HSS RECEIVES HALF MILLION DOLLAR GRANT TO INVESTIGATE HOW TO IMPROVE HEALTH CARE SYSTEM FOR CHRONICALLY ILL ADOLESCENTS
Newswise — An indomitable spirit. An inquisitive mind. And a most compassionate heart. Bobby Menges possessed intelligence and maturity far beyond his years and left a lasting impression on almost everyone he met. Friendly and outgoing, he was the kind of kid who went over and sat with the shy student eating alone at lunchtime. A diagnosis of cancer, originally at age 5, and other health problems didn’t stop him from living life to the fullest. Despite the treatments, and despite multiple surgeries, a profound capacity for empathy compelled him to look outside of himself, and he sought to help others, according to Elizabeth Menges, Bobby’s mother. He devoted much of his life to community service and fundraising, hosting charity events and blood drives. Although Bobby passed away last year at age 19, his legacy lives on in a foundation that his family created in his memory. The “I’m Not Done Yet” Foundation, based in Garden City, helps adolescent patients with serious, long-term, and chronic illnesses transition from pediatrics to adulthood. As part of its mission, the foundation has pledged a five-year, $500,000 research grant to Hospital for Special Surgery (HSS) in New York City to establish best practices to meet the changing needs of young patients as they become teenagers and young adults in the health care system. At HSS, a specialty hospital dedicated to orthopedics, rheumatology and rehabilitation, doctors often follow patients from a very young age through young adulthood. The patient population includes babies born with musculoskeletal conditions, such as cerebral palsy, and young people with chronic rheumatologic diseases who are treated from the time they are children. Bobby recognized the need for health care providers to be mindful of the evolving psychosocial needs of young people with any chronic illness, not only cancer, according to Peter Menges, Bobby’s father. “HSS is a world class organization with the right resources, the right experience and the right expertise to undertake a comprehensive research initiative to really hone in on what this patient population needs, whether it’s physical space, specific services, a certain kind of care, or emotional support,” Peter Menges said. “Although HSS will be the catalyst and epicenter of the research, our goal is to see the findings and best practices adopted throughout the U.S., and even worldwide.” The HSS grant, “The Bobby Menges ‘I’m Not Done Yet’ Initiative,” will address the psychosocial challenges young patients face as they become adolescents and teenagers in the health care system. The foundation’s website explains: “Imagine you're a 19-year-old cancer patient. You've been in and out of treatment since the age of 5, and because you were diagnosed with a pediatric cancer, you continue to be treated as a pediatric patient. The supports for young children were just what you needed as a child, but now, as an adolescent, you have different needs: peace and quiet, a study room, a place to connect to Wifi... But often those services do not exist.” Dr. S. Robert Rozbruch will lead the research project at HSS. Chief of the hospital’s Limb Lengthening and Complex Reconstruction Service, Dr. Rozbruch met Bobby after a skiing accident and subsequent fracture, treatment at another hospital, and a complication left him with one leg that was shorter than the other. Without the proper and highly specialized care, Bobby’s leg could have been five inches shorter than his unaffected leg. After several surgeries by Dr. Rozbruch and successful treatment over more than 10 years, Bobby’s leg was straight and the proper length. During that time, Dr. Rozbruch worked closely with Bobby’s oncologists, and his cancer was in remission. Dr. Rozbruch developed a close relationship with Bobby and his family. “Bobby was a very special person, even when he was a child,” Dr. Rozbruch says. “He had a sparkle in his eyes. He had a positive outlook. He had a kind of wisdom and an inner peace that was very dramatic.” “By the time patients turn 15, their needs start to change, and Bobby began to notice the void in health care as he got older,” explained Elizabeth Menges. “He realized that some of his doctors didn’t understand some of the issues he faced. He wondered why doctors still addressed me, but not him when they spoke. Dr. Rozbruch was among those Bobby felt understood him. He said Dr. Rozbruch had a knack for that.” Dr. Rozbruch, who treats many patients starting at a young age, has been interested in the developmental, emotional and psychological factors involved in caring for them as they get older. “The research initiative, which will include a psychologist, aims to evaluate the changing psychosocial and emotional needs of young patients in the health care setting and determine the best way to meet those needs. Surveys and