personal noise exposure.





















• Dr. Wenqi Gan: Little is known about the biological mechanisms underlying the associations between noise exposure and heart disease outcomes. Future studies, especially controlled human exposure studies, are needed to better understand the pathways for the observed associations.

• Citation:Exposure to loud noise, bilateral high-frequency hearing loss and coronary heart disease

• Wen Qi Gan, Jacqueline Moline, Hyun Kim, David M Mannino• Occup Environ Med oemed-2014-102778Published Online First: 15

September 2015doi:10.1136/oemed-2014-102778


















Declining Death Rates Largely Due To Decreased Tobacco ExposureMedicalResearch.com Interview with:Mohammed K. Ali, MBChB, MSc, MBAAssociate Professor of Global Health and Epidemiology Rollins

School of Public HealthEmory University


• Dr. Ali: The background of this study is that we attempted to provide a comprehensive overview so that readers could see what has been happening for the 4 most common sets of chronic non-communicable diseases (cardiovascular diseases, diabetes, common cancers, and chronic respiratory diseases) over the past 30 years (1980-2012). We looked at one measure: death due to these conditions as that is the longest-standing way to understand what diseases are most common in society and warrant efforts to address them. And, we picked these 4 groups of conditions because together, they account for one out of every two deaths worldwide. We compiled data for 49 countries where over 70% of deaths in the country are documented and reported to the World Health Organization’s Mortality Database. What we found is that:



http://medicalresearch.com/author-interviews/declining-death-rates-largely-due-to-decreased-tobacco-exposure/17640/














• Between 1980 and 2012, death rates for many conditions (heart disease and stroke; cervical and stomach cancers) declined worldwide.

• Second, deaths due to diabetes, liver cancers, and female lung cancer and female respiratory diseases increased worldwide.

• And third, there were disparities between high-income countries (like the US, Australia, European countries) and low- and middle-income countries (like Mexico or Eastern European countries) in that these latter countries experienced less impressive declines in deaths due to heart disease, stroke, stomach, and cervical cancers, and actual increases in deaths due to breast cancers and colon cancers.This suggests that we have made important strides in high-income countries, largely due to efforts to lower tobacco exposure, and that awareness, access to healthcare, screening, and earlier treatments seem to be having an effect on prolonging survival from many cancers. Similarly, greater attention to and treatment of cardiovascular risk factors may be yielding benefits. However, more efforts are needed in low- and middle-income countries, and these disparities should not be overlooked.


















• R Dr. Ali: In terms of relevance to clinicians and patients IN THIS COUNTRY, the reductions in mortality rates for many conditions (heart disease and stroke; lung, breast, colon, cervical, and stomach cancers) suggests that tobacco policies are having important impacts; and that clinicians and patients together are doing a great job in terms of preventive care – lowering blood pressure and cholesterol levels, encouraging screening (clinicians) and self-screening (patients), and possibly earlier treatments.

• The increases in diabetes mortality suggest two things: one that diabetes and obesity are the two cardio-metabolic conditions that we are not managing well, and we have to strive harder to help people adopt healthier lifestyles (better quality diets with some attention to portion size, more exercise). Second, the data suggest that non-cardiovascular impacts of diabetes need more attention – kidney diseases are especially overlooked.

















• Lastly, while much of this is good news that death rates are declining, that doesn’t mean we have less of these diseases; in fact, with population growth and lower deaths, it means that clinicians have and will increasingly face higher numbers of people with chronic conditions (cancers, diabetes, etc.). So, we are compressing mortality, but expanding morbidity, and we have to figure out how to handle the higher volume of patients clinicians will have to manage. Also, for patients and people at risk, they can help by use modern technologies to learn about their risks (there is more information online now than ever before), engage in their own preventive health care, and try to elongate their healthy years of life.


















• Dr. Ali: Since we used a strict definition of including only countries that had reliable death documentation, we were unable to include data from China, India, Indonesia, and most of Sub-Saharan Africa (which together account for 50% of the world’s population. As such, we need to invest in better cause-of-death documentation so that these trends can be monitored for the whole world.

