Mother's milk is OK, even for the in-between babies

“Stop feeding him milk right away – just to be safe” was not what a new mother wanted to hear. The call came several days after Tamara Caspary gave birth to fraternal twins, a boy and a girl. She and husband David Katz were in the period of wonder and panic, both recovering and figuring out how to care for them. “A nurse called to ask how my son was doing,” says Caspary, a developmental Read more

Focus on mitochondria in schizophrenia research

Despite advances in genomics in recent years, schizophrenia remains one of the most complex challenges of both genetics and neuroscience. The chromosomal abnormality 22q11 deletion syndrome, also known as DiGeorge syndrome, offers a way in, since it is one of the strongest genetic risk factors for schizophrenia. Out of dozens of genes within the 22q11 deletion, several encode proteins found in mitochondria. A team of Emory scientists, led by cell biologist Victor Faundez, recently analyzed Read more

Fetal alcohol cardiac toxicity - in a dish

Alcohol-induced cardiac toxicity is usually studied in animal models; a cell-culture based approach could make it easier to study possible interventions more Read more

H1N1 flu clinical studies start at Emory today

Emory doctors discuss H1N1 studies

Emory doctors discuss H1N1 studies

Today Emory researchers began vaccinating volunteer participants in the first of several planned clinical trials of a new H1N1 vaccine. A morning press briefing attended by Atlanta and national media provided Emory a platform to inform the public.

The clinical trials are expected to gather critical information that will allow the National Institutes of Health to quickly evaluate the new vaccines to determine whether they are safe and effective in inducing protective immune responses. The results will help determine how to begin a fall 2009 pandemic flu vaccination program.

Emory began signing up several hundred interested volunteers about two weeks ago and has been screening the volunteers to make sure they fit certain criteria. Volunteers will receive their first vaccinations over the first week of the trial and will return several times over the course of nine weeks to receive additional vaccinations and blood tests.

H1N1 clinical trial volunteer

H1N1 clinical trial volunteer

The clinical trials are in a compressed timeframe because of the possible fall resurgence of pandemic H1N1 flu infections that may coincide with the circulation of seasonal flu strains.

The clinical trials are being conducted by the eight Vaccine and Treatment Evaluation Units (VTEUs), supported by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH).

For more information about the Emory flu clinical trials, call 877-424-HOPE (4673) for the adult and senior studies, or 404-727-4044 for the pediatric studies.

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Discerning a prelude to Alzheimer’s

Imagine that an elderly relative has been having difficulty remembering appointments and acquaintances’ names, or even what happened yesterday. Memory problems can be signs of mild cognitive impairment (MCI), a prelude to Alzheimer’s disease.

Scientists believe that the outward effects of the slow damage that comes from Alzheimer’s only show up after the damage has been accumulating for years. However, memory difficulties can also be the result of stress or another health problem. Patients thought to have MCI at an initial doctor’s visit sometimes improve later.

That’s why researchers at Emory’s Alzheimer’s Disease Research Center have been testing noninvasive imaging approaches to distinguishing MCI from healthy aging and Alzheimer’s. Their goal is to identify individuals at risk of developing Alzheimer’s, at a time when intervention can make a difference in how the disease progresses.

“We believe that imaging technology may help us find the signature changes in brain structure that are specific to MCI,” says Felicia Goldstein, PhD, associate professor of neurology.

Color coded diffusion tensor image (DTI) of a brain section from a healthy individual (A) showed a thick and intact corpus callosum (orange color), a white matter fiber bundle connecting left and right hemisphere as illustrated in the 3D rendering of the tractograph derived from DTI (B). However, a thin and narrow corpus callosum is seen in an AD patient (C) due to the degeneration of this white matter structure

Color coded diffusion tensor image (DTI) of a brain section from a healthy individual (A) showed a thick and intact corpus callosum (orange color). However, a thin and narrow corpus callosum is seen in an AD patient (C) due to the degeneration of this white matter structure. Courtesy of Hui Mao.