questionnaires will be designed for past and current patients and their families,” Dr. Rozbruch says. “We intend to publish and share our research findings with the broad medical community well beyond orthopedics and HSS.” Carl Menges, Bobby’s great uncle, a life trustee of HSS and a significant financial supporter of the initiative, says the research grant is a way to honor Bobby’s memory. “The purpose of the initiative is to honor his deep concern for young people like himself facing complex conditions throughout childhood and young adulthood,” he said. “Bobby’s courage and spirit has been an inspiration to many, and this is a continuation of the work that he personally initiated and was so passionate about.” About HSS | Hospital for Special Surgery HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic of musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.About Hospital for Special Surgery
Newswise — WINSTON-SALEM, NC – Ever wonder why some people seem to feel less pain than others? A study conducted at Wake Forest School of Medicine may have found one of the answers – mindfulness. “Mindfulness is related to being aware of the present moment without too much emotional reaction or judgment,” said the study’s lead author, Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at the medical school, part of Wake Forest Baptist Medical Center. “We now know that some people are more mindful than others, and those people seemingly feel less pain.” The study is an article in press, published ahead-of-print in the journal PAIN. The researchers analyzed data obtained from a study published in 2015 that compared mindfulness meditation to placebo analgesia. In this follow-up study, Zeidan sought to determine if dispositional mindfulness, an individual’s innate or natural level of mindfulness, was associated with lower pain sensitivity, and to identify what brain mechanisms were involved. In the study, 76 healthy volunteers who had never meditated first completed the Freiburg Mindfulness Inventory, a reliable clinical measurement of mindfulness, to determine their baseline levels. Then, while undergoing functional magnetic resonance imaging, they were administered painful heat stimulation (120°F). Whole brain analyses revealed that higher dispositional mindfulness during painful heat was associated with greater deactivation of a brain region called the posterior cingulate cortex, a central neural node of the default mode network. Further, in those that reported higher pain, there was greater activation of this critically important brain region. The default mode network extends from the posterior cingulate cortex to the medial prefrontal cortex of the brain. These two brain regions continuously feed information back and forth. This network is associated with processing feelings of self and mind wandering, Zeidan said. “As soon as you start performing a task, the connection between these two brain regions in the default mode network disengages and the brain allocates information and processes to other neural areas,” he said. “Default mode deactivates whenever you are performing any kind of task, such as reading or writing. Default mode network is reactivated whenever the individual stops performing a task and reverts to self-related thoughts, feelings and emotions. The results from our study showed that mindful individuals are seemingly less caught up in the experience of pain, which was associated with lower pain reports.” The study provided novel neurobiological information that showed people with higher mindfulness ratings had less activation in the central nodes (posterior cingulate cortex) of the default network and experienced less pain. Those with lower mindfulness ratings had greater activation of this part of the brain and also felt more pain, Zeidan said. “Now we have some new ammunition to target this brain region in the development of effective pain therapies. Importantly this work shows that we should consider one’s level of mindfulness when calculating why and how one feels less or more pain,” Zeidan said. “Based on our earlier research, we know we can increase mindfulness through relatively short periods of mindfulness meditation training, so this may prove to be an effective way to provide pain relief for the millions of people suffering from chronic pain.” This work was supported by the National Center for Complementary and Integrative Health, R21-AT007247, F32-AT006949, K99/R00-AT008238 and F30-AT009165; the National Institute of Neurological Disorders and Stroke, R01-NS239426; the Mind and Life Institute Francisco J. Varela Award and the Wake Forest Center for Integrative Medicine. Co-authors are Tim Salomons, Ph.D., of the University of Reading, United Kingdom; Nichole M. Emerson, Ph.D., Adrienne Adler-Neal, Ph.D., Youngkyoo Jung, Ph.D., and Suzan Farris, M.S., of Wake Forest School of Medicine; and Robert Coghill, Ph.D., of Cincinnati Children’s Hospital Medical Center.
