New Haven, Conn. — Summer is here, but enjoying longer and sunnier days outdoors means your skin is vulnerable to sunburn. Experts at Yale Cancer Center (YCC) and Yale School of Medicine (YSM) say unless you take the right precautions, sun exposure (even if you don't get scorched) can damage your skin, causing wrinkles, age spots and even skin cancer. Just one sunburn during your youth doubles your chances of developing melanoma, the deadliest form of skin cancer. “Since skin cancer is the most common form of cancer in the United States—one in five people will be diagnosed with it in their lifetime—it’s important to practice sun safety before heading outdoors,” said Michael Girardi, MD, director of the Phototherapy Unit at YCC and professor of dermatology at YSM. “There is concern that rates of melanoma have been steadily rising over the last 30 years.” YCC and YSM skin cancer experts say these tips can help you avoid sun damage and reduce your chances of getting skin cancer: Generously apply high SPF sunscreen. Use a broad-spectrum, water-resistant sunscreen (SPF 30 or greater) every day. Be sure it hasn’t expired and reapply every two hours as well as after swimming or sweating. And apply everywhere on your body, not just your face and upper arms. Seal your lips from the sun’s rays. Lip balms, glosses and sticks often contain SPF ingredients. Opaque lipsticks contain pigments that help block harmful rays, according to the American Academy of Dermatology. More opaque formulas protect better. Create some shade. Clothing made of tightly woven fabric with a high ultraviolet protection factor (UPF) rating can create a physical barrier that protects your skin from the sun. Long sleeves or pants, sunglasses and a hat with a wide brim will also help shade you. Avoid peak sun hours. The sun is most damaging to skin between 10 a.m. and 2 p.m., so plan your outdoor activities before or after the sun is at its strongest. Check yourself out. Using a full-length mirror, scan your skin for spots that look suspicious (unusually shaped moles that are changing shape or are black, red or pink in color) and tell your physician. If you've previously had skin cancer, you should be checked annually by a dermatologist. At Connecticut and Rhode Island beaches this summer, volunteers from the Smilow Cancer Hospital Care Center in Waterford will be handing out sunscreen, lip balm and sun index cards at the locations and times below: Date and Hours Beach July 14th, 9:00AM - 12PM Rocky Neck State Park July 21st, 9:00AM - 12 PM McCook Beach Park Hole in the Wall Beach July 28th, 9:00AM -12PM Waterford Beach Park August 4th, 9:00AM - 12PM Ocean Beach Park August 11th, 9:00AM - 12PM Misquamicut State Beach To learn more about skin cancer screening at Smilow Cancer Hospital go to:https://www.yalecancercenter.org/patient/specialty/screening/types_cancer_screening/skin.aspx About Yale Cancer Center Yale Cancer Center (YCC) is one of only 49 National Cancer Institute (NCI-designated comprehensive cancer) centers in the nation and the only such center in southern New England. Comprehensive cancer centers play a vital role in the advancement of the NCI’s goal of reducing morbidity and mortality from cancer through scientific research, cancer prevention, and innovative cancer treatment.
Newswise — MADISON, Wis. — Modern microscopy has given scientists a front-row seat to living, breathing biology in all its Technicolor glory. But access to the best technologies can be spotty. Jan Huisken, a medical engineering investigator at the Morgridge Institute for Research at the University of Wisconsin–Madison and co-founder of light sheet microscopy, has a new project meant to bridge the technology gap. His Morgridge team has developed a portable, shareable light sheet microscope — an engineering feat that shrinks a tabletop-sized technology down to the weight and dimensions of a suitcase packed for a week’s vacation. The project can be mailed to a lab anywhere in the world, configured remotely by Morgridge engineers, and run one to three months of experiments. The microscope then either begins its mail-order journey to the next lab, or back to the Morgridge lab if a tune-up is needed — all at no cost to users. The first focus will be on sharing with the UW–Madison community. “If we succeed, this project will certainly have a huge impact in the field of fluorescence microscopy and significantly change the way we collaborate,” says Huisken. The technology targets two essential challenges. Labs lucky enough to afford a commercial microscope can keep their entire experiments in-house. But as biologists, not engineers, customizing from one project to the next is difficult and the expensive tool may drift into obsolescence, says Huisken. The budget-challenged may need to take their project to the nearest shared microscopy resource. But biology doesn’t travel well: Delicate samples may get altered or ruined along the way, and experiments may fail in the unfamiliar environment, he says. The team debuted the tool — nicknamed “Flamingo” for its one-legged stand and vertical profile — June 20 at the International Zebrafish Conference meeting at UW–Madison. It’s the perfect starting point for this device, since the zebrafish research community widely wants to use light sheet microscopy. What is light