Newswise — ANN ARBOR, Mich. – For medical student Katie Goldrath, the first time delivering difficult health news came when she had to tell a young woman named Robin and her mom, Delmy, that Robin had leukemia. As she broke the news, Goldrath was conscious of not only her words but also her body language: Was she leaning in, looking the patient in the eye and expressing empathy? The conversation, though, was just for practice. Robin and Delmy were virtual humans on a computer screen — lifelike beings that are intelligent and conversational and have the capacity to interact using a wide range of communication behaviors shared in typical face-to-face dialogue. Such intuitive interactions could help aspiring doctors better prepare for difficult and emotionally charged encounters with patients and hospital colleagues, according to a study recently published by researchers from Medical Cyberworlds Inc. and the University of Michigan in the international journal Patient Education and Counseling. “Communication is the most important part of the doctor-patient relationship,” says lead author Frederick Kron, M.D., adjunct research faculty in the department of family medicine at the U-M Medical School and founder of Medical Cyberworlds, the company that developed the virtual reality program. “We found that virtual human simulation was an engaging and effective tool to teach medical students advanced communication skills and, very importantly, that skills in the simulation transferred into a more realistic clinical situation.” Research shows that poor clinician communication skills may contribute to lower levels of patient satisfaction, poorer health outcomes, and higher risk of complaints and malpractice claims. Poor communication is consistently among the most frequently identified root causes for sentinel events in hospital settings — events that can lead to preventable patient harm or even death. “Finding an effective way to assess and teach advanced health care communication skills has been a long-standing challenge,” says co-author and U-M family medicine professor Michael Fetters, M.D. “Medical learners have a great need for practical, innovative methods to help them master the complexities of health care communication and develop excellent communication skills — both verbal and nonverbal. Ours is the first-ever research showing that it can be done effectively with virtual reality.” Researchers addressed this challenge using revolutionary virtual human technology called MPathic-VR. This Medical Cyberworlds application allows learners to talk with emotive, computer-based virtual humans who can see, hear and react to them in real time. The virtual humans use a full range of behaviors expected between two people talking together. The system assesses learners’ body language, facial expressions and communication strategies, then uses this information to produce real-time responses from the virtual human and provide personalized suggestions based on the learners’ strengths or weaknesses. Learners also see their interactions with the virtual human on video, then get the chance to apply what they’ve learned. The carefully designed structure of the learning experience, including the repeat interactions, improved the students’ communication skills, the findings suggest. Virtual practice, real benefits The study was conducted among 421 students at three U.S. medical schools. Half the group used virtual reality, half used more traditional computer-based learning. Goldrath, now in her fourth year of medical school at Michigan, says she benefited from the opportunity to practice scenarios in virtual reality, and the video feedback helped her understand how others might perceive her role and reactions. “Many times, patients don’t initially absorb a doctor’s explanations because of shock, denial, fear or other emotions,” she says. “Factors like whether the doctor was standing over you or leaning in to comfort you, or whether he or she read from a piece of paper or looked you in the eye, leave a lasting impact on the patient. These actions represent to the patient what kind of support system the provider will be to him or her during these difficult times.” Current teaching methods typically include small groups of learners and focus on role-playing with each other or with simulated patients. But this method, the study’s authors note, is very resource intensive, and different trainers may lead to discrepancies between groups. Improving outcomes As part of the study, students also practiced their interprofessional communication to learn the importance of effective dialogue on health care teams. In that scenario, learners had to manage an interaction with a virtual oncology nurse who was angry that the student inadvertently omitted her from a family meeting with a patient she was caring for. The virtual human communication system underscores the value of clear dialogue between and across health care teams in providing safe, effective patient care, the authors say. “Health care has long needed innovative learning methods to better engage students in constructing knowledge and produce better learning outcomes,” says research collaborator Tim Guetterman, Ph.D., of U-M Family Medicine. “We are hopeful that, through our work, we have taken a significant step in that direction.” Disclosures: Frederick Kron serves as president and Michael Fetters has stock options in Medical Cyberworlds Inc., the entity receiving grant funds for this project.