Newswise — NEW YORK (December 31, 2018) — With people worldwide getting their New Year’s resolutions ready, the Alzheimer’s Foundation of America (AFA) is encouraging individuals to take 10 steps to promote good brain health and healthy aging in 2019. “Taking care of your brain is a New Year’s resolution that everyone should make and, more importantly, keep,” said Charles J. Fuschillo, Jr., AFA’s President and CEO. “Just as we focus on improving other parts of our bodies, we need to look after our minds too. There are steps and lifestyle changes which we encourage individuals to take to support their brain health and wellness in 2019 and beyond.” “The best way to make 2019 a healthy and happy new year is by being proactive about your own well-being,” said Bert E. Brodsky, AFA’s Founder and Board Chairman. “The brain is one of the most vital parts of the human body; it’s so important to keep it in good shape. Start the New Year off ‘well’ by prioritizing your cognitive health.” AFA urges people to take the following 10 steps for healthy aging: Eat Well - Adopt a low-fat diet high on fruits and veggies, like strawberries, blueberries and broccoli. Take daily vitamins. Limit intake of red meats, fried and processed foods, salt and sugar. In general, foods that are “heart heathy” are also “brain healthy.” Stay Active – Physical activity increases blood flow to the brain and can also help improve mood and overall wellbeing. Brisk walking benefits brain health, while aerobics can boost your heart rate, and weight training builds strength and flexibility. Learn New Things – Challenge your brain by starting a new hobby like playing tennis, learning to speak a foreign language, trying a cooking class, or something you haven’t done before. Even something as simple as brushing your teeth with your non-dominant hand stimulates the brain by forcing it to think outside of its normal routine. Get Enough Sleep – Getting a consistent sleep every night is key; at least seven to nine hours is ideal. Having a good sleep environment is also helpful. Insomnia or sleep apnea can have serious physical effects and negatively affect memory and thinking. Mind Your Meds - Medication can affect everyone differently, especially as you age. When getting a new medication or something you haven’t taken in a while (whether over the counter or prescription), talk to your doctor or local pharmacist. Stop Smoking and Limit Alcohol - Smoking can increase the risk of serious illnesses, while too much alcohol can affect memory, impair judgment and present safety issues. Stay Connected – Social interaction and maintaining an active social life are very important for brain health, cognitive stimulation and mood. Invite friends and family over for a meal, board games, or just to hang out. Engaging in your community and participating in group activities is also beneficial. Know Your Blood Pressure – Blood pressure can impact your cognitive functioning. Visit your physician regularly to check your blood pressure and make sure it is in normal range. See Your Doctor - Maintain checkups. Health screenings are key to managing chronic illnesses, such as diabetes, cardiovascular disease, and obesity, all of which can impact brain health. Speak with your physician about any concerns or questions you have about your health. Get a Memory Screening - Our brains need regular checkups, just as other parts of our bodies do. A memory screening is a quick, easy, non-invasive exam for our brains. Talk to your doctor about getting a screening as part of your annual wellness exam or call AFA at 866-232-8484. Additional information about brain health and wellness and memory screenings can be found on AFA’s website, www.alzfdn.org or by calling AFA’s Helpline at 866-232-8484. The helpline is open from 9 am to 9 pm (ET) on weekdays and 9 am to 1 pm (ET) on weekends.
Newswise — Epigenetics refers to external changes to DNA that turn genes “on” or “off.” These modifications do not change the sequence of the “letters” in DNA, but are physical changes that affect how cells "read" genes. Researchershypothesized that alcohol’s effect on one kind of epigenetic change - called DNA methylation - oncertain genes is associated with the motivation to drink alcohol in binge and heavy drinkers. Methylation is a change in the DNA that reduces gene expression. They measured changes in the methylation of two genes that have been implicated in the control of drinking behavior or the response to stress: the period 2 (PER2) and proopiomelanocortin (POMC) genes. Methylation changes were measured in blood samples drawn from groups of non-smokers who were moderate drinkers, binge drinkers, or heavy drinkers. These drinkers also participated in a laboratory study that measured behavioral alcohol motivation. During the three-day experiment, the participants experienced stress-related, neutral, or alcohol-related mental images on consecutive days. After this imagery, participants were exposed to alcoholic beer cues followed by an alcohol taste test to assess their motivation to drink. The expression of the PER2and POMC genes was measured in blood samples immediately after the behavioral experiments. The researchers found that there was greater methylation of the DNA in the two genes, along with lower expression of the genes in the blood samples from the binge and heavy drinkers than those from the moderate drinkers. Greater PER2and POMCDNA methylation was associated with a greater subjective desire for alcohol immediately after presentation of the cues and after presentation of the alcoholic beer, and for alcohol consumed during the taste test. The authors concluded that there is a relationship between binge or heavy alcohol drinking and DNA methylation and changes in POMCand PER2genes. This is consistent with prior findings of a role for these genes in the control of drinking behavior and the stress response. The changes were also associated with a greater subjective and behavioral motivation for alcohol. These initial findings may further develop into a predictive biomarker of the risk for binge or heavy drinking.