• Second, we relied on existing literature to try to understand the trends in death rates for these countries, and while we know a fair amount about how much healthcare has contributed to declining death rates, we need more research to understand if and how much societal interventions like building bike lanes or taxing sodas or other such population-wide policies might affect health. Investing in this sort of research will hopefully help us make informed decisions about which policies to pursue and which to disregard.”

• Citation:• Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And

Decreases In Mortality Rates• Mohammed K. Ali, Lindsay M. Jaacks, Alysse J. Kowalski, Karen R. Siegel, and Majid Ezzati• Health Aff September 2015 34:91444-1455;doi:10.1377/hlthaff.2015.0570















Restless Legs Linked to Higher Mortality in US VeteransMedicalResearch.com Interview with:Miklos Z Molnar, MD, PhD, FEBTM, FERA, FASN Associate

Professor of MedicineDivision of Nephrology, Department of MedicineUniversity of Tennessee Health Science Center Memphis, TN, 38163


• Response: Restless legs syndrome is a common sleep disorder, but there is a paucity of large cohort studies examining the association of restless legs syndrome with clinical outcomes, including all-cause mortality, incident coronary heart disease, stroke and chronic kidney disease.

• From a nationally representative prospective cohort of over 3 million US veterans [93% male, median follow-up time of 8.1 years (interquartile range: 7.0–8.5years)] with baseline estimated glomerular filtration rate ≥60 mL/min/1.73 m2, a propensity-matched cohort of 7392 patients was created, and the association between incident restless legs syndrome and the following was examined:

• (1) all-cause mortality;• (2) incident coronary heart disease;• (3) incident strokes; and• (4) incident chronic kidney disease defined as estimated glomerular filtration rate

<60 mL/min/1.73 m2.



http://medicalresearch.com/author-interviews/restless-legs-linked-to-higher-mortality-in-us-veterans/17639/















• Compared with restless legs syndrome-negative patients, incident restless legs syndrome was associated with 88% higher mortality risk [hazard ratio and 95% confidence interval: 1.88 (1.70–2.08)], and almost four times higher risk of coronary heart disease and stroke [hazard ratio: 3.97 (3.26–4.84) and 3.89 (3.07–4.94), respectively]. The risk of incident chronic kidney disease was also significantly higher in incident restless legs syndrome patients [hazard ratio: 3.17 (2.74–3.66)] compared with restless legs syndrome-negative counterparts. These associations was independent from other confounders such as demographic data, comorbidities and other sleep disorders (sleep apnea and periodic limb movements in sleep).



















• Response: In this large and contemporary cohort of US veterans, incident restless legs syndrome was associated with higher risk of mortality, incident coronary heart disease, stroke and chronic kidney disease. The association between restless legs syndrome and chronic kidney disease is new, it was never observed before.



















• Response: Improvement of the diagnostics and early detection as well the effect of proper therapy of restless legs syndrome on preventing these clinical events needs to be tested in clinical trials.

• Citation:• Association of incident restless legs syndrome with

outcomes in a large cohort of US veterans.• Molnar MZ, Lu JL, Kalantar-Zadeh K, Kovesdy CP.• J Sleep Res. 2015 Sep 17. doi: 10.1111/jsr.12335. [Epub

ahead of print]• PMID: 26377112
















High Dose Flu Vaccine In Elderly Reduced Overall Health Care CostsMedicalResearch.com Interview with:Dr Ayman Chit PhD Sanofi PasteurSwiftwater, PA 18370


• Dr. Chit: Our analysis used data from a large-scale, multi-center efficacy trial, in which a higher-dose split-virus inactivated influenza vaccine (IIV-HD, Fluzone® High-Dose vaccine, Sanofi Pasteur) was compared to a standard-dose split-virus inactivated influenza vaccine (IIV-SD, Fluzone vaccine, Sanofi Pasteur) in persons 65 years of age and older. These data were supplemented with US healthcare cost data.