Newswise — Johns Hopkins researchers report that an analysis of survey responses and health records of more than 10,000 American adults for nearly 20 years suggests a “synergistic” link between exercise and good vitamin D levels in reducing the risk of heart attacks and strokes. Both exercise and adequate vitamin D have long been implicated in reducing heart disease risks, but in a new study — one not designed to show cause and effect — the researchers investigated the relationship between these two health factors and their joint role in heart health. Their findings, which were published in the April 1 issue of The Journal of Clinical Endocrinology & Metabolism, identified a positive and direct relationship between exercise and vitamin D levels in the blood, which may provide evidence that exercise may boost vitamin D stores. They also found that the two factors working together seemed to somehow do more than either factor alone to protect the cardiovascular system. The researchers caution that their study is an observational one and that long-term, carefully controlled clinical trials would be needed to establish evidence for cause and effect. Nevertheless, the study does support the notion that exposure to the “sunshine” vitamin D and exercise are indicators of good health. “In our study, both failure to meet the recommended physical activity levels and having vitamin D deficiency were very common” says Erin Michos, M.D., M.H.S., associate director of preventive cardiology and associate professor of medicine at the Ciccarone Center for the Prevention of Heart Disease at the Johns Hopkins University School of Medicine. “The bottom line is we need to encourage people to move more in the name of heart health.” Michos adds that exposure to a few minutes a day of sunlight in non-winter seasons, eating a well-balanced meal that includes oily fish such as salmon, along with fortified foods like cereal and milk, may be enough to provide adequate levels of vitamin D for most adults. For their data analysis, the Johns Hopkins researchers used previously gathered information from the federally funded Atherosclerosis Risk in Communities study beginning in 1987 and collected from 10,342 participants initially free of heart or vascular disease. Information about participants was updated and followed until 2013, and included adults from Forsyth County, North Carolina; Jackson, Mississippi; greater Minneapolis, Minnesota; and Washington County, Maryland. The participants were an average age of 54 at the start of the study and 57 percent were women. Twenty-one percent were African-American, with the remaining participants identifying as white. In the first visit between 1987 and 1989, participants self-reported their exercise levels, which were compared to the American Heart Association recommendations of more than 150 minutes per week of moderate intensity exercise or 75 minutes per week or more of vigorous intensity. The researchers used the information to classify each participant’s exercise level as adequate, intermediate or poor. People with adequate exercise levels met the AHA’s recommendations, those with intermediate levels exercised vigorously for up to 74 minutes per week or exercised moderately for less than 149 minutes a week, and those classified as poor didn’t exercise at all. About 60 percent of the participants had inadequate exercise in the poor or intermediate categories. The researchers converted the exercise to metabolic equivalent tasks (METs), an exercise intensity scale used by cardiologists and other clinicians to assess fitness. They then calculated physical activity levels by multiplying METs by minutes per week of exercise. Reviewing data from the second study visit by each participant between 1990 and 1992, the researchers measured vitamin D levels in the blood by detecting the amount of 25-hydroxyvitamin D. Anyone with less than 20 nanograms per milliliter of 25-hydroxyvitamin D was considered deficient for vitamin D, and levels above 20 nanograms per milliliter were considered adequate. Thirty percent of participants had inadequate vitamin D levels. In the first part of their study, the Johns Hopkins team showed that exercise levels positively corresponded to vitamin D levels in a direct relationship, meaning that the more one exercised, the higher their vitamin D levels seemed. For example, people with adequate exercise had an average 25-hydroxyvitamin D level of 26.6 nanograms per milliliter, those with intermediate exercise had 24.4 nanograms per milliliter, and those with poor exercise had 22.7 nanograms per milliliter. Those meeting recommended levels of exercise at visit 1 had a 31 percent lower risk of being vitamin D deficient at visit 2. Yet, the researchers only saw such a positive