Mouse studies reveal which cells and proteins in young animals can boost healing in the old Newswise — DURHAM, N.C. -- For a child, recovering from a broken bone is typically a short-lived, albeit painful, convalescence. But for older adults, it can be a protracted and potentially life-threatening process. Finding ways to speed bone repair is a public health priority that could save both lives and health care expense. The Centers for Disease Control and Prevention reports that more than 800,000 patients a year are hospitalized because of fall injuries, including broken hips, and these hospitalizations cost an average of $30,000. “Delayed fracture healing is a major health issue in aging, and strategies to improve the pace of repair and prevent the need for additional surgeries to achieve healing substantially improve patient outcomes,” said senior author Benjamin Alman, M.D., chair of the Department of Orthopedic Surgery at Duke. Duke Health researchers have previously shown that introducing bone marrow stem cells to a bone injury can expedite healing, but the exact process was unclear. Now, the same Duke-led team believes it has pinpointed the “youth factor” inside bone marrow stem cells -- it’s the macrophage, a type of white blood cell, and the proteins it secretes that can have a rejuvenating effect on tissue. Nature Communications will publish the findings online on Dec. 5. After tissue injury, the body dispatches macrophages to areas of trauma, where they undergo functional changes to coordinate tissue repair. During fracture healing, macrophages are found at the fracture site. But when they’re depleted, fractures will not heal effectively. Macrophage populations and characteristics can change with aging. “We show that young macrophage cells produce factors that lead to bone formation, and when introduced in older mice, improves fracture healing,” said Gurpreet Baht, Ph.D., assistant professor in orthopedic surgery and a lead author of the study. “While macrophages are known to play a role in repair and regeneration, prior studies do not identify secreted factors responsible for the effect,” Alman said. “Here we show that young macrophage cells play a role in the rejuvenation process, and injection of one of the factors produced by the young cells into a fracture in old mice rejuvenates the pace of repair. This suggests a new therapeutic approach to fracture rejuvenation.” In addition to Alman and Baht, study authors include Linda Vi, Erik J. Soderblom, Heather Whetstone, Qingxia Wai, Bridgette Furman, Vijitha Puviindran, Puviindran Nadesan, Matthew Foster, Raymond Poon, James P. White, Yasuhito Yahara, Adeline Ng, Tomasa Barrientos, Marc Grynpas, and M. Arthur Mosely. The research was supported by a grant from the National Institute on Aging, part of the National Institutes of Health (R01 AG049745) and by the Canadian Institutes of Health Research (FRN 62788). The authors declared no competing financial interests.
From toothbrush holders to typing aids to nail clippers, 3-D printing cuts the cost of devices aimed to help people with hand arthritis. Newswise — Adaptive aids are expensive. Additive manufacturing, using low-cost 3-D printers, can save upwards of 94 percent for simple household items. The Centers for Disease Control and Prevention (CDC) reports that almost a quarter of the U.S. population lives with some form of arthritis. Daily tasks — like opening drawers, turning door handles — can be difficult, so people turn to adaptive aids. Many are small pieces of plastic. “It never ceases to amaze me what a small piece of plastic sells for,” said Joshua Pearce, the Richard Witte Endowed Professor of Materials Science and Engineering at Michigan Technological University. “Anyone who needs an adaptive aid for arthritis should be 3-D printing it.” So, Pearce had his class take a shot. Now, Pearce is a co-author and corresponding researcher on a new study that analyzes how 20 of the 3-D printed adaptive aids his class printed see huge cost savings and either meet — or improve — standards for existing products. The study was published this week in Geriatrics and is co-authored by student research assistant Nicole Gallup and orthopedic surgeon Jennifer Bow, who is also a visiting scholar at Michigan Tech. More Pain, No Gain Adults with arthritis and other rheumatic conditions earn less than average yet spend more on medical expenses, on average about 12 percent of the average family’s income. To boot, the adaptive aids they may need to purchase to help them pull on socks, hold toothbrushes, knit, pull zippers, cut food and many other everyday tasks are pricey. Adaptive aids range from a cheap pop can opener for $5.99 to pill splitter for $23.75 to a phone holder for $49.99. With 3-D printing, those costs can come down to 45 cents to pop tabs, $1.27 to split pills and 79 cents plus a rubber band to hold a phone. The 3-D printed versions are not only cheaper but customizable. Dr. Bow recommended students take a look at designing adaptive aids because the customization available from 3-D printers could help her arthritis patients and others throughout the world. Subsequently, the group Makers Making Change approached Pearce because they needed to improve some existing designs that can be shrunk, expanded, tweaked to match different hand sizes, grip strength, color preference and task modification. “This is the difference between needing to go to someone to get your nails cut and being able to do your own, which, yes, there’s cost savings, but it’s also personal pride and being able to take care of yourself,” Pearce said. “And if your only problem is that the standard nail clipper is too tiny, we can fix that.” Cost for individual items may not be too onerous. However, following a diagnosis, some patients need to overhaul or install many adaptive aids, like putting light switch flippers throughout the house, which adds up quickly. 