I3 Venture awards info

Emory is full of fledgling biomedical proto-companies. Some of them are actual corporations with employees, while others are ideas that need a push to get them to that point. Along with the companies highlighted by the Emory Biotech Consulting Club, Dean Sukhatme’s recent announcement of five I3 Venture research awards gives more examples of early stage research projects with commercial potential. This is the third round of the I3 awards; the first two were Wow! Read more

Take heart, Goldilocks -- and get more sleep

Sleeping too little or too much increases the risk of cardiovascular events and death in those with coronary artery disease, according to a new paper from Emory Clinical Cardiovascular Research Institute. Others have observed a similar U-shaped risk curve in the general population, with respect to sleep duration. The new study, published in American Journal of Cardiology, extends the finding to people who were being evaluated for coronary artery disease. Arshed Quyyumi, MD and colleagues analyzed Read more

Repurposing a transplant drug for bone growth

The transplant immunosuppressant drug FK506, also known as tacrolimus or Prograf, can stimulate bone formation in both cell culture and animal Read more

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Manage stress to your advantage

Recently Charles Raison, MD, assistant professor, Emory Department of Psychiatry and Behavioral Sciences, wrote a blog for the Atlanta Journal-Constitution on stress. As clinical director of the Emory Mind-Body Program and director of the Behavioral Immunology Program, he has been studying stress.

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Raison says stress is everywhere today, both in our private and public lives, but also relentlessly in print, with discussion after discussion regarding what it is and what can be done to ease it.

He notes that you should think of stress like a sandwich. One trick for dealing with stress is to try to stay in the middle of the stress sandwich in the meat of life – the optimal challenge. The basic idea, he comments, is that you see what’s in front of you as a challenge, neither boring nor threatening, difficult enough to keep you fully engaged, easy enough for you to accomplish your goals.

You can read more by Raison by visiting the Atlanta Journal-Constitution Doctor Is In blog online.

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New tool in the fight for scarce donor organs

With so many men, women and children desperately awaiting a life-saving donor liver through traditional means – those donated by a deceased individual – transplant surgeons at Emory University Hospital looked for ways to improve the odds. transplantcenterlogo

Recently, Emory doctors were the first in Georgia to perform a rare “domino” liver transplant procedure – in effect saving two lives with one donor organ. The doctors had a opportunity to discuss the procedure at a media briefing held a few days ago.

The United Network for Organ Sharing (UNOS) says there are currently more than 16,000 Americans currently awaiting a liver transplant.

Domino liver transplant procedures are aptly named for the sequential, one-after-the-other nature of the process in which a viable liver from a deceased donor is transplanted into the first recipient, and the first recipient’s organ is then transplanted into a second recipient. The procedure is still extremely unusual, with fewer than 100 done in the United States since the first in 1996.

According to Stuart Knechtle, MD, professor of surgery in the Emory School of Medicine and director of the Emory liver transplant program, domino transplants are a rare but effective way of overcoming the national shortage of organs available for transplant. In most cases of domino liver transplants, one of the donated livers is transplanted from a patient with another type of disorder that does not affect the organ recipient.

“This successful domino liver transplant is something that simply does not start or end in a hospital operating room,” says Knechtle.

Liver recipient Bob Massie discusses his “miracle.”

Liver recipient Jean Handler discusses being “thankful and shocked.”

“This procedure, which saved two lives,” says Knechtle, “and will impact both families for many years to come, is the end result of a long chain of special events, starting with the decision by one person to donate the gift of life upon his untimely demise, which in turn allowed the recipient of that person’s organ to then donate hers to another patient.”

You can view the full briefing at this web site.

Posted on by Lance Skelly in Uncategorized Leave a comment

Biomaterials used for hips and knees

Orthopaedics is a constantly evolving subspecialty where medical technology and research drives the development of new products used for reconstruction of body parts, specifically for hip and knee replacements.

Emory has been on the forefront of investigating and using three materials for these replacements: ceramic on ceramic surfaces, metal on metal surfaces, or highly cross-linked polyethylene. These newer biomaterials can reduce wear rates by over 99 percent compared to previous materials, thus enhancing the life of the new hip or knee.