sheet? Huisken’s microscopes illuminate samples from the sides with noninvasive “sheets” of light, giving scientists the ability to image samples over hours and days from every angle. This helps generate a tremendous amount of data quickly and gives researchers a 3D view of development in an almost completely unaltered state. Zebrafish researchers use the technology because it can build striking movies of embryo, limb and organ development. But it’s also being adopted by other model organisms important to research, such as fruit flies and planaria, and for imaging early plant root growth. Susi Power, a Huisken lab member on the Flamingo development team, says the lab for years has been seeing the challenges biologists face in getting access to good imaging. One of the added benefits of the project for the Huisken lab is a kind of research crowd-sourcing. In exchange for using the technology, the lab helps expand the light-sheet user community and gets continual feedback on how to improve its core technology. “It does something magical for a biologist to have a technology like this entirely to themselves, where they can set it up and say, ‘that’s my Flamingo,’” Power says. “I think there will be a huge reward to the science.” The prototype device is built and ready to use. Ongoing work includes designing remote access to help calibrate the device from Morgridge, and building software that will give users real-time desktop and mobile access to the data. Power says the microscope is the opening project in a new Huisken lab initiative called “involv3d,” which is intended to improve collaboration and communication between different research disciplines. The Huisken lab has active members in developmental biology, medicine, physics, botany and others, and they want involv3d to bridge these fields and “help scientists profit from other scientists.” Liz Haynes, a postdoctoral fellow in the lab of UW–Madison neuroscientist Mary Halloran, says Flamingo will help address some challenges in the Halloran lab. They needed a technology that could track the neurodevelopmental consequences of gene editing changes made in zebrafish embryos, and traditional approaches were onerous. She’s looking forward to being one of Flamingo’s first customers. “I’m also excited because it is a beautiful scope and it seems really smartly designed,” Haynes says. “It’s a joy to look at. And, of course, the images you can get from (light sheet) are breathtaking.” —Brian Mattmiller, firstname.lastname@example.org
Newswise — PHILADELPHIA - Influenza A (flu A) hijacks host proteins for viral RNA splicing and blocking these interactions caused replication of the virus to slow, according to new research published in Nature Communications by Kristin W. Lynch, PhD, chair of the department of Biochemistry and Biophysics in the Perelman School of Medicine at the University of Pennsylvania, and doctoral student Matthew Thompson. Their results also suggest that infection with flu A may reduce splicing of some host genes, which could point to novel strategies for antiviral therapies. Influenza A virus is a common human pathogen that causes 250,000 to 500,000 deaths per year worldwide. “Although vaccines and some antiviral drugs are available, it is crucial to understand influenza virus-host interactions at a molecular level in order to identify host vulnerabilities targeted by flu viruses, which could lead to developing new therapeutic options,” said Lynch, whose lab focuses on the specific mechanisms and patterns of alternative RNA splicing and how it relates to human disease, The transcription of DNA into messenger RNA – the process of a single gene encoding a single protein – isn't as straightforward as once thought. The phenomenon of alternative RNA splicing – where a single gene can encode multiple proteins – was discovered over 30 years ago in viruses. The flu A genome is comprised of eight single-strand segments of RNA. Three of these segments use alternative splicing to produce two essential viral proteins each, which are important in helping the virus gain entry into host cells. Working with cultures of human lung cells, the team’s proposed mechanism of how flu A virus interacts with human RNA splicing machinery suggests that keeping human splicing proteins from binding to the viral genome would help to stop its replication. As a result, the researchers found that mutating sequences of the viral genome to prevent host proteins from binding caused viral RNA to splice incorrectly and eventually halt replication—thus slowing the spread of the virus in the body. A balance between the two viral messenger RNAs must be maintained for the virus to successfully infect host cells and replicate. “Regulating splicing of the two viral proteins is a fundamental step in viral-host interaction and so a potentially new anti-viral remedy,” Lynch said. For now, her team is refining their understanding of the intricacies of viral reproduction in host cells. Their hope is to one day identify a specific molecular target for antiviral medications that can be used in the clinic. This research was funded by the National Institutes of Health (R01AI125524, R35GM118048, HHSN272201400008C, U19AI10675, 4R33AI119304-03). 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 $500 million to benefit our community.