3-D printing can trim that cost, and Pearce’s team only used printers that cost $500 or less, but the upfront cost of a printer may curb some people’s enthusiasm. Also, some people do not have to pay the full price for adaptive aids if Medicare or their insurance policy helps cover the purchases. Pearce says neither substantially affects the numbers. “We printed and analyzed 20 different products and each one has a great return on investment, even for people who can use insurance to purchase adaptive aids with a co-pay, and a printer pays for itself easily,” Pearce said, explaining that the true challenge is not economic. “It’s a slam dunk — but the question becomes, how do people get these aids?” Access to 3-D Printing People can save a lot having a 3-D printer on their kitchen table. Not everyone is ready for the distributed manufacturing wave in their home, but there are still many ways to bring 3-D printed goods to people with arthritis, particularly older patients. “We’re not saying an 85-year-old with no personal computer experience is developing a CAD from scratch and prototyping a design 12 times,” Pearce said, explaining the open source designs are available for free online at Appropedia and MyMiniFactory. Pearce sees nursing homes, doctor’s offices and physical therapy clinics as the ideal hubs for 3-D printed adaptive aids. Local makerspaces and libraries also provide access to printers, designs and knowledgeable people in exchange for fees that cover plastic and printing costs; some businesses even make a living providing 3-D prints. Printed for Class With that dream in mind, Pearce says his class started with base functionality. Their assignment — turned around in a week— was printed on Rep-Rap printers that the students built themselves in the first two weeks of class. They did all their adaptive aid prints with PLA plastic, focused on handheld items, and many of the students designed features with a loved one, friend or acquaintance in mind. They all work, but there’s always room for improvement. “All the designs could be made much prettier and better — and that’s the beauty of open source. Because I hope in a couple years that we have a whole array of each one of these ideas that’s built out much further, applied all over the world and customized for individual people,” Pearce said. “This is a new field of 3-D printing design that’s just getting started. Lots of people can make real, honest-to-goodness, concrete contributions.”
Police Killings of Unarmed Black Americans Affect Mental Health of Black Community First Study to Show Mental Health “Spillover Effects” from Deaths of Unarmed Black Americans Newswise — PHILADELPHIA — Black Americans are nearly three times more likely to be killed by police than their white counterparts, with even larger disparities among those who are unarmed. The trend is also harming the mental health of the black community, according to new research published in The Lancet from the Perelman School of Medicine at the University of Pennsylvania and the Boston University School of Public Health. “These deaths don’t just have immediate consequences for the families and friends. There’s a true mental health spillover effect for those not directly involved,” said Atheendar S. Venkataramani, MD, PhD, an assistant professor of Medical Ethics and Health Policy in Penn’s Perelman School of Medicine, and co-lead author of the study. In a national survey of nearly 40,000 black Americans who were interviewed within three months following at least one death of a black American at the hands of police in their state, the team found that police killings of unarmed black Americans were associated with worse mental health among other black Americans in the United States general population. “Addressing this problem will require interventions to reduce the prevalence of police killings as well as programs that mitigate the adverse mental health effects in communities when these events occur,” said co-lead author Jacob Bor, ScD, SM, an assistant professor at the Boston University School of Public Health. “More broadly, the findings indicate that events widely perceived to reflect structural racism cause significant harm to the mental health of black Americans. Efforts to reduce health disparities should explicitly target structural racism.” Structural racism is described as policies, laws, practices, and other norms entrenched in institutions that can harm a certain racial group and perpetuate racial inequities. The researchers combined newly released data on police killings between 2013 and 2016 from the Mapping Police Violence Project database with data from the U.S. Behavioral Risk Factor Surveillance System (BRFSS) of over 103,000 black Americans. BRFSS is a nationally-representative, telephone-based, random-digit dial survey of adults ages 18 years and older. The primary exposure was the number of police killings of unarmed black Americans occurring in the three months prior to the person being surveyed. Exposure included word of mouth and news stories in print, radio, television, and/or social media. To measure mental health outcomes, the researchers asked respondents: “Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” Researchers then compared the number of poor mental health days experienced by black Americans surveyed after a police killing of an unarmed person to that of black Americans residing in the same state surveyed before that event. Overall, the study suggests the police killings could contribute 1.7 additional poor mental health days per person ever year, or 55 million more poor mental health days every year among black Americans in the United