Adult reconstruction or hip and knee arthritis surgery delivers quality outcomes that make a dramatic improvement in a patient’s quality of life. At the first post-operative visit, patients are more comfortable, have less pain and are even more functional than before their surgery.

Orthopeadic surgeon James R. Roberson, MD, chairman, Department of Orthopaedics in Emory School of Medicine, and professor of orthopaedic surgery specializes in adult reconstructive surgery of the hip and knee.

Roberson has been involved in clinical research for more than 20 years to solve difficult problems of the arthritic hip and knee. He pioneered a minimally invasive surgery technique for knee replacement that allows him to use smaller incisions in certain patients who have uncomplicated conditions.

Visit Emory University Orthopaedics & Spine Center and Emory University Orthopaedics & Spine Hospital to learn more about orthopaedic services and watch a video about the hospital.

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Pediatric liver disease on the rise

Miriam Vos, MD with patient.

Miriam Vos, MD with patient.

Miriam Vos, MD treats a growing number of children with nonalcoholic fatty liver disease. Yet little research has been conducted into the development of the illness. Nonalcoholic fatty liver disease in children, which often is associated with obesity, occurs when fat deposits itself in the liver. It eventually can lead to inflammation, cirrhosis and even liver failure.

In the hopes of preventing the disease in children, Vos, a pediatric hepatologist at Emory University School of Medicine

and Children’s Healthcare of Atlanta, is conducting research into the origins of this disorder in children. She suspects a diet high in sugar and too little exercise are tied to its onset.

In fact, a recent study led by Vos found that Americans are getting more than 10 percent of their daily calories from fructose, used mainly in sugar-sweetened beverages and processed foods.

The study analyzed the amount and sources of dietary fructose consumption among U.S. children and adults from 1988 to 1994. The researchers found that U.S. children and adults consumed 54.7 grams of fructose per day, an almost 50 percent increase from a national study sample conducted in 1977-1978.

Fructose occurs naturally in fruits and vegetables, however, it is added to many processed foods as table sugar (sucrose) and high-fructose corn syrup.

Vos has written a book aimed at helping children and their families shed pounds and achieve better nutrition through changes in lifestyle and diet.

To hear Vos’s own words about nonalcoholic fatty liver disease in children, listen to Emory University’s Sound Science podcast.

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Heated, targeted chemotherapy helps abdominal cancers

Cancer of the colon, ovaries, appendix or other organs within the abdomen often spreads to the lining of the abdominal cavity. Experts call this condition peritoneal surface malignancy. Until recently, treatment options for this form of cancer only provided relief from symptoms.

Emory University Hospital is one of a few facilities nationwide to utilize a new combination therapy to slow or prevent recurrence of this cancer. Hyperthermic intraperitoneal chemoperfusion (HIPEC) is a procedure done immediately following surgery that delivers heated chemotherapy directly into the abdominal cavity where it can penetrate cancerous tissue. Heat at 42 C (107 F) destroys cancer cells and enhances the power of chemotherapy.

The term “intraperitoneal” means that the treatment is delivered to the abdominal cavity. “Hyperthermic chemoperfusion” means that the solution containing chemotherapy is heated to a temperature greater than normal body temperature.

Charles Staley, MD, chief of surgical oncology at the Emory Winship Cancer Institute, says by bathing the abdomen with heated chemotherapy immediately following surgery doctors can administer a higher dose of medication than would normally be tolerated by a patient if given intravenously – the traditional way chemotherapy is administered.

During surgery, Staley removes all visible tumors throughout the abdomen, a procedure known as cytoreductive surgery. Following surgery, while still in the operating room, Staley administers the new treatment, which takes about two hours. Recent studies show improved prognosis in patients treated with HIPEC after the cytoreductive surgery.

Illustration of heated chemo therapy

Illustration of heated, targeted chemotherapy

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New heart valve replacement option under study

A new option for heart valve replacement is under study at Emory University Hospital. Cardiologists at the Emory Heart & Vascular Center are conducting groundbreaking research to study a non-surgical treatment option for patients with severe aortic stenosis, a narrowing of the aortic valve opening that affects tens of thousands of people each year. It is most common among elderly patients over 70 years of age, but can surface earlier in life in those with rheumatic heart disease or congenital abnormalities of the valve. Patients often develop symptoms of chest pain, shortness of breath, fainting spells and heart failure.