Two recent papers highlight the use of diffusion tensor imaging, an advanced form of magnetic resonance imaging.

The first paper was published by Brain Imaging and Behavior with Goldstein as first author, in collaboration with Hui Mao, PhD, associate professor of radiology, and ADRC colleagues.

It examines diffusion tensor imaging as a way to probe the integrity of the brain’s white matter, and compares it with tests of memory and behavior traditionally used to diagnose MCI and Alzheimer’s.

White matter appears white because of the density of axons, the signal-carrying cables allowing communication between different brain regions responsible for complicated tasks such as language and memory.

Diffusion tensor imaging allows researchers to see white matter by gauging the ability of water to diffuse in different directions, because a bundle of axons tends to restrict the movement of water in the brain.

Goldstein and her colleagues found that patients diagnosed with “amnestic” MCI showed greater loss of white matter integrity in a certain part of the brain — the medial temporal lobe – than cognitively normal controls of similar age. This loss of white matter was linked with poor recall of words and stories.

The second paper, with Liya Wang, PhD, a senior research associate in Mao’s laboratory as first author, was published by the American Journal of Neuroradiology in April. Here the authors try combining probing white matter integrity with a MRI measure of whether the brain has shrunk as a result of disease.

Combining the two methods improves the accuracy of MCI diagnosis with respect to either alone, the authors found.

Mao notes that Emory has been participating in a multi-center study called ADNI (Alzheimer’s Disease Neuroimaging Initiative). Diffusion tensor imaging is a relatively new technique and could add information to future large-scale Alzheimer’s imaging studies, he says.

The Dana Foundation’s BrainWorks newsletter had an article recently on Alzheimer’s and brain imaging.

Posted on by Quinn Eastman in Uncategorized Leave a comment

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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Heart care in women is key to long life

Heart care for women

Heart care for women

Many women do not realize the seriousness of heart disease – in women. Many more do not realize that some of the symptoms of heart attack for women may be different than symptoms experienced by men. Heart disease, also called cardiovascular disease (CVD), is the number one cause of death in women in the United States.

Enter Emory Heart & Vascular Center’s Michele Voeltz, MD. Her work in both the clinical setting and in research focuses on women and heart disease.

Voeltz, who practices at Emory University Hospital Midtown, says the number of women developing CVD is on the rise, with nearly 37 percent of all female deaths in the United States caused by heart disease. She is working to raise awareness about heart disease in women, and she wants to let women know about the resources available to them to take care of themselves.

With women making up 60 to 70 percent of her practice, Voeltz’s mission is to help women and men gain a greater understanding of the differences in risk factors, symptoms and treatment of heart disease in women as compared to men. She has found that women represent an underserved population with regard to cardiovascular care and hopes that her work can help bridge these gaps for women.

Voeltz conducts research in women with heart disease using percutaneous coronary intervention (angioplasty and stenting). With clinical trials to compare stents, medical devices and medications, all of which enroll both men and women, Voeltz analyzes female patients’ outcomes.

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Rapid radiation delivery increases accuracy

RapidArc for prostate cancer

RapidArc for prostate cancer

Doctors in Emory’s Department of Radiation Oncology are the first in Georgia to use a new radiation delivery system that speeds up treatment and increases accuracy.

The first patients treated have been men with prostate cancer, but the treatment can also be used for patients with head and neck cancers or brain tumors, says Walter Curran, MD, chair of the department and chief medical officer of the Emory Winship Cancer Institute.

Curran says the main advantage to the new system, called RapidArc, is faster treatment so a patient is not lying on a treatment table for a long period of time. Limiting the time it takes can help with patient comfort as well as minimizing the chance of movement, which affects accuracy during treatment.

Treatments that once took five to 10 minutes can be performed in less than two minutes. For patients getting radiation daily over several weeks, that can make a significant difference, Curran says.

Emory University Hospital and Emory University Hospital Midtown both have the RapidArc system. Emory Health magazine features RaapidArc this month.