relationship between exercise and vitamin D in whites and not African-Americans. In the next part of the study, they found that the most active participants with the highest vitamin D levels had the lowest risk for future cardiovascular disease. Over the 19 years of the study, 1800 adverse cardiac events occurred, including heart attack, stroke or death due to heart disease or stroke. After adjusting the data for age, sex, race, education, smoking, alcohol use, blood pressure, diabetes, high blood pressure medication, cholesterol levels, statin use and body mass index, the researchers found that those people who met both the recommended activity levels and had vitamin D levels above 20 nanograms per milliliter experienced about a 23 percent less chance of having an adverse cardiovascular event than those people with poor physical activity who were deficient for vitamin D. On the other hand, people who had adequate exercise but were vitamin D deficient didn’t have a reduced risk of an adverse event. In other words, the combined benefit of having adequate vitamin D and exercise levels was better than either health factor alone. But Michos says that sun exposure may not be the whole story of the direct relationship found between exercise and vitamin D levels, since vitamin D produced by the skin after exposure to sunlight tends to level off when the body makes enough, and the levels in these participants didn’t show signs of doing so. She says this points to evidence that there may be something else going on in the body that causes vitamin D and exercise to positively influence levels of each other. For example, people who exercise may also have other healthy habits that influence vitamin D levels such as lower body fat and a healthier diet. Alternatively, people who exercise may take more vitamin supplements. As for the racial disparity they saw, this could mean promoting physical activity may not be as effective for raising vitamin D levels in African-Americans as in whites. Michos notes that people with darker skin produce vitamin D less efficiently after sun exposure, possibly due to the greater amount of melanin pigment, which acts as a natural sunscreen. African-Americans also tend to have lower levels of 25-hydroxyvitamin D overall but they don’t seem to experience the same consequences, such as bone fractures, that whites have with similarly low levels. Michos cautions that people who meet the recommended daily amount of 600 to 800 International Units a day and who have adequate levels of vitamin D don’t need to take additional vitamin supplements. “More isn’t necessarily better once your blood levels are above 20 nanograms per milliliter,” says Michos. “People at risk of bone diseases, have seasonal depression, or are obese should have their physicians measure vitamin D levels to ensure they’re adequate, but for many, the best way to ensure adequate blood levels of the vitamin is from sun exposure, healthy diet, being active and maintaining a normal body weight.” She adds, “Just 15 minutes of sunlight in the summer produces about 3000 international units of vitamin D depending on latitude and skin pigmentation, which is equivalent to 30 glasses of milk. Just be sure to use sunscreen if you plan to be outside longer than 15 minutes.” While the health boost from regular physical activity is undisputed, the benefits of vitamin D supplements haven’t yet been proven for heart health. Michos notes that a recent randomized clinical trial published in JAMA Cardiology failed to show any cardiovascular benefit with high-doses of monthly vitamin D supplements among participants living in New Zealand. She says that larger studies including more diverse populations of patients and different dosing regimens are currently on-going and, when published, will provide further insight and guide recommendations for patients. Additional authors of the study included Kathleen Chin, Di Zhao, Martin Tibuakuu, Seth Martin, Chiadi Ndumele, Roberta Florido and Eliseo Guallar of The Johns Hopkins University; Gwen Windham of the University of Mississippi Medical Center; and Pamela Lutsey of the University of Minnesota. The study was funded by grants from the National Institute of Neurological Disorders and Stroke (R01 NS072243), the National Heart, Lung, and Blood Institute (R01 HL103706 and R01 HL103706-S1), and the Blumenthal Scholars Fund. The ARIC study was funded by contracts from the NHLBI (HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C and HHSN268201100012C). Martin receives research funding from the Aetna Foundation and Google and consulted for Abbott Nutrition, Pressed Juicery and Quest Diagnostics. He holds a patent for a new way of measuring cholesterol. Michos has participated in a Siemens Healthcare Diagnostics trial.