Newswise — DALLAS – June 22, 2018 – Men often tolerate stress urinary incontinence for more than two years before seeking medical help – and one-third put up with it for more than five years, making it important for doctors to check for this problem, a new study from UT Southwestern researchers advises. The study, published in the journal Urology, calls on men’s general practitioners and urologists to perform a standing cough test, in which a patient coughs while the doctor watches for any accidental urine release, as a routine part of their male patients’ physicals. “Our goal is to spread the word that effective and safe treatments exist for men with stress urinary incontinence, but also to facilitate an immediate and accurate diagnosis among stress urinary incontinence patients,” said Dr. Joceline Fuchs, Assistant Instructor of Urology and first author of the study. Stress urinary incontinence (SUI) occurs when physical activity or exertion – a cough, heavy lifting, exercise – causes the bladder to leak urine. About 13 million Americans suffer from some degree of incontinence, with women accounting for 85 percent of cases. However, some men who have had prostate cancer treatments involving surgery (prostatectomies) develop the condition. More about incontinence Q&A by Dr. Gary LeMack UTSW Incontinence Services Urinary Incontinence for Women Urology journal article Even though men are slow to complain, “Male SUI is rare but is known to have significant negative psychosocial and emotional effects and represents a common reason for post-treatment anxiety and depression,” said Dr. Allen Morey, Professor of Urology at UT Southwestern and senior author of the study. But there are simple and safe solutions – including minor surgeries that can either help boost a weakened sphincter muscle for patients with minimal leakage (the sling procedure), or replace the sphincter muscle altogether (installation of an artificial urinary sphincter) for more severe cases of leakage. “Using new diagnostic techniques, we are now able to accurately diagnose and streamline treatment recommendations to resolve this bothersome problem for our patients,” said Dr. Morey, who holds the Distinguished Chair in Urology for Urologic Reconstruction, in Honor of Allen F. Morey, M.D., and the Paul C. Peters, M.D. Chair in Urology. “This study highlights an opportunity for improvement.” During the study, UT Southwestern researchers reviewed the cases of 572 men evaluated for anti-incontinence surgery in Dallas between 2007 and 2017. They found the median length of time the men had waited to seek treatment for their SUI was 32 months, with almost a third having waited more than five years. Patients in their 80s had waited a median of more than seven years. Most recovery of urinary control occurs within the first 12 months after a prostatectomy, the study notes. Beyond the first year, improvement is unlikely. Care for such patients should include urologist-directed treatment plans that focus on non-cancer problems such as incontinence, researchers said. Some treatment delay may also be tied to patient reluctance to undergo more surgery or due to limited geographic access to appropriate specialists, researchers said. However, patient satisfaction and quality of life improvement measures for those who do undergo anti-incontinence surgery are high, ranging from 73 to 90 percent, according to the study. The American Cancer Society Prostate Cancer Survivorship Care Guidelines recommend screening for long-term functional effects such as urinary incontinence after prostate cancer treatment, the study points out, and those guidelines have been endorsed by the American Society of Clinical Oncology. Incontinence help UT Southwestern physicians offer patients who suffer from incontinence outstanding expertise in urodynamic studies – the use of X-ray imaging to help diagnose the causes of incontinence. UTSW physicians were the first in North Texas to offer the botulinum toxin injection for neurogenic bladder dysfunction in men and women. UTSW physicians offer unique treatments, like electrical stimulation, to patients who are unresponsive to other therapies and others that are offered at only a few medical institutions in the world. Treatments can include: Behavioral therapy Biofeedback Drug therapy Exercise In-office procedures Incontinence surgery Palliative measures 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, 16 members of the National Academy of Medicine, and 15 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.
