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Newswise — Researchers from Queen’s University Belfast have shown for the first time that the eye could be a surrogate for brain degeneration like Alzheimer’s disease (AD). This research results have recently been published in the Journal of Ophthalmic Research and is the first clinical study showing a potential for peripheral retinal imaging to be used in monitoring AD and potentially other neurodegenerative diseases. The team, led by Dr Imre Lengyel, Senior Lecturer and Researcher at the School of Medicine Dentistry and Biomedical Sciences at Queen’s University have found that by examining the eye we might be able to reflect on what might be taking place in the brain. The work was carried out alongside health professionals and care providers for AD patients and explored whether there are manifestations of AD in the eye. Based on laboratory observations the team hypothesized that changes in the peripheral retina could be important to explore the association between the eye and the brain. Using ultra-wide field imaging technology developed by Optos Plc, the team found that there are indeed several changes that seems to be, especially in the peripheral retina, associated with this debilitating condition. One of the changes in the eye that the study observed was a higher than normal appearance of drusen, the yellow ‘spots’ identifiable on retinal images, in people with AD. Drusen are small deposits of fat, proteins and minerals, including calcium and phosphate deposits that form in a layer underneath the retina.  These spots are a symptom of ageing and often seen in people over 40.  A few of these deposits are harmless, but once they increase in number and size they contribute to the degeneration of the retina.  Dr Lengyel explains: “These exciting research results suggests that our original hypothesis was right and wide field eye imaging could indeed help monitoring disease progression in patients with AD.” Another significant change observed in the study was measured in the peripheral retinal blood circulation in AD. The research team found that people with AD have wider blood vessels close to the optic nerve, but these thin faster than in control subjects towards the retinal periphery. Both of these are likely to slow blood flow and impair nutrient and oxygen flow in the peripheral retina. Dr Lengyel continues: “Eye imaging is quick, simple, well tolerated and costs a fraction to that of brain scans so there are tremendous benefits to both the professional and the patient.” While peripheral retinal imaging is not a diagnostic measure for AD, the simple, quick and inexpensive monitoring of change in the eye could serve as a tool for disease progression in the brain. Professor Craig Ritchie, Professor of the Psychiatry of Ageing at the University of Edinburgh is co-author on the study.  He comments: “Changes in the eye are very easy to measure relative to other measures of brain health. “Our research team, led by Queen’s University, was able to identify early markers in people many years before dementia develops.  We have opened a window to identify high risk groups who may benefit from specific prevention advice.” To extend these observations, the research team is currently involved in several further dementia related studies. They will be examining and following patients with very early stage AD through the Deep and Frequent Phenotyping study, the world's most in depth study to detect early signs of Alzheimer's disease progression conducted in the UK. Research in Dr Lengyel’s laboratory is supported by the Medical Research Council, Economic and Social Research Council, National Institute for Health Research, and Northern Ireland Clinical Research Facility as well industrial partners Optos Plc.
Newswise — Philadelphia, June 25–-Children with known skin, food and respiratory allergies should be screened for an emerging, chronic food allergy called eosinophilic esophagitis (EoE), a painful inflammation of the esophagus, the food tube between the mouth and stomach. Pediatric allergists who analyzed a very large group of children from birth to adolescence say that EoE should be considered a later component of the “allergic march”-- the natural history in which many children successively develop a series of allergies.  “The more allergies a child has, the higher is that child’s risk of developing EoE,” said study leader David A. Hill, MD, PhD, an allergist at Children’s Hospital of Philadelphia (CHOP). “The connection among these allergies suggests a common underlying biological cause, and also may imply that if we can successfully treat an earlier type of allergy, we may prevent later allergies.”  Hill and colleagues published their study online today in the Journal of Allergy and Clinical Immunology: In Practice.  In contrast to classic, potentially life-threatening anaphylactic food allergies (e.g., to peanuts), EoE has low mortality, but high morbidity. It has slow-onset symptoms, such as pain in swallowing, reflux, stomach ache, even food impaction (in which food may become lodged in the esophagus). Both types of allergies are triggered by specific foods, but the culprit in EoE may not be obvious, and a child may need to follow a restricted diet until healthcare providers can pinpoint the offending food. EoE may be slow to manifest, sometimes misdiagnosed or persisting undiagnosed into adolescence.  The research team analyzed health records in a longitudinal cohort of over 130,000 patients in the CHOP pediatric network followed from birth to adolescence, to determine whether and when patients acquired allergic diseases. The researchers also compared the risk of developing EoE between allergic and non-allergic children.  