States. To contextualize those numbers, the authors point to diabetes, which is responsible for an estimated 75 million poor mental health days among black Americans. “Our estimates therefore suggest that the population mental health burden from police killings among black Americans is nearly as large as the mental health burden associated with diabetes,” they wrote. The study shows, for the first time, that police killings of unarmed black Americans have a “meaningful, population-level impact” on the mental health of other black Americans. “The effects are likely even larger than what we estimated,” said Venkataramani, pointing to the fact that more high-profile cases of police killings that grabbed national media attention could have exerted mental health effects among black Americans living in other states, as well. Importantly, the researchers saw no spillover mental health effects among white respondents, nor among respondents of either race in response to police killings of unarmed whites or of armed black Americans. This striking specificity points to the importance of structural racism as a key mechanism underlying the study findings, and a driver of population health, more generally, the authors said: “[P]olice killings of unarmed black Americans are perceived by many as manifestations of structural racism and as implicit signals of the lower value placed on black lives by law enforcement and legal institutions – as well as by society at large.” Co-authors of the study include David R. Williams, PhD, of the Harvard T.H. Chan School of Public Health, and Alexander C. Tsai, of Massachusetts General Hospital. ### 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 $7.8 billion enterprise. The Perelman School of Medicine has been ranked among the top medical schools in the United States for more than 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 $405 million awarded in the 2017 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 Medicine Princeton 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, and Princeton House Behavioral Health, a leading provider of highly skilled and compassionate behavioral healthcare. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2017, Penn Medicine provided more than $500 million to benefit our community.
In rare occurrences, forceful manipulation of the neck is linked to a damaging side effect: vision problems and bleeding inside the eye. For those in the habit of getting their neck adjusted by a chiropractor, the University of Michigan Kellogg Eye Center has an interesting case to know about: High velocity neck manipulation has been shown to result in stress on the eye and lead to spotty vision. The risk is rare, but one that Yannis Paulus, M.D., a retina specialist at Kellogg, reports on in the American Journal of Ophthalmology Case Reports. The energetic thrusts and rotations sometimes performed in high-velocity neck manipulation have been linked to damage to the blood vessels in the retina. Resulting abnormal bleeding inside the eye may also cause vision loss. This was the case for a 59-year-old woman who experienced a “tadpole” shaped spot in her vision while driving home from a chiropractor visit — with her sight worsening the next day. She had just received cervical spine manipulation using the high-velocity technique to help with her headaches. The woman’s vision returned to normal in about two weeks without treatment. She was referred to Kellogg Eye Center by her optometrist who co-authored the case report. Because the cells of the retina are so sensitive, even small injuries to the blood vessels can translate to vision problems. That’s why Paulus encourages patients to report their alternative medicine pursuits — and for physicians to actively listen and inform them of possible related side effects. Risks from chiropractic treatment Cardiovascular experts have been outspoken about health risks of chiropractic treatment. High-velocity neck manipulation has been associated with a certain type of stroke, or vertebral artery dissection, which led the American Heart Association to issue a warning statement in 2014. The short, rapid movements of neck manipulation may cause a small tear in the artery walls in the neck. The artery wall injury can result in a stroke if a blood clot forms at the site and later breaks free to block a blood vessel in the brain. Eye problems can follow, including double vision or central retinal artery occlusion, a blockage of the artery carrying oxygen to the nerve cells in the retina at the back of the eye. But the case at Kellogg suggests a new complication: direct damage to structures in the eye due to the force of neck adjustments. It’s the first case report of chiropractic care leading to multiple preretinal hemorrhages, authors say. Other possible complications are disrupting the vitreous humor — the clear, gel-like substance that fills the eye between the lens and the retina. The high-velocity technique may have induced a posterior vitreous detachment, or PVD, which occurs when the vitreous humor pulls away from the retina. No specific treatment is needed for PVD. Most patients no longer notice flashes in their vision after three months and “floaters” tend to improve, according to the American Society of Retina Specialists. Complications from PVD are rare but can be serious and in some cases require urgent treatment such as laser treatment to seal the retinal tear or surgery for a retinal detachment. Although the connection to chiropractic care is considered a temporal association, the timing of the patient’s eye symptoms following the chiropractic visit is hard to ignore. Paulus didn’t rule out future chiropractic visits for the patient but notes that “her chiropractor may need to modify techniques used during her visits.”
