What does it take to be a leader – of cancer cells?
Adam Marcus and colleagues at Winship Cancer Institute are back, with an analysis of mutations that drive metastatic behavior among groups of lung cancer cells. The findings were published this week on the cover of Journal of Cell Science, and suggest pharmacological strategies to intervene against or prevent metastasis.
Marcus and former graduate student Jessica Konen previously developed a technique for selectively labeling “leader” Read more
Approximately 250,000 people each year suffer from a particularly deadly form of heart attack known as a STEMI (ST-Elevation Myocardial Infarction), in which blood flow is completely blocked to the heart. Restoring blood flow quickly is crucial in order to save the patientâ€™s life, yet more than 30 percent of these patients receive no life-saving intervention at all.
Michael Ross, MD
Led by Emory emergency medicine physician Michael Ross, the Society of Chest Pain Centers (SCPC) and the American Heart Association (AHA) recently announced they will be joining efforts to save even more lives. The joint agreement seeks to improve cardiac care, specifically the care of patients suffering from STEMI.
The new collaborative framework for hospital accreditation meets criteria of the AHA initiative â€œMission: Lifeline,” established in 2007 to improve the processes surrounding care of the STEMI patient by eliminating the obstacles that keep patients from accessing and receiving appropriate treatments.
Mission: Lifeline systems start with the 9-1-1 call or at the point of entry in the emergency system, continue through the catheterization laboratory and through hospital discharge by promoting best practices that use the latest scientific evidence-based treatment for STEMI.
Mission: Lifeline systems currently cover more than 56 percent of the United States. Mortality rates from STEMI have decreased from 5.8 percent in 2008 to 4.8 percent in 2010.
â€œSCPC, through their Chest Pain Center accreditation, has already improved cardiac processes in close to 14 percent of hospitals within the U.S. and has moved this accreditation to the international setting,â€ says Ross, who is immediate-past SCPC president and an associate professor of emergency medicine and medical director for observation medicine at Emory.
â€œCollaboration between these two non-profit organizations, who share similar missions, will help bring consistency to health care delivery by providing a standard approach to the treatment of STEMI. Providing cardiac accreditation programs is in the best interest of patients, meets the needs of the health care community, and will help to significantly reduce cardiac deaths.â€
Most commonly known as coronary angioplasty, PCI is a therapeutic procedure to treat the narrowed coronary arteries of the heart found in coronary heart disease. The designation is a distinguishing attribute since PCI is now the preferred treatment for heart attack patients.
For more information about heart disease and cardiac care option – from heart transplants and ventricular assist devices to imaging services and minimally-invasive interventional treatments, please visit Emory Healthcare at: http://www.emoryhealthcare.org/heart-center-atlanta/.
When Jon Pomenville of Anderson, SC, decided to donate a kidney altruistically to someone â€“ anyonein need, anywhere in the country â€“ little did he know his selfless sacrifice would in turn change the lives of not one, but numerous individuals and their families, including one little boy from Atlanta.
And little did he know that the selfless, anonymous act would quickly become not so anonymous. During a recent post-surgical clinic visit to Emory University Hospital, Pomenville met by accident â€“ right in the transplant clinic waiting room â€“ many of the individuals whose lives were changed. Soon the patients â€“ recipients and donors â€“ two father and son combinations and Pomenville, the man who would give to anyone â€“ were hugging, shaking hands, and recounting their backgrounds and experiences.
Pomenville and the others, who were all part of what is called a paired kidney exchange, were unwittingly scheduled for appointments within a short period of one another. As one person began recounting the experience, eyes and ears began to focus on the tale being told from across a crowded room.
A chance meeting in a doctors’ waiting room led to a meeting between most of the people involved in the paired kidney exchange.
The Emory Transplant Center created and opened its innovative Paired Donor Kidney Exchange Program in 2009, providing greater hope for patients in need of kidney transplants. According to Kenneth Newell, MD, director of Emory’s living donor program, a paired exchange donation allows healthy individuals to donate a kidney to either a friend, loved one, or even altruistically to a stranger, despite incompatible blood matches. In paired donation, a donor and recipient are matched with another incompatible donor and recipient and the kidneys are exchanged between the pairs.