The “allergic march,” a pillar concept in allergy, is usually compressed into the first five years of life. The typical childhood progression, said Hill, is a skin allergy, such as atopic dermatitis, followed by an anaphylactic food allergy, then a respiratory allergy, such as asthma. The current study was the first to suggest that EoE was a component of the allergic march.  “We found that if children had three allergies other than EoE, they were nine times more likely to develop EoE than children with no pre-existing allergies,” said Hill. The peak age of EoE diagnosis was 2.6 years. In addition, children with EoE had a higher risk than those without EoE of developing the respiratory allergy allergic rhinitis—commonly referred to as seasonal allergy. A key implication of the current study, said Hill, is that primary care clinicians should incorporate early EoE screening in children who have other allergies.  CHOP has been a world leader among pediatric institutions in investigating and treating EoE, which has been increasing over the past two decades, said study co-author Jonathan M. Spergel, MD, PhD. Spergel leads the hospital’s Food Allergy Center, which has just been designated a Frontier Program at CHOP, with the aim of accelerating translational research and advancing pediatric treatments.  Next steps in research, said Hill, will be to further investigate the underlying biological mechanisms among different allergies. He added, “Ultimately, we hope to find that intervening earlier in the allergic march, for example, in treating allergic skin conditions, may interrupt the march and prevent the child from developing later disorders such as EoE.”  Funding support for this research came from the National Institutes of Health (grants HD043021 and AI117804), the Food Allergy Research & Education, Inc. Clinical Network, and the Consortium of Eosinophilic Gastrointestinal Disease Researchers.  To see the CHOP Research Institute’s blog posting on this study, click here.  David A. Hill, et al, “Eosinophilic Esophagitis is a Late Manifestation of the Allergic March,” Journal of Allergy and Clinical Immunology: In Practice, online June 25, 2018. https://doi.org/10.1016/j.jaip.2018.05.010  About Children’s Hospital of Philadelphia: Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu
Newswise — Researchers at the Johns Hopkins Kimmel Cancer Center and the Bloomberg~Kimmel Institute for Cancer Immunotherapy (BKI) released a study investigating the use of combination checkpoint immunotherapy in the treatment of a lethal form of advanced prostate cancer. The study suggested a genetic subset of prostate cancer may benefit from this form of immunotherapy. The study targeted AR-V7+ prostate cancer with a combination of two checkpoint blockers, ipilimumab and nivolumab, in 15 patients with this aggressive variant, first discovered at Johns Hopkins in 2014. This is the first clinical trial to target this specific form of prostate cancer, which can kill patients in only six to nine months and has inadequate treatment options. It is the first reported study of combination immunotherapy using both ipilimumab and nivolumab in prostate cancer. The study was published by Oncotarget on June 19, 2018. “This is the first prostate cancer study to be supported by the Bloomberg~Kimmel Institute for Cancer Immunotherapy since the institute was launched and provides the first evidence that immunotherapy can indeed benefit some patients with prostate cancer, a cancer type previously thought to be completely immunotherapy resistant,” said Drew Pardoll, M.D., Ph.D., director of the BKI. Patients on the trial received treatment by IV infusion consisting of 3 milligrams per kilogram of nivolumab plus 1 milligram per kilogram of ipilimumab every three weeks for four doses, followed by a maintenance regimen of 3 milligrams per kilogram of nivolumab alone every two weeks thereafter. The patients were enrolled between December 2016 and October 2017. The data showed two out of the 15 men (13 percent) experienced a decrease in the level of prostate-specific antigen (PSA) of at least 50 percent. More encouragingly, one-quarter of patients achieved an objective response, meaning that their tumors shrank partially or completely with combination immunotherapy. These responses were typically lasted at least nine months. At least two of the patients remain alive for more than 18 months, which is much longer than expected for men with AR-V7+ prostate cancer. Six of 15 patients (40 percent) had a genetic subtype of prostate cancer that harbored somatic and/or germline mutations in one DNA-repair genes involved in the BRCA pathway, first shown to predispose women to breast and ovarian cancer. In these six men, gene mutations of BRCA2, ATM, and ERCC4 were individually detected in those patients.  “Remarkably, all of the benefit from ipilimumab plus nivolumab appeared to occur in patients who had one of these gene mutations, particularly in two men with BRCA2 mutations,” said Emmanuel Antonarakis, M.B.B.Ch., senior author of the study. “This finding is important, because BRCA2 is not a gene that was previously thought to sensitize patients to immune checkpoint inhibitors and, if true, will have profound implications for other diseases, such as breast and ovarian cancers where these genes are frequently mutated,” said Antonarakis. “In the setting of prostate cancer, about 20-25 percent of patients have mutations in BRCA2 and related genes, which are involved in a DNA-repair process called homologous recombination. This study suggests that these gene mutations may be even more common in men with the AR-V7+ type of prostate cancer.” While prostate cancer is generally regarded as a low–mutation-burden tumor and immune-checkpoint blockade has resulted in only rare clinical regressions when used as a monotherapy, the data suggested AR-V7+ prostate cancers may be associated with a greater number of DNA-repair gene mutations and a higher mutation load and could be further exploited by using combination immunotherapy.  “If these findings are confirmed, this could offer some hope to these patients with AR-V7+ disease who have few, if any, good treatment options,” said Antonarakis. The study showed the combination of nivolumab plus ipilimumab demonstrated acceptable safety and tolerability in men with AR-V7+ advanced prostate cancer. Based on the encouraging preliminary findings, Antonarakis said he will expand his study to involve a greater number of patients. The expanded study is open to enrollment and actively seeking new patients. The Bloomberg~Kimmel Institute for Cancer Immunotherapy was founded in 2016 with a series of philanthropic investments totaling $125 million from benefactors Michael R. Bloomberg, Sidney Kimmel and more than a dozen other supporters. It is a groundbreaking collaboration between clinical and scientific specialties, supporting cancer immunotherapy research across many cancer types. COI: Emmanuel Antonarakis is a paid consultant/advisor to Janssen, Astellas, Sanofi, Dendreon, Medivation, ESSA, AstraZeneca, Clovis and Merck; has received research funding to his institution from Janssen, Johnson & Johnson, Sanofi, Dendreon, Genentech, Novartis, Tokai, Bristol Myers-Squibb, AstraZeneca, Clovis and Merck; and is the co-inventor of a biomarker technology that has been licensed to Qiagen. Victor Velculescu is a founder of Personal Genome Diagnostics (PGDx), is a member of its scientific advisory board and board of directors, and owns PGDx stock. He is also on the Scientific Advisory Board for Ignyta. This research was sponsored by Bristol-Myers Squibb (Princeton, New Jersey), which also provided both study drugs free of cost. This research was also partially supported by National Institutes of Health grants P30 CA006973 and R01 CA185297, Department of Defense grants W81XWH-13-PCRP-CCA and W81XWH-15-2-0050, and the Bloomberg~Kimmel Institute for Cancer Immunotherapy. Genomic studies were partially supported by National Institutes of Health grant R01 CA121113 and the Commonwealth Foundation.
Newswise — A new study published online today by Pediatrics and conducted by researchers at the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital found that from January 2007 through December 2016 there were more than 11,000 calls to US Poison Centers for pediatric exposures to buprenorphine – a prescription opioid medication used to treat opioid use disorder. Most (86%) of the calls were about exposures among children younger than 6 years old. Most (98%) buprenorphine exposures among younger children were unintentional. Nearly half (45%) of the exposures resulted in the child being admitted to a healthcare facility and 21% resulted in serious medical outcomes, including 11 deaths. The most common symptoms for buprenorphine alone were drowsiness/lethargy (47%) and vomiting (17%). While most buprenorphine exposures among younger children were unintentional, 77% of exposures among teenagers (age 13-19 years) were intentional and 28% involved more than one substance. More than one-fifth of teen exposures resulted in being admitted to a healthcare facility, and 22% experienced a serious medical outcome, including 4 deaths. There were 150 suspected teen suicide attempts, 59% of which involved at least one other drug. “Buprenorphine is an important medication for the treatment of opioid use disorder among teenagers and adults,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “But it can cause decreased breathing and death if a young child swallows it. That is why all buprenorphine products should use unit-dose packaging to help prevent unintentional access by young children.” “Safe storage of all opioids, including buprenorphine, is vital,” said Henry Spiller, MS, D.ABAT, study author, and director of the Central Ohio Poison Center. “Parents and caregivers who take buprenorphine need to store it safely: up, away, and out of sight – in a locked cabinet is best. Additionally, there is rising concern of adolescents abusing buprenorphine.” Data for this study were obtained from the National Poison Data System, which is maintained by the American Association of Poison Control Centers (AAPCC). The AAPCC receives data on calls to regional poison control centers that serve the US and its territories. Poison control centers receive phone calls through the Poison Help Line and document information about the product involved, route of exposure, individual exposed, exposure scenario, and other data. The Center for Injury Research and Policy (CIRP) of The Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment, and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit www.injurycenter.org. The Central Ohio Poison Center provides state-of-the-art poison prevention, assessment, and treatment to residents in 64 of Ohio’s 88 counties. The center services are available to the public, medical professionals, industry, and human service agencies. The Poison Center handles more than 42,000 poison exposure calls annually, and confidential, free emergency poisoning treatment advice is available 24/7. To learn more about the Poison Center, visit www.bepoisonsmart.org.
