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Dr. Midya Vishal Midya, PhD, MStat Postdoctoral Researcher Icahn School of Medicine at Mount Sinai  MedicalResearch.com:  What is the background for this study?    Response: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in children in the U.S., Europe and other world regions, currently affecting 1 in every 10 children, and 1 in every 3 children with obesity in the U.S. The rate of pediatric NAFLD has more than doubled in recent decades following the epidemic rates also noted for childhood obesity. There is increasing interest in the role that environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals (EDCs) cause liver injury and damage; but, until now, the potential effects of prenatal EDC mixture exposures in pediatric NAFLD had not been studied. MedicalResearch.com:  What are the main findings? Response: In this study, we measured 45 chemicals in the blood or urine from 1,108 pregnant women from six European countries and found that maternal exposure to several environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals commonly used in consumer and industrial products increases risk for NAFLD in the child. Environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals are known to interfere with the hormone systems and pass through the placenta from the mother to the fetus altering fetal programming and development. Examples of chemicals we investigated include perfluoroalkyl substances (PFAS), also known as “forever chemicals”, used in nonstick cookware and food packaging, and polybrominated diphenyl ethers (PBDEs) used as flame retardants in furniture and infant products. Other chemical classes we studied include pesticides, plastics, and toxic metals. When the children reached the ages of 6 to 11 years old, we measured the levels of liver enzymes and cytokeratin-18 that indicate risk for NAFLD in the children’s blood, finding elevated levels of those biomarkers in children who had been more highly exposed to environmental chemicals, and especially to persistent organochlorine pesticides, PFAS, PBDEs, and metals, during pregnancy. MedicalResearch.com: What should readers take away from your report? Response: It is important to be aware of the health risks that endocrine-disrupting chemicals pose for the mother and the developing fetus and possible ways to avoid these exposures. Some effective ways in reducing exposure to EDCs in pregnancy and early childhood include avoiding the use of products that contain them, such as plastic containers, bottles, packaging and toys, canned food and beverages, fast/processed foods, non-stick cookware, pesticides and cosmetics, and consuming fresh and organic foods whenever possible. However, EDCs are ubiquitous in consumer products and the environment, and there are many sources of exposure that are beyond the control of individuals. Therefore, policy changes are sorely needed, such as banning the use of EDCs in consumer products and requiring companies to disclose what chemicals are in a product. This would let consumers make informed choices for their health. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: NAFLD is now diagnosed in children as young as 2 years of age, and NAFLD in childhood is associated with increased risk for severe chronic liver disease later in adulthood. We need more research and longitudinal studies to elucidate the potential effects of early life EDC exposures on pediatric NAFLD and its progression to more severe liver diseases such as non-alcoholic steatohepatitis (NASH), liver cirrhosis and liver cancer. We also need further research to understand how environmental chemical exposures may interact with our genes, diet and social factors in the development of pediatric liver disease. This information will be informative in designing more effective early life prevention and intervention strategies to reverse the current NAFLD epidemic in children and subsequently adults in the future. MedicalResearch.com: Is there anything else you would like to add?  Response: We are deeply grateful to all researchers and research staff of the HELIX consortium and all the participating families in the HELIX cohorts. This study was funded by the U.S. National Institute of Environmental Health Sciences (NIEHS) and the European Community’s Seventh Framework Programme. Citation Midya V, Colicino E, Conti DV, et al. Association of Prenatal Exposure to Endocrine-Disrupting Chemicals With Liver Injury in Children. JAMA Netw Open. 2022;5(7):e2220176. doi:10.1001/jamanetworkopen.2022.20176     The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Ahmad Sumayya Ahmad, MD Assistant Professor of Ophthalmology Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: The cornea is usually curved like a basketball or a globe. Roughly all of the edges are about equal distant from the center. With this shape, light enters the eye normally and the image is not distorted.  