Peter Block, MD

Peter Block, MD

Emory cardiologists, led by Peter Block, MD, FACC, professor of medicine, Emory School of Medicine, are performing percutaneous aortic valve replacement as part of a clinical trial, comparing this procedure with traditional, open-heart surgery or medical therapy in high-risk patients with aortic stenosis. It provides a new way for doctors to treat patients who are too ill or frail to endure the traditional surgical approach. So far, 115 people have participated in the phase II clinical trial.

In this new procedure, doctors create a small incision in the groin or chest wall and then feed a wire mesh valve through a catheter and place it where the new valve is needed. The standard therapy, which has been used to treat aortic stenosis for more than 30 years, is to remove the diseased valve through open-heart surgery.

Block says the results seen so far in this clinical trial show great promise for this procedure. He says this is especially important since tens of thousands of Americans are diagnosed with failing valves each year and that number is expected to increase substantially in the coming years as baby boomers pass the age of 70.

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Childhood cancer treatment may raise diabetes risk

Cancer survivors who got radiation treatments as children have nearly twice the risk of developing diabetes as adults. That’s according to a study led by Emory and Children’s Healthcare of Atlanta pediatric oncologist Lillian R. Meacham, MD.

Lillian Meacham, MD

Lillian Meacham, MD

The study, published in the August 10/24 issue of Archives of Internal Medicine, compared rates of diabetes in nearly 8,600 childhood cancer survivors diagnosed between 1970 and 1986, and nearly 3,000 of their siblings who did not have cancer.

Children who were treated with total body radiation or abdominal radiation to fight off cancer appear to have higher diabetes risks later in life, regardless of whether they exercise regularly or maintain a normal weight.

After adjusting for other risk factors, including body mass index – a ratio of height and weight – Meacham and team found that childhood cancer survivors overall were 1.8 times more likely to have diabetes.

And the more radiation that was used, the greater the diabetes risk. For those treated with total body radiation — a treatment often used before bone marrow transplants to treat childhood leukemia — the diabetes risk was more than seven times greater.

More study is needed to understand how radiation could promote diabetes in cancer survivors, notes Meacham.

She says it is imperative that clinicians recognize this risk, screen for diabetes and pre-diabetes when appropriate, and approach survivors with aggressive risk-reducing strategies.

Meacham is a professor of pediatrics in the Emory School of Medicine and medical director of the Cancer Survivor Program with the AFLAC Cancer Center and Blood Disorders Services, Children’s Healthcare of Atlanta.

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Relocating central vision

Susan Primo, MD

Susan Primo, MD

The patients seen by Emory low vision specialist Susan Primo, OD, MPH, have already exhausted most of their treatment options. They’ve completed medication regimens or had surgery to slow advanced age-related macular degeneration (AMD), a leading cause of blindness in the elderly. But still they don’t see well.

That’s where Primo comes in. At the Emory Eye Center, she’s studying whether behavioral modifications can lead to a change in brain activity to maximize use of remaining vision.

In macular degeneration, the macula—a layer of tissue on the inside back wall of the eyeball—gradually deteriorates. That delicate tissue is responsible for visual acuity, particularly in the center of the retina. Central vision is needed for seeing small and vivid details such as words on a page or the color of a traffic light, which means it is vital for common daily tasks such as reading or driving.

In more than two decades of working with patients who are visually impaired, Primo realized that people typically use their peripheral vision to compensate for loss in central vision. Studies have shown that people with progressive central vision loss compensate by spontaneously adopting a preferred retinal location (PRL) that takes over responsibility for visual clarity.

Normal vision

Normal vision

Vision with macular degeneration

But Primo and Georgia Tech psychologist Eric Schumacher wanted to know whether using these peripheral regions causes a change in how the brain is organized. Armed with Schumacher’s expertise in functional magnetic resonance imaging (fMRI) and Primo’s clinical experience, the researchers did indeed discover continued activity in the part of the brain that maps to the macula. The brain scans of people with AMD who had developed their peripheral vision showed substantially more activity than those of people who had not developed a PRL. Their study appeared in the December 2008 edition of Restorative Neurology and Neuroscience.