Newswise — Researchers at the University of Virginia School of Medicine have discovered that microglia, specialized immune cells in the brain, play a key role in clearing dead material after brain injury. The study, which will be published June 25 in the Journal of Experimental Medicine, reveals that microglia gobble up the remnants of injured neurons, which could prevent the damage from spreading to neighboring neurons and causing more extensive neurodegeneration. In every tissue of the body, dead and dying cells must quickly be removed to prevent the development of inflammation, which could trigger the death of neighboring cells. This removal is carried out by specialized cells that engulf and break down cellular debris, otherwise known as phagocytic cells. But scientists have yet to determine which cells are responsible for removing neuronal debris when the brain or spinal cord is damaged. Jonathan Kipnis, chairman of UVA’s Department of Neuroscience, and his colleagues examined injuries to the optic nerve of mice, which cause retinal ganglion neurons to degenerate and leave debris in a distant region of the brain. The researchers found that this debris is engulfed by microglia. Microglia, which permanently reside in the central nervous system, are a type of phagocytic cell that can engulf bacteria and other pathogens that have infected the brain. They also play an important role in the developing brain, pruning away neuronal synapses that have failed to become fully active. In adult brains, microglia appear to recognize degenerating neurons using some of the same molecules they use to recognize inactive synapses or invading pathogens. Kipnis and colleagues found that, after optic nerve injury, microglia produce “complement” proteins that help the phagocytic cells identify their targets. The researchers studied what happened after optic nerve injury in mice when microglia did not produce “complement” proteins and found that the microglia did not clear the debris. “In the future, we hope to further identify how microglia are activated in response to neurodegeneration and how they then remove neuronal debris,” says Kipnis, director of UVA’s Center for Brain Immunology and Glia (BIG). “Knowing these mechanisms might allow us to boost the clearance of potentially toxic debris by microglia and limit the spread of neurodegeneration following brain or spinal cord injury.” Norris et al. 2018. J. Exp. Med. http://jem.rupress.org/cgi/doi/10.1084/jem.20172244?PR # # # About the Journal of Experimental Medicine The Journal of Experimental Medicine (JEM) features peer-reviewed research on immunology, cancer biology, stem cell biology, microbial pathogenesis, vascular biology, and neurobiology. All editorial decisions are made by research-active scientists in conjunction with in-house scientific editors. JEM makes all of its content free online no later than six months after publication. Established in 1896, JEM is published by Rockefeller University Press. For more information, visit jem.org. Visit our Newsroom, and sign up for a weekly preview of articles to be published. Embargoed media alerts are for journalists only.  Follow JEM on Twitter at @JExpMed and @RockUPress.