Newswise — The U.S. Preventive Services Task Force issued recommendations earlier this month that change its stance on prostate screenings, suggesting that men have conversations about it with their doctors. The task force, made up mostly of primary care and family physicians, uses evidence to provide grading assessments for different types of screening modalities. Since 2012, the group has said there is no need for men to have a blood test that screens the level of PSA – prostate-specific antigen – in the blood. “The rationale was that we were picking up cancers of the prostate that were insignificant – ones you would die with rather than from – and possibly treating people unnecessarily,” said Dr. Jay Raman, chief of the Division of Urology at Penn State Health Milton S. Hershey Medical Center. Now, the task force recognizes that such a blanket statement for all ages may keep men for whom the disease is curable from catching it at the early stages. “When people began looking at statewide and national statistics, they started finding greater reported rates of metastasis – the disease spreading outside the prostate,” Raman said. “Once that happens, it’s more likely you could end up dying of your cancer.” The new guidelines recommend that men aged 55 to 69 with no signs of prostate cancer have a conversation with their doctor about the benefits and drawbacks of screening for the disease. The screening typically involves two parts – a blood test to determine the level of PSA in the body, and a rectal examination to feel for lumps, bumps or abnormalities. “Neither is perfect, but they complement each other,” Raman said. “Part of the challenge for clinicians is to figure out if the combination of the exam and PSA results is concerning enough to go down the road to investigate for cancer.” Because the prostate gets bigger as a man ages, the amount of PSA in the blood that is considered normal increases with age. For instance, a PSA of 5 may not be an issue for a 70-year-old, but it may be for a 55-year-old. The task force still recommends against the screenings for men age 70 and older, although other organizations such as the American Urological Association suggest screening discussions in this age cohort if the person has an anticipated life expectancy of more than 10 years. “This provides some standardized guidelines in a reasonable and measured manner,” Raman said. “Rather than not screening anyone, we should determine who the people are that need screening, diagnose and potentially treat those who need it, and monitor those whose cancers can be safely followed.” Raman is also pleased that the new draft recommendations have been opened up for feedback from urologists and others who treat prostate cancer. “One big criticism of the 2012 recommendation was that it was crafted almost exclusively by physicians who do not treat prostate cancer,” he said. “The current USPSTF statement appropriately includes some prostate cancer specialists which creates a reasonable balance for the panel.” The Medical Minute is a weekly health news feature produced by Penn State Health Milton S. Hershey Medical Center. Articles feature the expertise of faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.
Newswise — Chicago – Have you ever wondered why you keep eating certain foods, even if you know they are not good for you? Gene variants that affect the way our brain works may be the reason, according to a new study. The new research could lead to new strategies to empower people to enjoy and stick to their optimal diets. Silvia Berciano, a predoctoral fellow at the Universidad Autonoma de Madrid, will present the new findings at the American Society for Nutrition Scientific Sessions and annual meeting during the Experimental Biology 2017 meeting, to be held April 22–26 in Chicago. “Most people have a hard time modifying their dietary habits, even if they know it is in their best interest,” said Berciano. “This is because our food preferences and ability to work toward goals or follow plans affect what we eat and our ability to stick with diet changes. Ours is the first study describing how brain genes affect food intake and dietary preferences in a group of healthy people.” Although previous research has identified genes involved with behaviors seen in eating disorders such as anorexia or bulimia, little is known about how natural variation in these genes could affect eating behaviors in healthy people. Gene variation is a result of subtle DNA differences among individuals that make each person unique. For the new study, the researchers analyzed the genetics of 818 men and women of European ancestry and gathered information about their diet using a questionnaire. The researchers found that the genes they studied did play a significant role in a person’s food choices and dietary habits. For example, higher chocolate intake and a larger waist size was associated with certain forms of the oxytocin receptor gene, and an obesity-associated gene played a role in vegetable and fiber intake. They also observed that certain genes were