Newswise — In a proof-of-principle study, researchers at Johns Hopkins report that a certain liver immune cell called a macrophage contains only defective or inert HIV-1 copies, and aren’t likely to restart infection on their own in HIV-1-infected people on long-term antiretroviral therapy (ART). The study, the investigators say, strongly suggest that defective or inert HIV-1 can remain in the liver macrophages for up to ten years without functioning as an HIV-1 “reservoir” that can replicate the virus at high levels. A report of the findings was published online on Sept. 10 and in the Oct. issue of the Journal of Clinical Investigation. “Our study was the first, to our knowledge, in which purified liver tissue macrophages from HIV-1 infected people taking ART directly tested the idea that tissue macrophages are a long-lived active HIV-1 reservoir,” says Ashwin Balagopal, M.D., an associate professor in the Division of Infectious Diseases at the Johns Hopkins University School of Medicine. According to the U.S. Centers for Disease Control and Prevention (CDC), 36.7 million people worldwide and 1.1 million people in the U.S. are infected with HIV-1. Commonly, ART is successfully used to suppress the replication of HIV-1 and stop or control the progression of acquired immunodeficiency syndrome (AIDS) in humans. The virus infects the body’s immune system cells, commonly forming a persistent, and reservoir in humans in so-called resting memory CD4+ T white blood cells. Macrophages work with T cells normally to envelop and clear tissues of microbes and debris. The inability to completely wipe out pools of infectious HIV-1 has for decades frustrated efforts to completely cure the infection. And it means that the interruption or discontinuation of ART at any time re-activates HIV-1 replication, spreading the virus to new cells. As a result, Balagopal says, investigators are increasingly focused more specifically on the location and biology of these HIV-1 reservoirs. To determine if liver macrophages were a true source of infection-capable HIV-1 reservoirs after ART, liver tissue samples were taken from nine HIV-1 infected persons, seven of whom underwent liver transplantation at the Johns Hopkins Hospital and would have otherwise had their livers discarded. Eight of the nine persons were on ART for periods ranging from eight to 140 months. The sample group included only adults whose demographic information is considered exempt from human subject research because all samples were obtained strictly for scientific reasons or postmortem, and would otherwise have been discarded. The Johns Hopkins School of Medicine institutional review approved this study protocol. Using lab techniques that both measure HIV-1 containing T cells and separate out the liver macrophages, the researchers found HIV-1 to be present in the macrophages even after exposure to longstanding virus-suppressing ART. However, Balagopal said that when his team tried to simulate virus “rebound” from the liver macrophages in the laboratory, they found only “fragments of HIV-1 in small quantities, without robust growth of full-length, infectious virus.” The researchers found that HIV-1 was in the liver macrophages of one subject who took ART for 11.7 years. They concluded that while liver macrophages might harbor HIV-1 for a long time, it’s unlikely these viruses could continue an infection on their own, unlikely to function as a reservoir, because the viruses were not able to replicate. Balagopal cautioned that their study results still affirm the need to address liver macrophage infection, because even if inert, these cells may be able to produce portions of viral proteins that can misdirect the immune system. “These results contribute an important piece in our efforts to understand the role of non-T cells, such as macrophages, as HIV-1 cellular reservoirs in individuals on long-term ART, but also may help the research community focus on additional cure strategies," Abraham Kandathil, Ph.D., a research associate in the Division of Infectious Diseases at Johns Hopkins University School of Medicine who performed all of the key experiments. In the future, Kandathil says, more research is needed to determine if the inert HIV-1 infected liver macrophages have any functional significance in people taking ART because expression of defective HIV-1 proteins can confuse the immune system and cause tissue inflammation. “To find a comprehensive HIV-1 cure, it’s important to identify all of the relevant HIV-1 reservoirs in the body, since it’s possible that the virus hides in the DNA of numerous cell types and each may require different strategies to get a cure,” says Balagopal. Balagopal noted that their study was limited by the small number of liver macrophages and human samples studied, as well as the small number of CD4+ T cells in the liver cell cultures that may have prevented the researchers’ ability to detect them. Other authors on this paper include Sho Sugawara, Christine M. Durand, Jeffrey Quinn, Jaiprasath Sachithanandham, Andrew M. Cameron, and Justin R. Bailey of the Johns Hopkins University School of Medicine along with Ashish Goyal and Alan S. Perelson from Los Alamos National Laboratory. This research is supported by grants from the National Institute of Allergy and Infectious Diseases (K08 AI 081544, R56 AI 118445, R01 AI024333, R01 AI116868, and P01 AI131365), the National Institute on Drug Abuse (R01 DA 016078), the National Institutes of Health Office of the Director (R01 OD 011095 and 108707-54-RKRL ) and amfAR, the Foundation for AIDS Research (108814-55-RGRL). The authors have declared that no conflict of interest exists.