A study led by Mayo Clinic researchers has found that proton beam therapy, in combination with chemotherapy, prior to surgery, may be a better option than a combination using traditional radiation therapy techniques with chemotherapy when treating elderly patients with esophageal cancer. Standard X-ray radiation therapy techniques include 3-D conformal radiation and intensity-modulated radiation therapy. Results were presented by Scott Lester, M.D., a radiation oncologist at Mayo Clinic, today at the fourth-annual Particle Therapy Cooperative Group ─ North America Fourth Annual Conference in Chicago. “Elderly patients experience more posttreatment heart and lung problems, and are at higher risk for death after surgery than younger patients after receiving a combination of preoperative chemotherapy and radiation therapy,” says Dr. Lester. “Our study found that patients treated with proton beam therapy experienced lower rates of postoperative heart and lung problems, such as acute respiratory distress syndrome and death.” Researchers followed 571 patients treated with traditional radiation therapy and chemotherapy followed by surgery at Mayo Clinic Cancer Center, MD Anderson Cancer Center and the University of Maryland Cancer Center from 2007 to 2013.  Thirty-five percent of patients were age 65 or older at diagnosis and classified as elderly for the study. Forty-three percent of elderly patients received 3-D conformal radiation, 36 percent of patients received intensity-modulated radiation, and 21 percent of patients received proton beam therapy. Researchers analyzed outcomes by the type of radiation treatment and compared outcomes. They found that elderly patients treated with proton beam therapy had lower rates of heart and lung problems after surgery and a lower postoperative morality rate than patients treated with conventional techniques. None of the patients treated with proton beam therapy experienced a postoperative death, which the researchers think is partially related to proton therapy's ability to reduce the dose to important structures near the esophagus, such as the heart and lungs. “Age itself should not be a disqualifying factor for aggressive cancer treatment, but efforts to minimize the side effects of treatment are especially important in the elderly,” says Dr. Lester. “This study showed that advanced radiation techniques, especially proton beam therapy, can help improve outcomes in this population and may allow for more patients 65 years and older to undergo aggressive treatment for their esophagus cancer.” ### About Mayo Clinic Cancer CenterAs a leading institution funded by the National Cancer Institute, Mayo Clinic Cancer Center conducts basic, clinical and population science research, translating discoveries into improved methods for prevention, diagnosis, prognosis and therapy. For information on cancer clinical trials, call the Clinical Trial Referral Office at 1-855-776-0015 (toll-free). About Particle Therapy Cooperative Group – North America ChapterParticle Therapy Cooperative Group – North America is the North American chapter of the international Particle Therapy Cooperative Group. This nonprofit professional society was established in January 2013 to enhance collaboration among its members; create a platform for scientific exchange; and develop treatment guidelines, education and training initiatives for particle therapy. For more information visit ptcog-na.org. About Mayo ClinicMayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. For more information, visit mayoclinic.org/about-mayo-clinic or newsnetwork.mayoclinic.org.
A UCLA Nursing professor has found that culturally tailored multimedia content holds great promise for encouraging Latina woman seek help for, and address the symptoms of, anxiety and depression. “In my previous research, I found that Latina participants were hard-working and dedicated to their families,” said MarySue Heilemann, an associate professor at the UCLA School of Nursing, the study’s lead author. “To them, getting much-needed mental health care felt selfish and indulgent. If it doesn’t help the family, they just won’t pursue it.” The research is published in JMIR Mental Health October 19. Heilemann focused her study on English-speaking Latinas because they report more anxiety, depression and suicide attempts than immigrants or Spanish-speaking only Latinas. To create compelling storylines that would attract her target audience, she teamed up with a Latino screenwriter-director and gathered input from focus groups of English-speaking Latina women. The resulting project is called “Catalina: Confronting My Emotions.” The videos, which were made available to participants on a password-protected website, focus on a fictional character named Catalina, a 28-year-old dealing with symptoms of depression and anxiety. The stories include drama, intrigue, tension and romance as Catalina decides whether to seek treatment. In one segment, she reflects on her experience after having a very positive session with a Latina nurse-therapist, Veronica. In other segments, Veronica speaks directly to the viewer, providing basic information about depression and anxiety, therapeutic exercises and how to seek help. All of the story videos are in English; a video with basic information about depression is also available in Spanish. Twenty-eight Latina women participated in the pilot study. Within one week after seeing the story-based videos, nearly 40 percent of them took action to get help and 82 percent discussed the content with others. “Our findings showed that the women found the