• In the efficacy trial, a total of 31,989 adults 65 years of age and older were randomly assigned in a 1:1 ratio to receive either IIV-HD or IIV-SD and followed for six to eight months post-vaccination for the occurrence of influenza, serious adverse events, and medical encounters. Healthcare utilization (HCU) data were captured for all participants through a surveillance program that covered each influenza season, including the following events occurring within 30 days after any respiratory illness: use of prescription and non-prescription medications (limited to antipyretics/analgesics/non-steroidal anti-inflammatory drugs, antivirals and antibiotics), emergency room visits, non-routine or urgent care visits, and hospitalizations. In addition, all hospitalizations were captured for participants for the entire duration of the study.



http://medicalresearch.com/infections/flu-influenza/high-dose-flu-vaccine-in-elderly-reduced-overall-health-care-costs/17650/


















• The primary results from the efficacy trial were published in The New England Journal of Medicine, which reported that IIV-HD was 24.2% (95% confidence interval [CI], 9.7% to 36.5%) more effective in preventing laboratory-confirmed influenza-like illness compared to IIV-SD.1 In the current supplemental analysis of the trial, we used US healthcare cost data to evaluate economic impacts of using IIV-HD compared to IIV-SD within the efficacy trial participants. In this analysis, total healthcare payer costs (the combined costs of study vaccine, prescription drugs, emergency room visits, non-routine and urgent-care visits, and hospital admissions) were about $116 less per person.

• DiazGranados et al, NEJM, 2014;14;371(7):635-45






















• Dr. Chit: In this newly published economic evaluation, total healthcare payer costs, which included vaccine costs, were about $116 less per person who received IIV-HD.






















• Dr. Chit: New cost-effectiveness analyses of IIV-HD should focus on other populations eligible to receive IIV-HD that were not covered in our analysis—e.g., residents of nursing homes. Further, the design of our analysis provides an example of how a cost-effectiveness analysis can be added onto a randomized controlled trial.

• Citation:• Cost-effectiveness of high-dose versus standard-dose inactivated

influenza vaccine in adults aged 65 years and older: an economic evaluation of data from a randomised controlled trial

• Chit, Ayman et al.• The Lancet Infectious Diseases• DOI: http://dx.doi.org/10.1016/S1473-3099(15)00249-2




















African American Women Have More Aggressive Breast Cancer Tumor BiologyMedicalResearch.com Interview with:Aditya Bardia MBBS, MPH

Attending Physician, Massachusetts General Hospital Cancer Center,Assistant Professor, Harvard Medical SchoolBoston, MA 02114


• Response: Multiple studies have consistently shown that African American women with cancer, including breast cancer, have worse outcomes than Caucasian counterparts. While socioeconomic issues, including access to care plays an important role, the contribution of tumor biology has been less clear.

• In this study, utilizing exome sequencing data, we linked the racial distribution of primary breast cancer with tumor genotypic traits, including somatic mutations, gene-expression profiles and intra-tumor heterogeneity. We observed that in addition to having a higher prevalence of triple negative breast cancer than Caucasian women (something that has been documented in the literature), African American women had a significantly higher prevalence of TP53 mutations, TNBC basal-like 1 and mesenchymal stem-like tumors, and intratumor genetic heterogeneity, and all of which suggest more aggressive tumor biology, suggesting that differences in tumor genomic profile contribute, at least partly, to the known racial disparity in survival between African Americans and Caucasians breast cancer patients.



http://medicalresearch.com/cancer-_-oncology/breast-cancer/african-american-women-have-more-aggressive-breast-cancer-tumor-biology/17686/














• Response: Our findings suggest that triple negative breast cancer, even within the basal-subtype, behaves more aggressively in African Americans and thus deserves more attention from researchers and clinicians to develop treatment regimens tailored to tumor biology. It also underscores the critical need to involve higher numbers of African American patients in precision medicine research aimed at developing novel targeted therapies for subtype of triple negative breast cancer specifically seen in African Americans.

















• Response: Additional research is needed to confirm these findings and understand why African Americans have a worse tumor biology. Also, additional research is needed to develop specific therapies that target the molecular breast cancer subtypes specifically seen in African Americans and potentially reduce the racial divide in breast cancer outcomes.

• Citation:• Keenan, B. Moy, E. A. Mroz, K. Ross, A. Niemierko, J. W. Rocco, S.