More than 1 in 10 people aged 50-64 have had genetic tests ordered by a doctor or ordered directly. Many more want to – but also worry about worrying Newswise — ANN ARBOR, MI – Only a small percentage of people in their 50s and early 60s have had their DNA tested – either for medical reasons, to learn their ancestry or out of curiosity – but far more have an interest in getting such tests done, according to a new poll. One in 10 have taken genetic tests offered directly to consumers, and one in 20 have taken genetic tests ordered by a doctor, according to new findings from the National Poll on Healthy Aging. More than half expressed interest in getting DNA tests to guide medical care, understand health risks or know their ancestry. Still, the poll finds, that desire to know more about their risk of disease or heritage comes with a grain of salt. Two thirds of those polled said they thought genetic testing could lead them to worry too much about their future health. The poll of 993 adults between the ages of 50 and 64 was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M’s academic medical center. It comes at a time when the U.S. Food and Drug Administration has approved several disease-specific tests to be marketed directly to the public, instead of requiring a physician to order them. The poll also asked respondents their interest in testing to learn their genetic risk for three later-life disorders: Alzheimer’s disease, Parkinson’s disease or macular degeneration. Around two-thirds had at least some interest in each test. Scott Roberts, Ph.D., a professor from the U-M School of Public Health who has studied use of genetic testing, including direct-to-consumer testing, worked on the poll’s design and analysis. He notes that even those who get direct-to-consumer genetic tests mainly to learn about their ancestral heritage could end up being “blindsided” by findings showing that they have a high risk of diseases such as Alzheimer’s. “Compared to previous findings in the general adult population, this age group appears to be a little more lukewarm about their views of the benefits versus the risks of genetic testing overall,” he says. “The majority said they might be interested in knowing their risk for specific conditions, but on other hand they were worried about potential psychological distress from the results.” Roberts points out that the accuracy of any genetic test is not 100 percent. He also notes that testing ordered by physicians often comes with a chance to meet with a genetic counselor – a specially trained clinician who can help patients decide whether to get tested, prepare them for handling the results, and help them understand what the results do and don’t mean. By contrast, direct-to-consumer testing often comes with none of these services, and individuals who buy DNA tests directly may encounter difficulty in interpreting them, or getting access to a genetic counselor after they receive their results. Genetic counselors are already in high demand for clinical cases, and their appointment times are prioritized for those who have a clinical reason for DNA testing, including family history of a serious genetic illness. “Patients may not think about the downstream effects of direct-to-consumer genetic testing. An unexpected positive result may lead to several additional tests that may or may not be covered by insurance,” says Preeti Malani, M.D., director of the poll and a professor of internal medicine at the U-M Medical School who has special training in geriatric medicine. Experience with testing The five percent of the poll respondents who had already had a genetic test ordered by their physician said it was done either because the physician suggested it or because they had wanted to find out more about their risk of disease or how best to manage a current condition. Ten percent had had a direct-to-consumer test. More than 70 percent of them said they were interested in learning more about their ancestry, and just under half said they were just curious about their genetic make-up. Just over one in 10 said they got tested to find out more about their health in general, or their risk of a particular disease. Combining the two types of genetic testing, 14 percent had had either kind. “We’re living in an era when advances like DNA testing are providing an amazing amount of useful health information,” says Alison Bryant, Ph.D., senior vice president of research for AARP. “As genetic testing becomes even more sophisticated and common among older adults, the challenge will be to ensure that people understand the benefits and limitations of these tests.” Future of genetic testing Roberts, who specializes in genetic testing for Alzheimer’s disease, notes that 70 percent of poll respondents had an interest in learning their Alzheimer’s risk. Newer clinical trials of drugs that aim to prevent, delay or slow progression of memory loss and other cognitive problems are actually looking to enroll people who have a higher-than-usual genetic risk of Alzheimer’s. So those who elect to buy such a test, or whose doctors order one for them because of family history, may now have an action they can take based on their results. “Before, there wasn’t much we could recommend, but now there are more research opportunities to take part in, and we know more about health behaviors earlier in life that can affect the risk of Alzheimer’s and other forms of dementia later in life,” he says. Poll respondents seemed to understand how genetic testing provides a potential window into the future, both for their own health risks (90 percent agreed with this idea) or for those of their children and grandchildren (86 percent). But 41 percent said that a genetic test wasn’t necessary if they already know what disease risks run in their family. The poll results are based on answers from a nationally representative sample of 993 people ages 50 to 64. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it. A full report of the findings and methodology is available at www.healthyagingpoll.org, along with past National Poll on Healthy Aging reports.