Newswise — MADISON, Wis. — The human gut is teeming with microbes, each interacting with one another in a mind-boggling network of positive and negative exchanges. Some produce substances that serve as food for other microbes, while others produce toxins — antibiotics — that kill their neighbors. Scientists have been challenged trying to understand how this collection of gut microbes known as the microbiome is formed, how it changes over time and how it is affected by disturbances like antibiotics used to treat illnesses. A new study from Ophelia Venturelli, a biochemistry professor at the University of Wisconsin–Madison, and her collaborators at the University of California, Berkeley, may help alleviate some of that difficulty. Published June 21 in the journal Molecular Systems Biology, the study provides a platform for predicting how microbial gut communities work and represents a first step toward understanding how to manipulate the properties of the gut ecosystem. This could allow scientists to, for example, design a probiotic that persists in the gut or tailor a diet to positively influence human health. “We know very little about the ecological interactions of the gut microbiome,” Venturelli says. “Many studies have focused on cataloging all of the microbes present, which is very useful, but we wanted to try to understand the rules governing their assembly into communities, how stability is achieved, and how they respond to perturbations as well.” By learning these rules, researchers say they can better predict interactions between microbes using computational tools instead of performing laborious and time-consuming laboratory experiments. The data can also start to answer questions about how pathogens cause damage when they invade communities, and how to prevent it. For the study, the researchers chose 12 bacterial types present in the human gut. They represented the diversity of the gut microbiome and the majority have been shown to significantly affect human health. They have associations with diseases such as diabetes, irritable bowel syndrome, Crohn’s disease and colon cancer. The team collected data on what are called pairwise interactions, which means each bacterial species was paired with just one other to study how the two interacted, without worrying about what all of the others were doing. This was done for every single possible pairing in the 12-member community. The researchers fed data about the pairwise interactions, along with data on each individual species, into a dynamic model to decipher how all of the bacteria would likely interact when combined. They found the pairwise data alone was sufficient to predict how the larger community assembles. “This model allows us to better understand and make predictions about the gut microbiome with fewer measurements,” Venturelli explains. “We don’t need to measure every single possible community of, say, three, four or five of a set of species. We just need to measure all the pairs, which still represents a very large number, to be able to predict the dynamics of the whole gut.” While this is still a challenge, Venturelli says it will significantly reduce the number of measurements scientists need to make. The researchers also looked at which species seemed to be the most important in the community by measuring substances microbes produce, called metabolites. To their surprise, “the metabolite data was not able to predict the role of important species in the community,” Venturelli says. She and the research team then tested the model’s predictive power by trying to estimate the characteristics of different combinations of their 12 chosen bacteria. Although not perfect, the model did well at predicting dynamic behaviors. Additionally, the team found more positive interactions between microbes in the community than they expected based on other studies that have shown mostly negative interactions. “We found there’s a balance between positive and negative interactions and the negative interactions kind of provide a stabilizing force for the community,” Venturelli says. “We are beginning to understand the design principles of stability of the gut microbes and what allows a community to recover from perturbations.” The model allows the scientist to now begin to ask questions about the composition and dynamics of thousands of microbial communities. “Without a model, we are basically just blindly testing things without really knowing what we are doing and what the consequences are when we are, for example, trying to design an intervention,” she says. “Having a model is a first step toward being able to manipulate the gut ecosystem in a way that can benefit human health.” This work was supported by the Defense Advanced Research Projects Agency (DARPA) (HR0011516183). —Kaine Korzekwa, email@example.com, (608) 265-4002
Newswise — The fifth annual Metastatic Breast Cancer Conference invites participants from around the world to discuss ongoing research, showcase new ideas from young scientists, and bring together advocates who are working with metastatic breast cancer patients. This year, the conference will be hosted by the Johns Hopkins Kimmel Cancer Center and the Johns Hopkins School of Medicine in Baltimore on Nov. 15 and 16. The Metastatic Breast Cancer Conference was established in 2014 by Theresa’s Research Foundation, with leadership from Matthew Ellis, Ph.D., M.B., McNair Scholar at Baylor College of Medicine, and Danny Welch, Ph.D., at the University of Kansas Medical Center. The first conference was held at the University of Kansas Medical Center in Kansas City, Kansas, in 2014. For the past three years, it was hosted by Baylor College of Medicine in Houston. The conference is unique from other breast cancer-centered conferences due to its specific focus on addressing metastatic disease as a major, but yet unmet, clinical need. For 2018, it moves to Baltimore under the guidance of Vered Stearns, M.D., and Andrew Ewald, Ph.D., at the Johns Hopkins Kimmel Cancer Center. Registration for the conference can be done at the Johns Hopkins Medicine website. Stearns said the goal of this year’s conference is to bring together a diverse audience in a collaborative environment to seek curative approaches for metastatic breast cancer patients. “There has been frustration on the patient side and from advocates with the lack of emphasis with metastatic/stage IV breast cancer,” Stearns said. “Less than 7 percent of funding goes toward metastatic breast cancer research. We want to bring in the best researchers, the best ideas, and invite patients and patient advocates to Johns Hopkins to find new ways and get them into the thought process.” The conference will feature discussions about therapy, predictive models, drug development and more. The keynote addresses, one each day, will focus on how reprogramming the tumor microenvironment determines metastatic progress of breast cancer and management of metastatic inherited breast cancer. Invited speakers from the United States and Europe will bring their knowledge and expertise to the conference and seek to inspire conversation and collaboration on new approaches regarding metastatic breast cancer. “Metastatic breast cancer needs a dedicated, long-term effort to find curative approaches. This conference helps to benchmark these efforts and create the collaborative research environment that is a prerequisite for progress,” Ellis said. Abstract submissions are encouraged, and the top five will be chosen for oral presentation during a Friday morning session. The others will be on display as posters. The submission period will open July 5 and close Sept. 5. The conference will be held at the Thomas B. Turner Auditorium on the Johns Hopkins medical campus in Baltimore. It is co-provided by the Baylor College of Medicine and Theresa’s Research Foundation. For more information, visit the Metastatic Breast Cancer Conference website.