Isakoff, L. W. Ellisen, A. Bardia. Comparison of the Genomic Landscape Between Primary Breast Cancer in African American Versus White Women and the Association of Racial Differences With Tumor Recurrence. Journal of Clinical Oncology, 2015; DOI:10.1200/JCO.2015.62.2126














Tai Chi Improves Physical and Mental Health in Some Chronic ConditionsMedicalResearch.com Interview with:Yi-Wen Chen PhD Candidate, andDarlene Reid, BMR(PT), PhD Professor and Chair Department

of Physical Therapy University of TorontoToronto, Ontario


• Response: Tai Chi is a time-honored exercise in China, developed during the Sung Dynasty, which has gained increased popularity in Western society. Most styles of Tai Chi consist of slow rhythmic movements that often emphasize typical attributes of exercise including range of motion, strengthening, balance, and postural alignment. In addition, there are spiritual aspects of Tai Chi that focus on relaxation, breath control, and cultivating internal energy. Several studies have demonstrated its multifaceted benefits in the elderly and in people living with chronic diseases including cancer, cardiovascular diseases, respiratory disorders and arthritis.



http://medicalresearch.com/exercise-fitness/tai-chi-improves-physical-and-mental-health-in-some-chronic-conditions/17710/



















• Many individuals that require increased exercise and physical fitness also have one or more comorbidities; 9 out 10 Canadians live with more than one chronic condition and this proportion increases to 98% in adults over the age of 65 years. Increased fitness can increase quality of life and decrease risk of mortality and morbidity in older persons and in many chronic conditions. However, treatment, including exercise is often prescribed within a single specialty. Rarely is information provided to health professionals that integrates therapeutic approaches across several common chronic disorders. Accordingly, we performed a systematic review to determine if Tai Chi is an effective physical activity that improves symptoms, physical function, quality of life and depression in cancer, osteoarthritis (OA), heart failure (HF) and chronic obstructive pulmonary disease (COPD)? We also examined if Tai Chi had similar effects for the same outcome measures across different chronic conditions?























• Response: This systematic review with meta-analyses examined 33 studies that included a total sample size of 1584 patients. The main findings were that Tai Chi can improve physical performance and mental health measures consistently in three of the four chronic conditions. Improvements in physical performance included longer walk distances, greater thigh strength, and better performance in measures that required coordination, balance and lower extremity strength. Quality of life and depression scores improved as well. These benefits were more often demonstrated in people living with OA, HF and COPD but not in those with breast cancer. The lack of consistent benefits in women with breast cancer might be due to their younger age (54 yr versus 68-72 yr), the physical impairments induced by breast cancer and other ongoing interventions that are often provided to people with this type of cancer.

• Besides measures examined in all disorders, the primary symptoms of a particular condition also improved. Symptoms of pain and stiffness decreased in OA patients and dyspnea tended to decrease in people with COPD.























• Response: Major points to consider are that unequivocally, exercise and physical activity can improve function and quality of life. The conundrum is that many people may not like or sustain typical exercise programs. Another important fact is that the systematic review reported the probability of findings in large groups of patients whereas exercise is prescribed to an individual who has many personal considerations. Keeping in mind these contextual issues, Tai Chi is a viable exercise option that provides many exercise benefits and appears to alleviate rather than aggravate primary symptoms that are experienced by people with OA, HF, and COPD. At first glance, its more gentle, spiritual presentation may appear less therapeutic. However, many of the movements work through large ranges of motion of all extremities and impose stress on balance and strength. In summary, Tai Chi has been demonstrated to improve important outcomes of physical activity –strength, coordination, balance and sense of well being, and might benefit many individuals who live with OA, HF and COPD.























• Response: The systematic review reported data from studies that included people living with a primary disorder and often these types of studies exclude patients with complex presentations and multimorbidity. Future studies need to examine people with several coexisting chronic conditions and complex presentations of these disorder rather than recruiting those living with a single disorder. A second issue is selection of the most effective Tai Chi form and movements. Currently, there are many traditional and contemporary styles of Tai Chi, some of these require complex and possibly excessive exercise demands. It would be very helpful to define the most effective Tai Chi movements that can efficiently result in the desired physical function and well-being for people living with multimorbidity and complex presentation of these disorders.