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A new and faster way to diagnose and fight flu

flu imageA new method of rapidly producing highly targeted monoclonal antibodies could soon be used to rapidly diagnose H1N1 influenza. Just a month after vaccinating people with a seasonal flu vaccine, the researchers were able to use just a few tablespoons of the vaccinated individuals’ blood to generate antibodies against that specific strain of flu. The research was published last spring in Nature.

The scientists believe their discovery could be applied to any infectious disease. By using a few drops of blood from infected people, they could isolate antibodies to rapidly diagnose a newly emerging flu strain such as H1N1.

There are many variations of H1N1, says Rafi Ahmed, director of the Emory Vaccine Center and a Georgia Research Alliance Eminent Scholar, but this technology could be used to identify a very specific strain, such as the one we’re dealing with in the current pandemic. The diagnostic tests available now are not specific to any particular H1N1 strain.

Ahmed and his colleagues, including postdoctoral fellow Jens Wrammert, and Patrick Wilson from the University of Chicago, hope their work will lead to a new, specific test for H1N1 within the next several months.

Conventional methods of making human monoclonal antibodies are time-consuming and laborious, says Ahmed. For example, one method involves sifting through human B cells —white blood cells that make human antibodies—and then looking for specific cells that make the right antibodies.

Not only is the new method quicker and less cumbersome, it could be applied to almost any infectious disease. In any kind of emerging infection, speed is essential, says Ahmed.

To listen to Ahmed describe the new monoclonal antibody method, listen to Emory’s Sound Science podcast.

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America’s health care system: Emory experts weigh in

It’s broken, and it needs fixing. That much everyone can agree on when it comes to U.S. health care. Much of the conversation about health reform centers on cost, but access and quality of care are key factors, too.

Emory University experts are adding their voices to the health reform debate. Here are some of their thoughts and suggestions for fixing America’s health care system.

Modernizing Medicare

Adam Atherly, PhD, health policy professor at Emory’s Rollins School of Public Health (RSPH), says eliminating Medicare Parts A and B would make the federal program more user friendly. “It makes sense to do a good job of running the programs we already have,” says Atherly.

Medicaid promises

Kathleen Adams, PhD, RSPH health economist, says Medicaid is fragmented and should be uniformed for all states. “State Medicaid programs are our labs for health care reform,” says Adams. “Unfortunately, that is adding to the fragmentation in health care. What we really have is not one but 50 Medicaid programs.”

Universal consequences

The President, Congress, and leaders in the public and private sector need to figure out how to achieve health insurance coverage for everyone,” urges Art Kellermann, MD, MPH, Emory School of Medicine health policy dean and professor of emergency medicine. “Uninsurance has consequences for everyone,” says Kellermann. “Communities struggle to recruit and retain doctors. Specialists are reluctant to take ER and trauma calls because of payment issues, and hospitals are less likely to offer vital but unprofitable services.”

Primary care pulpit

As director of the Emory Center on Health Outcomes and Quality at the RSPH, Kimberly Rask, PhD, wants to go beyond the debate on health care costs. “In the long run, achieving cost savings depends on how we organize our health care,” she says. “We need programs that provide the right care at the right time for the right condition.”

Controlling chronic conditions

Kenneth Thorpe, PhD, chair of the RSPH department of health policy and management, reports that 75 percent of national health spending is for chronic conditions such as diabetes and hypertension. Rising rates of obesity account for 20 percent to 25 percent of the overall rise in spending. And right now, less than 1 percent of national health spending is directed to avoiding health problems rather than preventing them. Thorpe says prevention could significantly lower overall health care costs.

Arguing for basics

William Bornstein, MD, chief quality officer for Emory Healthcare, says medical innovation and discovery has shifted focus from health care fundamentals. “We have focused on the rocket science instead and have left out the basic blocking and tackling,” says Bornstein. “If we just gave regular immunizations, we’d have had more impact on saving lives than we’ve had with some groundbreaking discoveries.”

Read more Emory experts’ health care reform analysis in the new issue of Emory Health magazine.