In a current study, Primo and Schumacher are exploring whether occupational training and biofeedback can help people with AMD focus on using good retinal cells and in turn speed up the brain’s reorganization.

“Although others have tried to study this reorganization of macular degeneration before, no one, to our knowledge, has tried to influence it,” says Primo. “Yet it’s important to begin to come up with therapies, treatments, and technology to help patients begin to use their residual vision faster and better than they could before.”

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Making a joyful noise: Joey finds his ‘real voice’

Emory Voice Center patient Joey Finley

Emory Voice Center patient Joey Finley

Last year, seven-year-old Joey Finley sang Christmas carols for the first time in his life. For most parents, this would be uneventful, but for Joey’s mom, Melanie, it was a breakthrough.

Joey was literally silenced all these years because of a rare disease called recurrent respiratory papillomatosis (RRP). The disease allows tumors to grow in the respiratory tract, and is caused by the human papilloma virus (HPV). Currently there are 20,000 active cases in the United States.

Although the tumors mostly occur in the larynx on and around the vocal cords, these growths may spread downward and affect the trachea, bronchi and sometimes the lungs, obstructing breathing. RRP papillomas are the same tumors that cause cervical cancer. There is no cure for RRP. And left untreated, the lesions may grow and cause suffocation and death.

Initially, doctors confused Joey’s RRP symptoms with pediatric GERD or acid reflux disease. Since Joey was two months old, he’s been in and out of hospitals, OR’s and doctor’s offices, and had more than 60 surgeries to remove the tumors on his vocal chords.

RRP adversely affected Joey’s speech. He began compensating for the “frogs” as he called them, by using other vocal muscles to talk.

When Joey met Edie Hapner, PhD, a speech pathologist at the Emory Voice Center, she says he sounded “like a little old man.” His voice was very raspy like that of a 60-year-old smoker.

After several speech therapy sessions at the Emory Voice Center with Dr. Hapner, Joey is a normal sounding child. Joey now sings in the school chorus and takes gymnastics and swimming lessons. It’s hard to imagine these activities for a child that not so long ago had trouble breathing because of HPV tumors blocking his airways.

Read more about Joey’s journey to ‘find his voice’ and hear him speak in the new issue of Emory Health magazine.

Listen to Emory patient Karon Schindler recount her experience at the Voice Center.

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Dialing 911 saves time and lives

In the time it takes to write this short piece, more than 90 people across the United States will have suffered a heart attack – and almost 40 of them will have died. In the same time frame, a call to 911 could have a patient in an ambulance and on the way to a nearby hospital where lifesaving treatment is ready on a moment’s notice. More often that not, the difference between surviving a heart attack and becoming another statistic is a matter of a few minutes. Precious time.

EMS representative prepares

EMS representative prepares

The very best way someone suffering a heart attack can save time and have a fighting chance for survival is to call 911 instead of driving to the hospital. Here in the Atlanta area, a one-of-a-kind initiative, appropriately named TIME, makes it possible for Emergency Medical Services (EMS) to quickly respond to a patient and transmit life-saving data to local Atlanta hospitals in order to shorten the time to treatment and increase a heart attack victim’s chance of survival. Two Emory hospitals – Emory University Hospital and Emory University Hospital Midtown – are partners with three other local hospitals in this effort to make Atlanta one of the safest cities in America in which to have a heart attack.

Bryan McNally, MD, emergency medicine physician at Emory University Hospital and co-director of the TIME program, says the collaboration is the first cooperative urban program in the United States. It was developed to provide the most rapid response to a cardiac emergency by improving every step of care from the onset of symptoms to treatment at the hospital. The time from the onset of the heart attack to the opening of the artery is critical in reducing heart damage and improving survival.

An EMS call results in quick evaluation, treatment and vital information transmitted to the nearest hospital where a team will stand ready to meet the patient at the door and begin opening a blocked artery within minutes. Kate Heilpern, MD, chair of the Emory Department of Emergency, says the chain of survival from pre-hospital 911 to the emergency room to the catheter lab is available 24 hours a day, seven days a week at our institutions. In these instances, when EMS suspects a heart attack, getting the patient to the right place at the right time with the right providers to do the right thing definitely optimizes patient care and enhances quality and outcome.

Read more about chest pain center accreditation.

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