• Citation:• The effect of Tai Chi on four chronic conditions—cancer, osteoarthritis, heart failure and chronic

obstructive pulmonary disease: a systematic review and meta-analyses• Yi-Wen Chen, Michael A Hunt, Kristin L Campbell, Kortni Peill, W Darlene Reid• Br J Sports Med bjsports-2014-094388Published Online First: 17 September

2015doi:10.1136/bjsports-2014-094388




















Meaningful Use Registries May Improve Care and Reduce Costs for Type 2 DiabetesMedicalResearch.com Interview with:Wencui Han PhD Assistant Professor Business AdministrationUniversity of Illinois at Urbana Champaign


• Dr. Han: Well-designed disease registries integrate a variety of information, including patient demographics, laboratory results, pharmacy data, and comorbidity data, to serve a variety of functions outside the clinical encounter. However, the adoption of disease registries by healthcare organizations is associated with significant direct and indirect costs. The impacts of using disease registries that meet meaningful use (MU) requirements in improving health outcomes and creating cost savings are understudied. This study examines the impact of using a registry for patient reminders and for improvement of the quality of care, hospital utilization, and cost saving. The results suggest that the use of diabetes registries meeting Meaningful Use core objectives is associated with higher completion or recommended lab tests and a lower hospital utilization rate for patients with type 2 diabetes.



http://medicalresearch.com/diabetes/meaningful-use-registries-may-improve-care-and-reduce-costs-for-type-2-diabetes/17716/












• Dr. Han: As suggested in the results, in practices that use registries for quality improvement, patients with type 2 diabetes are 15% less likely to have avoidable hospitalization, defined according to ACSC criteria. These patients are also 20% less likely to have ED visits. This improvement in the quality of care will lead to significant cost saving. This study provides support for the investments in diabetes registry.















• Dr. Han: The results of our study show that overall, patients with type 1 diabetes are less sensitive to the use of a disease registry. Future research can further investigate the cause of this difference. Because Meaningful Use standards were still in evolution at the time of the survey, we used open-ended questions to allow for expression in participants’ own words and also indicated other unanticipated usage. The measurement of meeting MU standards should be revised in future studies. In this study, the outcome measures and the survey of registry use cover approximately the same time period. It is possible that some practices that claimed to use registries had not been using the tool for a sufficiently long period of time to see a benefit. Longitudinal studies can better access the impact of registry use.

• Citation:• J Am Med Inform Assoc.• 2015 Jul 1. pii: ocv040. doi: 10.1093/jamia/ocv040. [Epub ahead of print]• Impact of electronic diabetes registry ‘Meaningful Use’ on quality of care and hospital utilization.• Han W1, Sharman R2, Heider A3, Maloney N3, Yang M4, Singh R4.













Beetroot Juice Enabled Better Sprint and Decision Making TimesMedicalResearch.com Interview with:Chris Thompson BSc MSc ANutr AFHEAUniversity of ExeterSt. Luke’s CampusExeter Devon


• Response: Dietary nitrate has been shown to favourably alter the contractility of type II muscle fibres and enhance blood flow to working muscles that are predominantly type II. Dietary nitrate may also improve perfusion to areas of the brain responsible for cognitive function. It is therefore possible that through these mechanisms, nitrate-rich beetroot juice supplementation may improve both physical and cognitive performance during exercise which reflects the high intensity intermittent nature of team sport play.



http://medicalresearch.com/exercise-fitness/beetroot-juice-enabled-better-sprint-and-decision-making-times/17721/


















• Response: Participants were able to complete greater total work during an intermittent sprint test following nitrate-rich beetroot juice supplementation. We also found that dietary nitrate enabled a reduction in response time to decision making during the cognitive tasks performed throughout the exercise test.





















• Response: Beetroot juice high in nitrate is able to enhance repeated sprint performance and attenuate the decline in decision making reaction time which occurs over the course of prolonged exercise. A high-nitrate diet containing beetroot and green leafy vegetables should be encouraged to team sport athletes for its performance enhancing capabilities. However we cannot always be sure how much nitrate is contained within these, as a number of factors such as where the vegetables are grown can influence this. If athletes wish to explore the use of nitrate as a dietary supplement it may be more convenient to use a beetroot juice shot with known concentrations.