Please note that, unless stated otherwise, the opinions of these experts do not necessarily reflect official Emory health care reform policy positions.

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Cancer survivors may have psychological distress

Long-term survivors of cancer that developed in adulthood are at increased risk of experiencing serious psychological distress, according to a report in the July 27 issue of Archives of Internal Medicine.

The estimated 12 million cancer survivors in the United States represent approximately 4 percent of the population.

Commenting on this week’s study, Michael Burke, MD, clinical director of psychiatric oncology at Emory Winship Cancer Institute, says only recently has the emotional wellbeing of cancer patients been given serious consideration by physicians and patients. Yet, easing the disease’s emotional burden on patients and families may improve patients’ treatment and prognosis.

Michael Burke, MD

Michael Burke, MD

Burke has conducted studies focused on the effects of the disease’s emotional burden on patients and families and whether easing that burden can improve patients’ treatment and coping skills. Burke and his colleagues offer a collaborative approach toward therapies for the emotional, psychological, and physical symptoms associated with cancer and its treatment.

A history of cancer may affect current mental health in several ways, says the Archives study author and Brigham and Women’s Hospital and Dana-Farber Cancer Institute researcher. The researcher reports that cancer diagnosis and treatment can produce delayed detrimental effects on physical health and functioning such as secondary cancers, cardiac dysfunction, lung dysfunction, infertility, neurological complications and neurocognitive dysfunction. A cancer history, they continue, can also affect social adaptation, employment opportunities and insurance coverage. Adjusting to these functional and life limitations may create long-term psychological stress.

Emory’s Burke says to help patients cope with a diagnosis of cancer, he and his colleagues evaluate patients’ medical and personal history, environment and health behaviors, such as whether they’re getting enough exercise or increasingly using alcohol and tobacco.

Listen to Burke’s own words on Sound Science about how he helps patients cope with the emotional aspects of cancer.

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Lampreys’ alternative immune system

Lampreys are primitive creatures – basically, tubes with teeth. Their primitive nature makes them a fascinating entry-point for studying the evolution of the immune system.

At Emory, Max Cooper and his colleagues have been studying lampreys’ versions of white blood cells. In a recent Nature paper, they show that lampreys have two kinds of cells that look very much like B and T cells in mammals, birds and fish.

Non-immunologists may shrug at this revelation.  But consider: lampreys have a completely different set of tools for fighting infections. They have proteins in their blood that glob on to invaders, but they don’t look anything like the antibodies found in mammals, birds and fish.

Lampreys in a laboratory tank

Lampreys in a laboratory tank. Courtesy of Masa Hirano.

Similarly, lampreys have cells that look like T Ray Ban outlet cells, in terms of some of the genes that are turned on. However, they don’t have MHC genes, which are important in human transplant medicine because they determine how and when T cells get excited and reject transplanted organs.

Lampreys are thought to be an early offshoot on the evolutionary tree, before sharks and fish, and way before critters that crawl on land. This suggests that the categories (B or T) came first even though the characteristic features of the cells (antibodies/responding to MHC) are different.

“Lampreys have the same types of cells, but they just use different building blocks to put them together,” Cooper says.

Cooper, now a Georgia Research Alliance Eminent Scholar and a member of Emory’s pathology department, made pioneering studies defining the role the thymus plays in immune development at the University of Minnesota in the 1960s. The thymus is where T cells develop and where they get their name.

He says he is now collaborating with Thomas Boehm in Freiburg, Germany to better understand the evolution of the thymus. Again, lampreys don’t have a thymus, but they may have an area next to their gills where the T-like cells develop.

John Travis at Science has a more extensive discussion of this research.

In a Darwin-anniversary essay, Travis tells the story of how the evolution of the immune system was a centerpiece of the 2005 Kitzmiller v. Dover trial, when a Pennsylviania school district’s requirement to teach intelligent design was successfully challenged.

Link to Sound Science podcast with Cooper

Posted on by Quinn Eastman in Immunology Leave a comment