involved in salt and fat intake. The new findings could be used to inform precision-medicine approaches that help minimize a person’s risk for common diseases—such as diabetes, cardiovascular disease and cancer—by tailoring diet-based prevention and therapy to the specific needs of an individual. “The knowledge gained through our study will pave the way to better understanding of eating behavior and facilitate the design of personalized dietary advice that will be more amenable to the individual, resulting in better compliance and more successful outcomes,” said Berciano. The researchers plan to perform similar investigations in other groups of people with different characteristics and ethnicities to better understand the applicability and potential impact of these findings. They also want to investigate whether the identified genetic variants associated with food intake are linked to increased risks for disease or health problems. Silvia Berciano will present this research at 5–7 p.m. Saturday, April 22, in Hall F Swing Space, McCormick Place Convention Center (poster D151 996.2) and during the Nutrigenomics and Personalized Nutrition Session at 10:30-12:30 p.m. Monday, April 24, in Center Room S103BC (abstract). Contact the media team for more information or to obtain a free press pass to attend the meeting. Image available. About Experimental Biology 2017 Experimental Biology is an annual meeting comprised of more than 14,000 scientists and exhibitors from six host societies and multiple guest societies. With a mission to share the newest scientific concepts and research findings shaping clinical advances, the meeting offers an unparalleled opportunity for exchange among scientists from across the United States and the world who represent dozens of scientific areas, from laboratory to translational to clinical research. www.experimentalbiology.org #expbio About the American Society for Nutrition (ASN) ASN is the preeminent professional organization for nutrition research scientists and clinicians around the world. Founded in 1928, the society brings together the top nutrition researchers, medical practitioners, policy makers and industry leaders to advance our knowledge and application of nutrition. ASN publishes three peer-reviewed journals and provides education and professional development opportunities to advance nutrition research, practice and education. www.nutrition.org Find more news briefs and tipsheets at: https://www.eurekalert.org/meetings/eb/2017/newsroom. ### SEE ORIGINAL STUDY
Newswise — Chicago – A new study finds that carvedilol, a drug typically used to treat high blood pressure, can protect against the sun-induced cell damage that leads to skin cancer. Researchers serendipitously discovered the beta blocker’s cancer-fighting properties after making an error in the lab. Sherry Liang, a graduate student at the Western University of Health Sciences College of Pharmacy, will present the new findings at the American Society for Pharmacology and Experimental Therapeutics annual meeting during the Experimental Biology 2017 meeting, to be held April 22-26 in Chicago. “What began as an experimental error led to a very interesting scientific discovery,” said Ying Huang, PhD, coleader of the research team with Bradley T. Andresen, PhD. “Our research could lead to the development of a class of new cancer-preventive agents.” Carvedilol’s cancer-fighting properties were discovered when a former graduate student in Huang’s lab was studying whether carvedilol and similar beta blockers might increase cancer risk. The student inadvertently tested carvedilol’s anticancer effect rather than its ability to promote cancer, finding that carvedilol surprisingly showed some protective effects against skin cancer. The researchers then conducted experiments with cell cultures and mice to see if carvedilol could prevent skin cancer caused by ultraviolet-B (UVB), the portion of sunlight that tends to damage the skin's top epidermal layers and plays a key role in skin cancer development. The researchers found that carvedilol exhibited a protective effect in cultured mouse skin cells exposed to UVB and in hairless mice given the drug after UVB exposure. The experiments showed that carvedilol acted by protecting cells against the cancer-causing DNA damage and cell death produced by UVB. Hairless mice exposed to UVB and given carvedilol showed decreases in both the severity and number of tumors that developed compared to those not given carvedilol. The mouse studies also showed that carvedilol delayed skin tumor formation more than sunscreen. The researchers also discovered that not all beta blockers show cancer preventive properties, indicating that the cancer-fighting beta blockers likely act on not yet identified molecules. “We have preliminary data indicating that the cellular targets for carvedilol are not related to the beta-adrenergic receptors that are the commonly accepted targets for all beta blockers,” said Andresen. “They likely target unexpected mechanisms involved in cancer development.” The researchers