Newswise — Promising experimental cancer chemotherapy drugs may help knock out another life-threatening disease: tuberculosis (TB). A new study published by scientists at Texas Biomedical Research Institute in San Antonio pinpoints a mechanism in regulating cell death called apoptosis that is a potential new target for helping to control the bacterial infection (Mycobacterium tuberculosis or M.tb) that causes the lung disease TB. Lead author of the newly-published study, Eusondia Arnett, Ph.D., a Staff Scientist at Texas Biomed, and her colleagues have been testing this theory for about two years. Using human immune cells called macrophages and infecting them with M.tb in the lab, scientists were able to test their theory that pathways regulated by a master regulator of gene expression – a host protein called PPARᵧ -- are a good target for intervention to halt the progression of the disease. When Dr. Arnett’s team treated M.tb-infected macrophages with Mcl-1 inhibitors that target this important apoptotic pathway, they found a reduction of M.tb growth by 80%. Almost 20 people develop TB and four people die from the disease every minute, somewhere in the world. TB is now the world’s deadliest single infectious disease, surpassing AIDS. “If we can stimulate apoptosis in M.tb-infected cells, then we can reduce M.tb growth, Dr. Arnett explained. “Induction of apoptosis and subsequent reduced M.tb growth should ultimately result in less inflammation and damage to the lungs, and increased control of TB.” Tuberculosis infection also creates granulomas in the lungs – dense cellular structures that are the body’s attempt to wall off an infection it is unable to eliminate. However, granulomas also provide a niche for the bacterium to become recalcitrant to antibiotics, Dr. Arnett’s study showed that these experimental cancer drugs also reduced M.tb growth in granulomas using a human granuloma model holding promise for the activity of these drugs in human and animal models. Cancer drugs similar to those used in the study are already in Phase II of Food and Drug Administration clinical trials. The next step for testing on the TB front will be to find out the effectiveness of this therapy in a mouse model, and then finally, in a nonhuman primate before moving on to human trials. “It’s very exciting that these have already gone through a lot of testing in humans and we can capitalize on that,” Dr. Arnett said, explaining this could speed up the time it takes to get a new treatment to patients with tuberculosis. This study is a great example of why basic scientific research is so important,” said senior investigator of the study Dr. Larry Schlesinger, the President & CEO of Texas Biomed. “When we study important host cell pathways for disease, we can find relationships we didn’t even know existed. We can forge new ways to use current knowledge to create novel strategies for host-directed therapy for infection to be used along with antibiotics.” The study is published in the June 21, 2018 edition of the Journal PLOS Pathogens. This work was supported in part by a National Institutes of Health T32 Fellowship, “Molecular Mechanisms of Lung Inflammation”, award # T32HL007946 (to EA) and a National Institutes of Health T32 Fellowship, "Interdisciplinary Program in Microbe-Host Biology, award #1-T32-AI-112542 (to EA), and National Institutes of Health grants AI059639 and AI052458 (to LSS). ### Texas Biomed is one of the world's leading independent biomedical research institutions dedicated to advancing health worldwide through innovative biomedical research. The Institute is home to the Southwest National Primate Research Center (SNPRC) and provides broad services in primate research. SNPRC contributes to a national network of National Primate Research Centers (NPRCs) with specialized technologies, capabilities and primate resources, many of which are unique to the SNPRC. The Center also serves investigators around the globe with research and technical procedures for collaborative projects. For more information on Texas Biomed, go to www.TxBiomed.org or for more information on SNPRC, visit www.SNPRC.org.