• The consumption of nitrate-rich foods is to be encouraged to other populations too. Although the performance enhancing effects of dietary nitrate is becoming increasingly recognised in a number of exercise settings, the existing data for the positive impact on cardiovascular health is already very strong.





















• Response: With the evidence mounting for the targeted effect of dietary nitrate on type II muscle fibres, the potential of nitrate supplementation to improve muscle speed and power must be further explored. It is important to identify the populations and activities in which dietary nitrate will have the greatest applications.

• Citation:• Eur J Appl Physiol. 2015 Sep;115(9):1825-34. doi: 10.1007/s00421-

015-3166-0. Epub 2015 Apr 7.• Dietary nitrate improves sprint performance and cognitive function

during prolonged intermittent exercise.• Thompson C1, Wylie LJ, Fulford J, Kelly J, Black MI, McDonagh

ST, Jeukendrup AE, Vanhatalo A, Jones AM.



















Periodontal Disease Increases Inflammation and Cardiovascular Disease RiskMedicalResearch.com Interview with:Boxi Zhang PhD Student School of Health and Medical Sciences Örebro University


• Response: In the past decade, many studies raise concerns about the increased prevalence of cardiovascular disease and mortality among patients with periodontitis. Porphyromonas gingivalis is the major pathogen causing periodontal disease. This bacterium also plays a significant role in the pathogenesis of atherosclerosis. In this study, we infect human aortic smooth cells with P. gingivalis and show that this periodontal pathogen affects gene and protein expression in human aortic smooth muscle cells associated with increased inflammation and atherosclerosis.



http://medicalresearch.com/heart-disease/periodontal-disease-increases-inflammation-and-cardiovascular-disease-risk/17725/














• Response: Periodontal disease might be a risk factor for cardiovascular disease. The specific mechanisms at a molecular level that we found in this study are also vital to understand how periodontal pathogens induced other systemic diseases. People should pay more attention to oral health.

















• Response: Gingipains are the important virulence factors that are produced by P. gingivalis. In this study, we have found that gingipains have a crucial role in P. gingivalis induced inflammatory response in AoSMCs. The proteolytic fragments formed by gingipains can probably be used as diagnostic biomarkers and inhibition of gingipain activity may be a successful strategy for treatment.

• Citation:• Infect Immun. 2015 Aug 17. pii: IAI.00498-15. [Epub ahead of print]• Gingipains from the periodontal pathogen Porphyromonas

gingivalis play a significant role in regulation of Angiopoietin 1 and Angiopoietin 2 in human aortic smooth muscle cells.

• Zhang B1, Khalaf H2, Sirsjö A2, Bengtsson T2.Read the rest of the interviews on MedicalResearch.com. NOT an














Patient Support Services Grow But Strain Cancer Centers’ ResourcesMedicalResearch.com Interview with:Steven L. D’Amato, BSPharm, BCOP President and Executive DirectorNew England Cancer Specialists Scarborough

, MaineAssociation of Community Cancer Centers


• Response: The Trends in Cancer Programs annual survey, which began in 2009, provides key insight into nationwide developments in the business of cancer care. It’s a joint project between the Association of Community Cancer Centers and Lilly Oncology. The goals of the survey are to:

• Provide ACCC with information to help guide its education and advocacy mission• Assist member organizations to understand nationwide developments in the business of cancer

care• Assist members in evaluating their own cancer program’s performance relative to similar

organizations through a consistent and meaningful benchmark.• This year’s key findings show that patient-centered services – like nurse navigation, psychological

counseling, survivorship care and palliative care – are continuing to grow in U.S. cancer programs. However, the biggest challenge facing cancer centers is reimbursement for these types of services. Additionally, mirroring what we are seeing in the industry in general, measurement is becoming more and more important. More cancer programs are now using quality metrics to show payers the value of care provided.

• More information about our findings can be viewed here: http://www.accc-cancer.org/surveys/pdf/Trends-in-Cancer-Programs-2015.pdf.



http://medicalresearch.com/cancer-_-oncology/patient-support-services-grow-but-strain-cancer-centers-resources/17728/























• Medical Research: What are the challenges facing today’s oncology providers? What effects do these challenges have on cancer patients?