aim to incorporate carvedilol or similar beta blockers into a skin cream or spray that could hopefully be used to prevent skin cancer arising from UV light exposure. The treatment would act on the skin without affecting blood pressure and heart rate, which are commonly altered by beta blockers. Understanding carvedilol’s mechanisms of action could also allow scientists to design completely new treatments that target these mechanisms without introducing any cardiovascular effects. Sherry Liang will present the findings at 12:30–2:30 p.m. Tuesday, April 25, in Hall F, McCormick Place Convention Center (poster D151 996.2) (abstract). Another poster from the same group will be presented at 12:30–2:30 p.m. Sunday, April 23, in Hall F, McCormick Place Convention Center (poster D146 671.13) (abstract). Contact the media team for more information or to obtain a free press pass to attend the meeting. Video available. About Experimental Biology 2017 Experimental Biology is an annual meeting comprised of more than 14,000 scientists and exhibitors from six host societies and multiple guest societies. With a mission to share the newest scientific concepts and research findings shaping clinical advances, the meeting offers an unparalleled opportunity for exchange among scientists from across the United States and the world who represent dozens of scientific areas, from laboratory to translational to clinical research. www.experimentalbiology.org #expbio About the American Society for Pharmacology and Experimental Therapeutics (ASPET) ASPET is a 5,100 member scientific society whose members conduct basic and clinical pharmacological research within the academic, industrial and government sectors. Our members discover and develop new medicines and therapeutic agents that fight existing and emerging diseases, as well as increase our knowledge regarding how therapeutics affects humans. www.aspet.org Find more news briefs and tipsheets at: https://www.eurekalert.org/meetings/eb/2017/newsroom ### SEE ORIGINAL STUDY
Newswise — Conservation projects that protect forests and encourage a diversity of plants and animals can provide many benefits to humans. But improved human health is not among those benefits ― at least when health is measured through the lens of infectious disease. That's the main finding of a paper published April 24 in Philosophical Transactions of the Royal Society B, which analyzed the relationship between infectious diseases and their environmental, demographic and economic drivers in dozens of countries over 20 years. The new study found that increased biodiversity ― measured as the number of species and amount of forested land ― was not associated with reduced levels of infectious disease. In some cases, disease burdens actually increased as areas became more forested over time. "There are a lot of great reasons for conservation, but control of infectious disease isn't one of them," said lead author and parasite ecologist Chelsea Wood, an assistant professor in the School of Aquatic and Fishery Sciences at the University of Washington. "We're not going to improve public health by pushing a single button. This study clearly shows that ― at the country level ― conservation is not a disease-control tool." Surprisingly, Wood said, the study also found that increasing urbanization reduced disease, probably because cities bring people closer to medical care and give them greater access to vaccinations, clean water and sanitation. Even though cities crowd people together, the net benefit of their services results in reductions of infectious disease. "It seems pretty clear that urbanization is good for people's health ― at least when it comes to infectious disease. And that's good news, because the world is rapidly urbanizing," Wood said. The researchers relied on the UW-based Institute for Health Metrics and Evaluation's Global Burden of Disease database, a massive, worldwide effort to document premature death and disability from hundreds of diseases and injuries from 1990 to the present. The study's authors compared data on 24 infectious diseases ― ranging from malaria, dengue and rabies to typhoid, tuberculosis and leprosy ― with separate, published data on population density, wealth, bird and mammal species richness, forest cover, precipitation and other environmental measures to analyze the effects these factors had, if any, on disease burden per country. This study is the first to look at the association between biodiversity and disease over time. Most conservation decisions are made at the country level, so the researchers focused at that scale when analyzing whether conservation could be used as a tool for improving public health. Over the 20-year period, they saw no relationship between biodiversity (number of species present) and the overall burden of infectious disease. But for each individual disease, there was a unique set of drivers that were important in deciding whether burden increased or decreased over time. For example, as rates of precipitation went up, so did the burden of "geohelminths" ― a