intervention compelling, therapeutic and resourceful. We were thrilled to see that the stories really spoke to our participant,” Heilemann said. The intervention uses a type of platform known as “transmedia,” which involves digital storytelling across multiple platforms, extending from a webisode or television episode to bonus videos, video-logs, blogs, or interactive modules and are accessible on a smartphone, tablet or computer via the internet. Latinos are the largest ethnic minority group in the U.S., and they receive less mental health care than whites, even if they have insurance, despite more commonly reporting symptoms of depression and anxiety than whites. Another reason the program was designed for Latina women is their higher than average use of smartphones and the internet. Latinos use smartphones more than any other ethnic group, per a 2016 Nielsen report; and a Pew Research Center analysis found that a high percentage of both English- and Spanish-speaking Latinos use the internet. Heilemann hopes to produce more episodes for the series to bring the series to a larger audience. “Several women in the study said they wanted more — they wanted to know what happened to Catalina, if she continued with the therapy, if it was working,” Heilemann said. “So many people are struggling with anxiety and depression and don’t feel comfortable getting help. This creates a whole different avenue for them to access therapy discreetly.” Heilemann’s research is in line with the goals of UCLA’s Depression Grand Challenge, a campuswide effort to reduce the health and economic impacts of depression by half globally by the year 2050.   Journal Citation: Heilemann MV, Soderlund PD, Kehoe P, Brecht ML  Title: A Transmedia Storytelling Intervention With Interactive Elements to Benefit Latinas’ Mental Health: Feasibility, Acceptability, and Efficacy  JMIR Ment Health 2017;4(4):e47  ****URL: http://mental.jmir.org/2017/4/e47/ 
Heart attack and stroke patients without medical insurance face “devastating” health care costs that can bankrupt them, research from UT Southwestern and other centers shows. “Many patients with large medical bills may have had to declare bankruptcy, sell their home, and be hounded by medical bill collectors as they struggled to juggle rent or mortgage payments while paying for utilities and food,” said cardiologist Dr. Rohan Khera, an Internal Medicine fellow at UT Southwestern Medical Center and co-first author of the paper, “Medical expenses are the leading cause of bankruptcy in the United States.” For uninsured patients hospitalized with acute myocardial infarction (heart attack), the median cost for their stay totaled $53,384 in 2012, according to the research. Uninsured stroke patients had a median bill of $31,218. Recent UTSW findings: Calcium in arteries influences heart attack risk Patients without calcium buildup in the coronary arteries had significantly lower risk of future heart attack or stroke despite other high risk factors such as diabetes, high blood pressure, or bad cholesterol levels. Even small weight gain is bad for the heart Modest weight gains – even among those who aren’t overweight – can cause dangerous changes to the heart, but small amounts of weight loss can improve the condition. Based on the likely annual incomes of the uninsured patients, which were modeled on the median incomes of their residential zip codes, the researchers estimated that 85 percent of the heart attack patients and 75 percent of the stroke patients faced hospital bills greater than 40 percent of the income they had left after buying food. About 60 percent of the uninsured heart attack patients had bills higher than their annual income, after allowing for the purchase of food, according to the paper. “The potentially devastating financial impact of these events on the uninsured is considerable,” according to the paper, which pointed out that more than 1 in 8 of heart attack and stroke patients were without insurance before the Affordable Care Act (ACA). The research, published in the journal Circulation, looked at thousands of patients hospitalized for acute myocardial infarction (heart attack) or stroke between 2008 and 2012, the year before Americans began signing up for subsidized insurance on exchanges created under the federal Affordable Care Act (ACA). The patients studied ranged from age 18 to 64 (federal Medicare insurance is available to those 65 and older). More than 39,000 hospitalizations for heart attack and more than 29,000 hospitalizations for stroke were analyzed. Information for the paper came from the National Inpatient Sample, a large database developed by the federal Agency for Healthcare Research and Quality. Collaborators included cardiologist Dr. James de Lemos, Professor of Internal Medicine and holder of the Sweetheart Ball‐Kern Wildenthal, M.D., Ph.D. Distinguished Chair in Cardiology and Medical Director for the Dallas Heart Study, and researchers were from Baptist Health South Florida, Johns Hopkins Bloomberg School of Public Health, Florida International University, Michael E. DeBakey VA Medical Center, Brigham and Women’s Hospital, and Yale New Haven Hospital. About UT Southwestern Medical Center UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 22 members of the National Academy of Sciences, 18 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The faculty of more than 2,700 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in about 80 specialties to more than 100,000 hospitalized patients, 600,000 emergency room cases, and oversee approximately 2.2 million outpatient visits a year.