• Response: The challenges facing today’s oncology providers is developing and maintaining the infrastructure required to meet future quality and payment reform initiatives while maintaining economic viability with reduced reimbursement and the additional demands of quality program delivery.

• Additionally, at a time when a patient should be focused on their treatment, more are focused on how they are going to pay for treatment. Patients benefit from supportive care services, such as navigators, social workers, and financial advocates and if these are not reimbursed, some cancer programs may have to cut these services.



























• Response: We need future research to support reimbursement of services that improve outcomes and quality of life. Our survey found evidence that supportive care services such as navigation, survivorship and advocacy improve patient outcomes.

• Citation:• Trends in Cancer Programs 2015 survey
























Switching to Prasugel in Plavix Non-Responders Improved PCI OutcomesMedicalResearch.com Interview with:Renato Valenti, MD David Antoniucci, MDCardiology Department; Careggi HospitalFlorence; Italy


• Response: Previous data have shown that high residual platelet reactivity in patients receiving clopidogrel is associated with high risk of ischemic events and cardiac death after PCI at short- and long-term follow-up. Clopidogrel nonresponders patients of the REsponsiveness to CLOpidogrel and StEnt thrombosis (RECLOSE-2) ACS study received an increased dose of clopidogrel or switched to ticlopidine under light transmittance aggregometry (LTA) adenosine diphosphate (ADP) test guidance. Despite some decrease of ADP test after treatment adjustment, there was no improvement on clinical outcome. Currently no evidence exists that the achievement of an optimal platelet aggregation inhibition in clopidogrel nonresponders modifies the risk profile of these patients. The RECLOSE-3 study invesigated if a new antiplatet therapy with prasugrel in clopidogrel nonresponders can modify the risk profile of these patients and improve the outcome in term of cardiac mortality.



http://medicalresearch.com/heart-disease/switching-to-prasugel-in-plavix-non-responders-improved-pci-outcomes/17623/
















• From the RECLOSE-3 registry we identified 302 consecutive patients who were clopidogrel nonresponders. Nonresponders switched to prasugrel therapy. Due to the nonrandomized study design the clinical outcome of clopidogrel nonresponders switched to prasugrel (from RECLOSE-3 study) was compared with the historical cohort of clopidogrel nonresponders of the RECLOSE-2 ACS (248 patients) study. The primary endpoint of the study was cardiac mortality. The 2-year cardiac mortality rate was 4.0% in the RECLOSE-3 group and 9.7% in the RECLOSE-2 group (p=0.007). The difference in 2-year cardiac mortality remained also considering exclusively patients with ACS on admission: 3.2% and 9.7%, respectively, p=0.023.At the final model of multivariable analysis, prasugrel treatment was inversely related to the risk of 2-year cardiac death (HR 0.32; p=0.036) after adjusting for ACS and other well known covariates related to the outcome.




















• Response: The main finding of the RECLOSE-3 study is that nonresponsiveness to clopidogrel may be a “modifiable risk factor” for cardiac death after PCI. Prasugrel treatment overcomes nonresponsiveness to clopidogrel and results in thrombotic risk similar to the one of clopidogrel responders.




















• Response: Three major messages:• 1) An optimal platelet aggregation inhibition is

one important “link” with a good clinical outcome.

• 2) Platelet reactivity assessment is useful to guide and for “tailoring” the antiplatelet therapy.

• 3) We have the capability to manage the nonresponsiveness to clopidogrel, both for ACS and non-ACS patients.




















• Response: The results of this study support the benefit for further studies of a tailored therapy using new antithrombotic agents. Anyway, I think that ethical issues make the possibility of performing a randomized study using clopidogrel in the control arm in clopidogrel nonresponders unlikely.

• Citation:• Valenti R, Marcucci R, Comito V, et al. Prasugrel in Clopidogrel

Nonresponders Undergoing Percutaneous Coronary Intervention: The RECLOSE (REsponsiveness to CLOpidogrel and StEnt Thrombosis) 3 Study.J Am Coll Cardiol Intv. 2015;():. doi:10.1016/j.jcin.2015.07.010.


