group of gut parasites that includes hookworm, whipworm and roundworm. Together, the geohelminths affect 1.5 billion people. Moist soil is an ideal environment for the development of these worms. Humans can become infected when they contact or accidentally ingest contaminated soil ― for example, on unwashed vegetables. As rates of precipitation increase with climate change, this public health threat should be acknowledged and accounted for, the researchers said. The authors hope the disease-specific information included in this study reveals pathways toward effective control, and helps country officials to avoid inadvertently exacerbating existing public health problems. "I hope this study encourages people to explicitly acknowledge the potential disease-related risks and benefits of conservation projects," Wood said. "The absolute last thing we want to do is a conservation project that gets people sick." This paper is the concluding piece in an entire special edition dedicated to exploring whether conservation promotes or hinders infectious disease control. The edition's co-authors convened about two years ago to explore all sides of this controversial question, and the resulting papers examine specific diseases such as malaria, Lyme disease and schistosomiasis, as well as broader topics of policy and economics. "The special issue arose from an interest in moving away from the very heated but some somewhat academic debate about the influence of 'biodiversity' on disease prevalence, to the more practical question about the efficacy of conservation action as a public health intervention strategy, particularly as compared to other intervention strategies," said paper co-author Hillary Young of the University of California, Santa Barbara, who is also an editor for the special edition. Other co-authors are Alex McInturff of the University of California, Berkeley; DoHyung Kim of the University of Maryland; and Kevin Lafferty of the U.S. Geological Survey. This study was supported by the Michigan Society of Fellows and the Department of Ecology and Evolutionary Biology at the University of Michigan, along with funding from the authors' institutions and agencies. ###
Newswise — Bhoomi Manjunatha, 5, has been able to rely less on her walker and wheelchair, and more on her own two feet, because of a surgery performed at Nationwide Children’s Hospital. Her hard work and determination in physical and occupational therapy post-surgery has also helped Bhoomi continue to make strides. Bhoomi was born with cerebral palsy and spasticity, a muscle control disorder that involves tight or stiff muscles and the inability to control those muscles. Spasticity affects more than 12 million people worldwide, including 80 percent of people with cerebral palsy. The spinal surgery Bhoomi had in January, called selective dorsal rhizotomy, was performed by Jeffrey R. Leonard, MD, chief of Neurosurgery at Nationwide Children’s. In the operating room, the surgery team anatomically divided out dorsal nerve roots which control the sensory portion of the spinal cord. They stimulate them electronically to determine which rootlets were abnormal and section about 60 percent of the feedback to prevent the tightening and stiffness that Bhoomi experienced. “The surgery went well, but my part is easy. It is Bhoomi who has months of hard work and therapy ahead of her to strengthen her muscles to take advantage of her newfound mobility,” said Dr. Leonard, who is also a faculty member at The Ohio State University College of Medicine. “Without a multidisciplinary team of inpatient rehabilitation, outpatient physical therapy and occupational therapy working together, the benefits of rhizotomy would not materialize.” Bhoomi is now four months post-surgery and the clinical team continues to work with her and collect data. So far, her walking has progressed, she has less pain and Dr. Leonard predicts her posture will improve and that she will require less orthopedic procedures in the future. “Bhoomi is bright and energetic, you can see that from her smile. She is motivated and did everything that the therapist asked of her, working really hard in rehabilitation,” said Dr. Leonard. “I think she is going to be dramatically effected in a very positive manner after having undergone the rhizotomy.” Dr. Leonard says there is data for different treatment options for spasticity: orthopedic procedure, therapy alone, pump placement and rhizotomy. However, there are very few studies that have compared them, so he discusses with the family what is available, what has been studied and where the limitations in the data exist to determine what the best treatment options are for each individual patient. Dr. Leonard’s team is currently collecting more information to help fill the gap in data. At Nationwide Children’s, every child diagnosed with a condition requiring neurosurgical expertise is handled with an individualized treatment plan. Children with spasticity must be screened and tested to determine if they are a candidate for rhizotomy. Request an appointment here.