However, not all eyes are shaped that way. About 30% of eyes have  astigmatism, in which the cornea is shaped like a football, or elongated in one axis. If the longest diameter is up and down, we call that with the rule astigmatism, and if it is to the side, we call that against-the rule astigmatism. A lot of studies have been devoted to astigmatism over the years, but nobody has looked at it from a population perspective in the United States and tried to figure out the relationships it may have. Most studies are from one center or other country's databases, but not ours. The National Health and Nutrition Examination Survey, or NHANES, is a survey composed in the United States each year that looks at a representative sample of people from across the country. It's a great way to study the relationship between the environment and people. We tried to look at demographic factors (like age, gender, race) and ocular factors related to against and with the rule astigmatism. MedicalResearch.com: What are the main findings? Response: We found that with the rule (WTR) astigmatism decreased iwih age, and against the rule increased with age. There were higher odds of being WTR for females (1.39), Mexican Americans (1.79), college graduates (1.48) compared to male, non-hispanic whites with less than a 9th grade education. Myopic patients (or near sighted patients)  had higher odds (1.53) of having WTR astigmatism than people who did not have far or near-sightedness.   MedicalResearch.com: What should readers take away from your report? Response: There are clear differences in astigmatism between groups of people, and it's not clear why. We have speculations as to why these trends exist, but because we looked at a general population, it is difficult to extrapolate these results to individual people. However, it is useful for a cataract surgeon to know that, for instance, women tend to have more WTR astigmatism than men and tend to have it for longer during their lives.  This could affect  surgical planning for patients receiving cataract surgery.   MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: We hope that this study will shed some light into trends of astigmatism and ultimately help ophthalmologists and vision researchers to optimize results for patients getting cataract surgery. Thank you for the opportunity to present my research! Citations: Characterizing Astigmatism in the U.S. Population  AAO 2019 Abstract Sumayya Ahmad, MD,Assistant Professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai 9am Saturday – 1pm Tuesday, Poster 0335, Location E-poster and video terminals Abstract: Purpose-To identify demographic associations with astigmatism in the United States. Methods-Keratometry and demographic data from the National Health and Nutrition Examination Survey (NHANES) from 1999-2008 was analyzed using multinomial logistic regression and adjusted for confounders. Results-With-the-rule (WTR) astigmatism decreased with age: a 20-24 year old had a 20 times higher odds of having WTR astigmatism than an 80-85 year old. Females (39%), Mexican Americans (79%) and college graduates (48%) had higher odds for having WTR compared to males and non-Hispanic whites with less than a ninth grade education. Myopes with >1.5 D sphere had a 53% higher chance of ATR than emmetropes Higher degrees of astigmatism (>1.5 D) was 48% more common in WTR patients than in ATR. Conclusion-There is a significantly higher odds of having WTR astigmatism with younger age, myopia, having lower educational status and being female. These findings require further study for mechanistic insight.   MedicalResearch.com is not a forum for the exchange of personal medical information, advice or the promotion of self-destructive behavior (e.g., eating disorders, suicide). While you may freely discuss your troubles, you should not look to the Website for information or advice on such topics. Instead, we recommend that you talk in person with a trusted medical professional. The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Moskowitz Alan J Moskowitz, MD Professor of Population Health Science and Policy Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Where do these mesenchymal cells come from?  Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery. Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients. MedicalResearch.com: What are the main findings?  Response: Although, in the overall trial population, the mean proportion of successful temporary weans from LVAD support was not significantly different between MPC and control patients, there was a signal of efficacy in a post-hoc sub-group analysis of patients whose heart failure was due to coronary ischemia. Moreover, interestingly MPCs significantly reduced the frequency of.GI bleeding, a common and potentially fatal complication (occurring in 30 to 70% in LVAD patients depending on risk factors).  