INHALED NITRIC OXIDE MAY REDUCE KIDNEY COMPLICATIONS FROM HEART SURGERY REQUIRING CARDIOPULMONARY BYPASS
MEDIA CONTACT Available for logged-in reporters only CHANNELS Diabetes, Kidney Disease, Obesity, Surgery, Local - New York, Local - New York Metro KEYWORDS Kidney Function, Cardiac Disease, Cardiac Surgery, Chronic Kidney Disease, Nitric Oxide Newswise — June 22, 2018─ Administration of nitric oxide gas during and for 24 hours following heart surgery decreased the risk of patients developing acute and chronic kidney problems, a randomized, controlled trial conducted in China found. The study, “Nitric Oxide Decreases Acute Kidney Injury and Stage 3 Chronic Kidney Disease after Cardiac Surgery,” is published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine. Researchers studied 244 adults in Xi’an, China, who underwent surgery to replace more than one heart valve. Because of the duration of the procedure, the patients required placement on cardiopulmonary bypass (a heart-lung machine) for at least 90 minutes. “Previous studies showed that prolonged cardiopulmonary bypass causes disruption of circulating red blood cells and the release of hemoglobin, which can cause acute kidney injury, leading to kidney failure and the need for long-term hemodialysis,” said lead study author Lorenzo Berra, MD, medical director of respiratory care at Massachusetts General Hospital in Boston and assistant professor at Harvard Medical School. “We tested whether administration of nitric oxide, a gas normally produced by cells in the lining of blood vessels, might render hemoglobin ‘inert,’ thereby decreasing the risk of both acute and chronic kidney injury.” The authors found that patients who received 80 parts per million of nitric oxide during and for 24 hours after surgery were less likely to develop acute kidney injury, with a decrease from 64 percent in the placebo-treated patients to 50 percent in those who received nitric oxide. The risk of progressing to more serious kidney disease (Stage 3 Chronic Kidney Disease) was also reduced at 90 days, with a decrease from 33 percent in the placebo-treated patients to 21 percent in those who received nitric oxide. After one year, 31 percent in the placebo group had serious kidney disease compared to 18 percent in the nitric oxide group. There was also a decrease in the overall mortality rate after one year, from 6 percent in the placebo group to 3 percent in the nitric oxide group. This decrease did not reach statistical significance, possibly because of the relatively small number of patients included in the study, the researchers wrote. According to the authors, several drugs have been tested and shown to be ineffective at protecting the kidneys after cardiac surgery. This is the first study to show that a pharmacological treatment can reduce acute and chronic kidney injury resulting from cardiac surgery. Importantly, the authors noted that administration of nitric oxide gas appears to be safe: nitric oxide delivery did not have to be reduced or stopped in any of the patients who received the gas. The authors caution that study results may not be generalizable to all cardiopulmonary bypass patients. In the Chinese study, all patients underwent the same type of surgery, and most of the patients were young (average age: 48) because their heart valve problems were caused by rheumatic fever. In North America and Europe, degenerative heart disease is a more common cause of valve dysfunction, and these older patients are more likely to have additional medical problems. The researchers are now conducting a similar trial at the Massachusetts General Hospital to determine whether nitric oxide provides similar benefits as those seen in the Chinese study. Compared to the younger, relatively healthy patients in the Chinese study, Dr. Berra said, “We believe that the older patients with an increased number of cardiovascular risk factors, including obesity, hypertension and diabetes, may derive even greater benefit from nitric oxide administration during and after heart surgery.” This study was funded by the National Natural Science Foundation of China, the Xijing Hospital Foundation, the National Key Technology Research and Development Program at the Ministry of Science and Technology of China, the Changjiang Scholars and Innovative Research Team at the University of China, and the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital. Contact for Article Lorenzo Berra, MD firstname.lastname@example.org Share via Twitter “Inhaled nitric oxide, #NO, appears to reduce risk of #acute kidney injury and long-term kidney problems in patients who undergo #heart surgery requiring a heart-lung machine.” Follow Us ATS - @atscommunity AJRCCM - @ATSBlueEditor About the American Journal of Respiratory and Critical Care Medicine (AJRCCM): The AJRCCM is a peer-reviewed journal published by the American Thoracic Society. The Journal takes pride in publishing the most innovative science and the highest quality reviews, practice guidelines and statements in pulmonary, critical care and sleep medicine. With an impact factor of 12.996, it is the highest ranked journal in pulmonology. Editor: Jadwiga Wedzicha, MD, professor of respiratory medicine at the National Heart and Lung Institute (Royal Brompton Campus), Imperial College London, UK. About the American Thoracic Society: Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society’s more than 16,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes three journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology and the Annals of the American Thoracic Society The ATS will hold its 2019 International Conference, May 17-22, in Dallas, Texas, where world-renowned experts will share the latest scientific research and clinical advances in pulmonary, critical care and sleep medicine.