Newswise — Medical complications of brown recluse spider bites are uncommon but they can be severe, particularly in children, researchers at Vanderbilt University Medical Center (VUMC) reported today. The hallmark sign of a brown recluse spider bite is a painful, blistering skin lesion. In rare cases the bite also can cause a severe illness called systemic loxoscelism, characterized by a blood clotting disorder and hemolysis, destruction of red blood cells. Patients presenting with these symptoms often don’t know they were bitten. But loxoscelism should be suspected, particularly if patients live in parts of the Southeast and Midwest where the spiders thrive and especially if they are children, the researchers concluded. “Children are much more likely to develop this systemic syndrome,” said Vanderbilt hematologist Jeremy Warner, M.D., M.S., senior author of the report published in PLOS ONE, a journal of the Public Library of Science. In severe cases, treatment may require hospitalization, blood transfusions and other supportive measures. African-Americans also may be at higher risk, said Warner, assistant professor of Medicine and Biomedical Informatics in the Vanderbilt University School of Medicine. “We were inspired to carry out this analysis after treating a patient with a particularly striking episode of hemolysis several days after a brown recluse spider bite,” he said. “He lost literally half of his blood supply over the course of 24 hours but was ultimately OK.” Warner, who is from New England, had never seen a case of systemic loxoscelism before. The vulnerability of children to the venom of the brown recluse spider was picked up during a review of more than 2.4 million patient records stored electronically at VUMC between 1995 and 2015 and de-linked from personal identifying information. Called the Synthetic Derivative, the vast database allows researchers to search for phenotypes – clinical descriptions, lab measures, demographic and environmental characteristics – that are common to patients with the same diagnosis. Led by first author Jamie Robinson, M.D., a General Surgery resident and post-graduate fellow in Biomedical Informatics, the researchers used this approach to identify 57 patients – the largest cohort of individuals with moderate to severe loxoscelism ever reported. Only a third of the patients knew they’d been bitten. It may be possible to use phenotypes to pick out patients who don’t know they’ve been bitten and have not been formally diagnosed. In this way, Warner said, the study advances the goal of personalized medicine, to diagnose conditions earlier and provide the most effective treatment based on patients’ genetic and phenotypic characteristics. Contributing to the study was Joshua Denny, M.D., M.S., professor of Biomedical Informatics and director of the Data and Research Support Center of the National Institutes of Health All of Us Research Program, formerly known as the Precision Medicine Initiative Cohort Program. Other co-authors were Vanessa Kennedy, M.D., Youssef Doss and Lisa Bastarache.
Newswise — It has been shown that both heavy and occasional drinking among the general population are linked to eating less fruits and vegetables, and eating more processed and fried meat. This is particularly worrisome for pregnant women, as both drinking and inadequate nutrition can have adverse consequences for the fetus. This study investigated links between maternal diet and drinking during pregnancy. Researchers analyzed data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a study of pregnant women from west England and the children born to them. The women (n=9,839) provided information about drinking at 18 weeks gestation and diet at 32 weeks gestation. The researchers examined associations between drinking and dietary patterns in this sample. There were two key findings: one, eating more processed foods was associated with heavier drinking; and two, healthier dietary choices that included fruit, vegetables, whole grains, and fish were associated with light to moderate drinking. Study authors suggest that the joint consequences of these behaviors have implications for both maternal and fetal health. SEE ORIGINAL STUDY
Newswise — Princeton, NJ— Value in Health, the official journal of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), announced today the publication of new research indicating that testing for variants in 7 cancer-associated genes (versus the usual process of testing in just 2 genes) followed by risk-reduction management could cost-effectively improve life expectancy for women at risk of hereditary breast cancer. The report of these findings, A Multigene Test Could Cost-Effectively Help Extend Life Expectancy for Women at Risk of Hereditary Breast Cancer, was published in the April 2017 issue. Using hypothetical cohorts of women at risk of hereditary breast cancer, the authors used a decision-analytic model to compare the relative cost and effectiveness of two test strategies for detecting pathogenic genetic variants: 1) the usual BRCA1/2 test strategy, and 2) a next-generation 7-gene strategy that tests for variants not only in BRCA1 and BRCA2, but also in TP53, PTEN, CDH1, STK11, and PALB2. The authors then used these test results to select appropriate breast cancer risk reduction treatments / therapies. In the base-case scenario for 50- and 40-year-old women undergoing genetic testing, the incremental cost-effectiveness ratio (ICER) for the 7-gene test strategy compared with the BRCA1/2 test strategy was $42,067 and $23,734 per life-year gained, or $69,920 and $48,328 per quality-adjusted life-year gained, respectively. At these ICER levels, the 7-gene test strategy would be considered cost effective according to the World Health Organization guidelines. “Pathogenic variants in the BRCA1 and BRCA2 genes explain only about 15% of the breast cancer familial relative risk,” said lead author Yonghong Li, PhD, Quest Diagnostics, USA, “while pathogenic variants in other genes, including TP53, PTEN, CDH1, and PALB2 contribute further to the familial relative risk. The results of this study,” Dr. Li added, “demonstrate the potential value of newer testing options that allow for the simultaneous analysis of expanded panels of additional genes whose pathogenic variants confer moderate to high risk for breast cancer.” ###