MedicalResearch.com: What should readers take away from your report? Response: Mesenchymal precursor cells therapy is a potential therapeutic approach for reducing GI bleeding in LVAD patients, and for improving myocardial function in ischemic patients. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: We need to conduct a confirmatory trial that determines, with precision, the efficacy of Mesenchymal precursor cells therapy in reducing GI bleeding in LVAD patients, as well as mechanistic studies to identify the biological mechanisms associated with this effect. In addition, we need to explore whether intramyocardial MPC injections improve cardiac functional status in the high proportion of patients with ischemic cardiomyopathy.  No disclosures Citation: Yau TM, Pagani FD, Mancini DM, et al. Intramyocardial Injection of Mesenchymal Precursor Cells and Successful Temporary Weaning From Left Ventricular Assist Device Support in Patients With Advanced Heart Failure: A Randomized Clinical Trial. JAMA. 2019;321(12):1176–1186. doi:10.1001/jama.2019.2341   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Safer Joshua Safer, MD, Executive Director Center for Transgender Medicine and Surgery Mount Sinai Health System Senior Faculty, Medicine, Endocrinology, Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: The standard trans feminizing hormone regimen includes estrogen both to suppress testosterone and so that the individual has sufficient circulating sex hormone in the body for good bone health. After orchiectomy, there is no need to suppress testosterone because the levels are very low and it is common to cut the estrogen dose in half.  Cis women with premature ovarian failure often take about 2 mg of estradiol daily so that dose has seemed reasonable for trans women without testes.  However, when my co-author Sira Korpaisarn and I checked estradiol levels and gonadotropins (pituitary hormones, LH and FSH) as a guide to dosing, we found that based on that testing, trans women may require higher doses of estrogens than the 2 mg that we expected. MedicalResearch.com: What should readers take away from your report? Response: Trans women may require higher doses of estrogens than previously suspected.  Indeed cis women might benefit from more estrogen also. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: While the observation is provocative, it is hardly conclusive.  Future studies will need to ascertain both risk and actual benefit from the higher doses. No disclosures ENDO 2019 abstract: Feminizing Regimen Requirements in Transgender Females Following Orchiectomy The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Read the full article

Dr. Chen Darwin Chen, MD Assistant Professor of Orthopedic Surgery Icahn School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? What are the main findings? Response: Periprosthetic joint infection unfortunately remains a leading cause of total knee arthroplasty failure. One method of mitigating the risk of PJI is to use antibiotic loaded bone cement in a prophylactic fashion. While the use of antibiotic cement makes inherent sense, the decision is not as simple as it seems. There are potential side effects such as renal damage, antibiotic hypersensitivity, and antibiotic resistance. Antibiotics decrease the mechanical strength of cement fixation, which may impact component loosening. Additionally, antibiotic cement is significantly more expensive than standard cement, driving up cost. Currently there is no consensus on if antibiotic cement truly reduces infection risk and there are many conflicting studies. The purpose of our study is the use a large national database to evaluate real world utilization patterns of antibiotic cement, and assess outcomes, complications, and cost associated with antibiotic cement usage. Our hypothesis was that antibiotic cement is associated with a decreased risk of infection and no increased risk of systemic complications.  MedicalResearch.com: What should readers take away from your report? Response: We found that there are decreased odds of postoperative infection when antibiotic cement is used routinely in primary total knee replacement, however this is offset by increased odds of acute kidney injury. With regards to antibiotic cement usage trends nationally, overall utilization is approximately 27%. There was higher usage in medium/large size and urban hospitals. There was also non-selective usage, meaning surgeons are choosing to routinely use or not use antibiotic cement, not based on risk.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Our recommendation is for use of antibiotic cement in high risk cases, however to also consider usage in routine primary cases as long as there is no preexisting renal disease. No Disclosures  Citation: AAOS 2019 abstract Poster Presentation: Antibiotic-Loaded Bone Cement in Primary Total Knee Arthroplasty: Utilization Patterns and Impact on Complications Using a National Database Date: Tuesday, March 12th               The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article