Teenagers Carry Fewer Guns In States With Stricter Gun Control LawsMedicalResearch.com Interview with:Dr. Ziming Xuan ScD, SM, MAAssistant Professor, Community Health Sciences

School of Public HealthBoston University


• Dr. Xuan: With respect to background, among the 15000 some teenagers died annually in the US, the 3 leading causes of death were unintentional injuries, homicide, and suicide. Among these fatal youth injuries, 83% homicides were gun-related, and about half of suicides involved a gun (45%).

• So, The purpose of the study was to investigate the association between state gun law environment and youth gun carrying in the United States, and whether this association is mediated by adult gun ownership.



http://medicalresearch.com/pediatrics/teenagers-carry-fewer-guns-in-states-with-stricter-gun-control-laws/17647/

http://medicalresearch.com/pediatrics/teenagers-carry-fewer-guns-in-states-with-stricter-gun-control-laws/17647/



• Medical Research: What are the main findings?• Dr. Xuan:• Among 38 states in our study, 5.7%of high school

students living in the 19 states with stricter gun laws carried a gun in past 30 days while 7.3% of students living in states with the weaker gun laws carried a gun.

• A 10-point increase in the strictness of the state gun law score was associated with a 9% decrease in the odds of youth gun carrying.

• Across states, restrictive gun laws may reduce youth gun carrying by limiting adult gun ownership.






• Dr. Xuan: According to our study, limiting adult gun ownership likely results in reducing youth access to gun.






• Dr. Xuan: In addition to the overall impact of gun policies environment identified in this study, future research can examine relative effects of specific gun policies on youth gun-related health outcomes. The findings will be relevant to policy recommendations.

• Citation: • Ziming Xuan, David Hemenway. State Gun Law

Environment and Youth Gun Carrying in the United States. JAMA Pediatrics, 2015; 1 DOI:10.1001/jamapediatrics.2015.2116



“Breakthrough” FDA Labeling of New Drugs Can Lead To Unwarranted ExpectationsMedicalResearch.com Interview with:Dr. Tamar Krishnamurti PhDDepartment of Engineering & Public Policy Carnegie

Mellon UniversityPittsburgh, PA 15213


• Dr. Krishnamurti: In 2012, the Food and Drug Administration Safety and Innovation Act became law. As part of this law, FDA can assign drugs the “breakthrough” designation. Breakthrough drugs are drugs that are intended to treat a serious or life threatening condition and have shown preliminary evidence of a substantial improvement over existing therapies on at least one one clinically significant endpoint. These clinical endpoints can be surrogate outcomes and don’t have to be a direct outcome of the disease. All FDA press releases announcing approval of breakthrough-designated drugs use the term “breakthrough” and about half use the term “promising” when describing the drugs. Our study randomly assigned participants to read 1 of 5 short descriptions of a recently approved drug. These vignettes differed by the term assigned to the drug (e.g. “breakthrough” or “promising”) or by whether the basis for the designation was clearly and succinctly explained in the description. We found that using the terms “breakthrough” and “promising” to describe these drugs resulted in people having unwarranted confidence about the effectiveness of breakthrough drugs, which could prevent them from making a fully informed decision about whether to take the drug or not. The influence of these terms on peoples’ judgments was mitigated by explaining the regulatory meaning of the drug’s approval (which is required in the drug’s professional label, but not in public discourse about the drug).






• Dr. Krishnamurti: In communicating about breakthrough drugs, clinicians should carefully examine and clearly communicate the basis for approval for these drugs, being aware that the designation “breakthrough” should not be interpreted in the colloquial sense.






• Dr. Krishnamurti: Future research should focus on determining the most effective ways to communicate with the public about how various drugs are approved, including the strength of the clinical evidence on which these approvals are made, so that both physicians and patients can confidently make informed decisions about treatment.

• Citation:• Ross JS, Redberg RF. Would a Breakthrough Therapy by Any

Other Name Be as Promising?. JAMA Intern Med. Published online September 21, 2015. doi:10.1001/jamainternmed.2015.5311.



medicalresearch.com medical research news and interviews september 26 2015

Health & Medicine