Newswise — PITTSBURGH, June 22, 2018 – In the first 90 days of concurrent opioid and benzodiazepine use, the risk of opioid-related overdose increases five-fold compared to opioid-only use among Medicare recipients, according to a new study from the University of Pittsburgh School of Pharmacy, published today in JAMA Network Open. The U.S. Centers for Disease Control and Prevention recommends against concurrent use of opioids and benzodiazepines, but nearly a quarter of Medicare recipients who are prescribed opioids also fill prescriptions for benzodiazepines. Both drugs have sedative effects. “Patients who must be prescribed both an opioid and a benzodiazepine should be closely monitored by health care professionals due to an increased risk for overdose, particularly in the early days of this medication regimen,” said Inmaculada Hernandez, Pharm.D., Ph.D., assistant professor at Pitt’s School of Pharmacy and the study’s lead author. “Moving forward, policy interventions should focus on preventing concurrent exposure instead of simply reducing the length of time patients use both drugs.” Hernandez and her team used 2013-2014 Medicare Part D data to assess how the duration of simultaneous exposure to the two types of drugs impacts the risk of overdose. Beneficiaries not being treated for cancer who filled at least one opioid prescription during that year were included in the analysis, which ultimately looked at more than 71,000 beneficiaries who averaged 66.5 years of age. Patients were divided into two groups, those with a supply of only opioids the day before an overdose, and those with an opioid and benzodiazepine supply. The second group was then divided into four subgroups based on the cumulative number of days with overlapping opioid and benzodiazepine supplies. For patients who did not have an overdose event in the first 90 days of concurrent use, overdose risk in the next 90 days decreased from five-fold to less than double, which is still elevated compared to opioid-only use. After 180 days of concurrent use, the risk of overdose was no higher than the risk for opioid-only use. Results were adjusted to account for patient demographics, health insurance factors, clinical characteristics, and the number of unique clinicians who prescribed opioids or benzodiazepines to the patients. Hernandez and her team also found that a beneficiary’s risk of concurrent opioid and benzodiazepine use and of overdose increased with the numbers of opioid and benzodiazepine prescribers. In other words, the more clinicians prescribing medications to a beneficiary, the higher the risk of that beneficiary overdosing. “These findings demonstrate that fragmented care plays a role in the inappropriate use of opioids, and having multiple prescribers who are not in communication increases the risk for overdose,” said Yuting Zhang, Ph.D., director, Pharmaceutical Economics Research Group, Health Policy and Management, Pitt Graduate School of Public Health, and the study’s senior author. “Prescription monitoring programs and policy interventions can help curb this problem and reduce risk for patients.” Additional authors of this research include Meiqi He, M.S., and Maria M. Brooks, Ph.D., both from Pitt. The research was funded by The Commonwealth Fund grants 20150380 and 20160326.