A new treatment program that combines the power of technology with tried and true methods to help cancer patients overcome their addiction to tobacco is ready to enroll its first patients at Penn Medicine’s Abramson Cancer Center. As part of the program, doctors are alerted about a patient’s tobacco use through the electronic medical record. At that point, an automated referral is made for the patient to Penn’s Tobacco Use Treatment Service (TUTS), which then directly provides patients with state-of-the-science tobacco use treatment in an effort to get them to quit for good and assist with their medical treatment and recovery. Nearly 10 percent of survivors continue to smoke cigarettes, according to the American Cancer Society. More than 80 percent of those survivors smoke every day. And, importantly, the most recent United States Surgeon General’s report concluded that, based on the existing scientific evidence, quitting smoking improves the prognosis of cancer patients. “We wanted to develop the infrastructure to ensure that all cancer patients are screened for tobacco dependence and contacted by a trained tobacco treatment specialist who can help them quit,” said the project’s co-leader Robert A. Schnoll, PhD, an associate professor in the Department of Psychiatry, the co-leader of Penn’s Tobacco and Environmental Carcinogenesis Program, the program leader and director of the Center for Interdisciplinary Research on Nicotine Addiction, and a member of Penn’s Abramson Cancer Center. Once doctors get an electronic alert about a patient’s tobacco use, that patient is screened for available smoking cessation clinical trials or for a smoking cessation program. Certified Tobacco Treatment Specialists then provide behavioral counseling and recommend medication, and each patient is provided with an individualized treatment plan. This can also include referral to the free PA Quit-line cessation service, navigation to find medication, and hands-on, individualized in-person or phone smoking cessation counseling.  The initial focus of the program is the Department of Radiation Oncology, which Schnoll says they chose because it “provides a nexus point for many cancer patients, so we can ensure substantial access to Penn patients.” “Our oncologists are dedicated to addressing tobacco dependence among our patients, and we as a department are committed to expanded training and education,” said James Metz, MD, chair of Radiation Oncology. “Being part of an academic institution like Penn gives us the chance to work with outside departments to further these sorts of important initiatives to improve patient care, and we’re always pleased to take advantage of opportunities like this.” “Building this program in such a focused population will allow us to understand what works best and what needs to be refined,” said the project’s co-leader Frank T. Leone, MD, MS, an associate professor of Medicine. “In the long term, we hope to bring this program to the rest of the Abramson Cancer Center and possibly other specialties throughout the health system.” Initial support for the program came from a $100,000 grant from the CVS Health Foundation. Penn was also awarded a $500,000 grant as part of the National Cancer Institute’s Cancer Centers Cessation Initiative – known as C3I and part of the Cancer Moonshot initiative – to further develop and then expand this program across the cancer center. ### Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year. The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center -- which are recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report -- Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.
Patients diagnosed and treated for a long-term potentially fatal diseases such as cancer, can accumulate distressing and traumatic experiences along the way. A new study from the Marcus Institute of Integrative Health at Thomas Jefferson University examines how the brain is activated when the Neuro Emotional Technique (NET) is used to help cancer patients process traumatic memories. The research, published in the Journal of Cancer Survivorship, also adds to the basic understanding of the pathophysiology of traumatic stress in general and the underlying mechanisms involved with resolving it. “The results of this study are a breakthrough in understanding how an intervention like NET works, particularly in regard to the cerebellum’s role in the regulation of emotional experiences. We now understand that the cerebellum does much more than coordinate motor activity,” said principal investigator Daniel Monti, MD, MBA, Director of the Marcus Institute of Integrative Health who is also a member of the Sidney Kimmel Cancer Center at Jefferson. The intervention, Neuro Emotional Technique (NET), is unique in allowing the practitioner to not only gauge the patient’s subjective distress but also how the nervous system is reacting to that stress, using biofeedback tools. This provides information that is not usually part of standard interventions, and is what potentially makes NET an especially efficient and efficacious therapeutic solution for traumatic stress. By showing the link between the cerebellum, limbic (emotional) centers, and autonomic nervous system, the present study expands current understanding of traumatic memories and how and intervention like NET can significantly alleviate the suffering associated with them. “This is the first study that offers a demonstrable solution for cancer patients with traumatic stress symptoms. It also expands our understanding of the importance of the cerebellum in coordinating traumatic emotions, and the body’s response to them,” said Dr. Monti. This new data suggests that a brief therapeutic course of the NET intervention substantially alters the brain’s response to traumatic memories, and it elucidates the potential importance of the cerebellum in regulating the brain and body’s response to traumatic stress. (Previous research from the Marcus Institute demonstrated the efficacy of the NET intervention for relieving stress in cancer patients.) “Just four to five brief NET sessions result in significantly less emotional and physical distress, and these improvements are associated with connectivity changes throughout the brain,” said Dr. Monti. “Patients, even those who were skeptical at first, have reported the NET intervention as ‘diffusing a bomb’ on ‘the worst anxiety ever.’” The study was funded by the One Research Foundation. Authors declare no conflicts of interest.