Newswise — Health care insurers including Medicare, Medicaid and major private insurers have not done enough to combat the opioid epidemic, suggests a study led by researchers at Johns Hopkins Bloomberg School of Public Health. The Bloomberg School researchers examined major insurers’ 2017 coverage policies for drugs to treat chronic lower-back pain, and concluded that these policies missed important opportunities to steer patients towards safer and more effective treatments than prescription opioids. “Our findings suggest that both public and private insurers, at least unwittingly, have contributed importantly to the epidemic,” says study senior author G. Caleb Alexander, MD, MS, associate professor in the Bloomberg School’s Department of Epidemiology and co-director of the Johns Hopkins Center for Drug Safety and Effectiveness. The study, which will be published online on Friday, June 22, in the journal JAMA Network Open, provides one of the most comprehensive looks ever at insurers’ pain coverage policies, and comes as the opioid epidemic continues to ravage communities across the country. The U.S. Department of Health and Human Services (HHS) has estimated that in 2016, the most recent year for which complete data are available, over 42,249 Americans died from opioid overdoses, the most of any year on record. More than 2.1 million Americans had an opioid use disorder (addiction) in 2016, with economic costs from the epidemic estimated to be as high as $504 billion dollars. Alexander and colleagues, with funding and technical assistance from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) (DHHS), the National Institutes of Health and the Centers for Disease Control and Prevention (CDC), analyzed the coverage policies of 15 Medicaid plans, 15 Medicare Advantage plans and 20 commercial insurers in 2017. The team focused on common plan types within 16 states that together comprise about one-half of the U.S. population. Many of the states examined have been hit especially hard by the epidemic. In addition to analyzing plan details, the researchers also conducted in-depth interviews with over 43 senior health care executives that administered representative plans. The investigators focused on 62 prescription drugs used to treat chronic lower back pain, one of the most common types of chronic, non-cancer pain for which prescription opioids have been overused. Their analysis included 30 prescription opioids and 32 other drugs including non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and topical analgesics. The analysis revealed that many insurers failed to apply evidence-based “utilization management” rules to discourage opioid overuse and encourage safer and more effective alternatives. What’s more, many of the utilization management rules in place were applied as often to non-opioids as opioids. “Opioids are just one tool in the pain management tool box, and unfortunately, many of the plans that we examined didn’t have well-developed policies in place to limit their overuse,” Alexander says. There are three types of common “utilization management”—quantity limits, step therapy and prior authorization. While “quantity limits”—which restrict the number of pills that can be dispensed—were commonly used for opioids, they were generally for a 30-day supply, rather than a shorter supply as is recommended in the CDC Guideline for Prescribing Opioids for Chronic Pain. This is important since the duration of early prescriptions for opioids is associated with the likelihood that a patient will convert to chronic use. Since the study was initiated, several major insurers have begun implementing more stringent quantity limits on first prescriptions. “Step therapy”—which requires that treatment start with a less risky drug such as an NSAID, an over-the counter, anti-inflammatory and pain medication, and allows a riskier opioid only if the first drug fails to work—is another strategy to reduce inappropriate opioid use. But the researchers found that the plans they studied rarely required step therapy for opioids. Among the Medicaid plans, for example, a median of only 9 percent of covered opioids required step therapy. For commercial plans, the median figure was just 4 percent. Among the Medicare plans there were virtually no step therapy requirements for opioids. Similarly, the practice of “prior authorization,” in which the prescriber must contact the insurer for pre-approval before writing a prescription the insurer will cover, was applied to only a minority of covered opioids. Although, here too, some insurers have begun implementing policies such as requiring prior authorization for individuals with chronic, non-cancer pain, initiating treatment with extended release/long-acting (ER/LA) opioids. The researchers found too that both public and commercial plans tended to make covered opioids available relatively cheaply to patients. The median commercial plan, for example, placed 74 percent of opioid painkillers in Tier 1, the lowest cost category, and the median commercial co-pay for Tier 1 opioids was just $10 for a month’s supply. “To their credit, while every health plan we examined was actively trying to combat the epidemic, their focus was generally on utilization management and identifying high-volume prescribers and patients, rather than on comprehensive strategies to improve the treatment of chronic pain,” Alexander says. On the whole, these coverage policies “help explain why the opioid epidemic has taken root,” he adds. In 2016, the CDC issued recommendations for stricter limits on opioid prescribing, noting among other things that “Non-opioid therapy is preferred for chronic pain outside of active cancer, palliative, and end-of-life care.” These guidelines, as well as soaring rates of injuries and deaths from opioids, continue to shape changes in clinical practice. “Insurers can either be part of the problem, or part of the solution,” says Alexander. “The good news is that an increasing number of health plans are recognizing their contribution to the epidemic and developing new policies to address it. The bad news is that we have a very long way to go. “Prescription drug coverage for treatment of low back pain among U.S. Medicaid, Medicare Advantage, and Commercial Insurers” was written by Dora Lin, Christopher Jones, Wilson Compton, James Heyward, Jan L. Losby, Irene B. Murimi, Grant Baldwin, Jeromie M. Ballreich, David A. Thomas, Mark Bicket, Linda Porter, Jonothan C. Tierce, and G. Caleb Alexander. The study was funded by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, with technical and financial assistance from the National Institute on Drug Abuse of the National Institutes of Health and the Centers for Disease Control and Prevention.