The procedure is another form of living donor transplantation. Donated kidneys also come from recently deceased donors. While most kidneys from deceased donors function well, studies have shown that a kidney from a living donor, either a blood relative or an unrelated person, provides the greatest chance for long-term success.
“Paired donor exchanges allow us to cast a much wider net to find compatible donors and recipients,” says Newell. “With a paired kidney transplant, one incompatible donor-pair is able to give a healthy kidney to a compatible recipient. In exchange, the second donor-recipient pair will give a compatible kidney to the first donor-recipient pair, making two compatible living donor transplants possible and increasing the potential number of available donor kidneys. This option can help those patients waiting for kidney transplants who have family members or friends willing to be donors and who are medically suitable, but who have an ABO blood type that is incompatible with the recipient’s blood type.”
Because of Pomenvilleâ€™s donation, a 7-year-old boy named Zion was able to receive a lifesaving kidney from an unrelated donor because his dad, Mike, was able to donate. His surgery took place at Children’s Healthcare of Atlanta at Egleston.
And Gerald Smith of Five Points, Ala., would receive his life-saving kidney because his son, Matt, a recent University of Alabama graduate, would donate his to Zion. And finally, 20 year-old Edward Hill of Macon, a young man with a history of health challenges, would also receive his transplant at Childrenâ€™s Healthcare of Atlanta â€“ completing the six-person cycle, although the donor of Edwardâ€™s kidney is still unknown.
And Zion and Matt Smith will not only share a common bond and connection throughout life in the form of a kidney, but something even sweeter that that â€¦ blue Powerade.
â€œIâ€™ve always really enjoyed drinking Powerade, particularly the blue flavor,â€ says Smith. Shortly after Zion awoke from his surgery, he inexplicably began requesting the blue-tinted soft drink too.
Other powerful kidney transplant stories out of Emory:
Emory Healthcare is a key player in plans to bring the worldâ€™s most advanced radiation treatment for cancer patients to Georgia.Â Emory Healthcare has signed a letter of intent with Advanced Particle Therapy, LLC, of Minden, Nevada, opening the door to a final exploratory phase for development of The Georgia Proton Treatment Center – Georgiaâ€™s first proton therapy facility.
For certain cancers, proton therapy offers a more precise and aggressive approach to destroying cancerous and non-cancerous tumors, as compared to conventional X-ray radiation. Proton therapy involves the use of a controlled beam of protons to target tumors with precision unavailable in other radiation therapies. According to The National Association for Proton Therapy, the precise delivery of proton energy may limit damage to healthy surrounding tissue, potentially resulting in lower side effects to the patient. This precision also allows for a more effective dose of radiation to be used.
Proton therapy is frequently used in the care of children diagnosed with cancer, as well as in adults who have small, well-defined tumors in organs such as the prostate, brain, head, neck, bladder, lungs, or the spine.Â And research is continuing into its efficacy in other cancers.
The gantry, or supporting structure, of a proton therapy machine.
The closest proton therapy facility to Georgia is the University of Florida Proton Therapy Institute in Jacksonville.Â Currently there are only nine proton therapy centers in the United States, including centers at Massachusetts General Hospital, MD Anderson Cancer Center in Houston and the University of Pennsylvania.
This is an exciting development in our ability to offer not only patients throughout Georgia and the Southeast the widest possible array of treatment options but patients from around the world who can come to Atlanta via the world’s busiest airport, Hartsfield-Jackson International. In addition, we will work to expand its utility and access for patients through collaborative research projects with Georgia Tech and other institutions. Winship physicians will also be able to reach out to their international colleagues and provide direction in how best to study and implement this technology in the care of cancer patients.
Under the letter of intent, Emory Healthcare faculty and staff will provide physician services, medical direction, and other administrative services to the center. Advanced Particle Therapy, through a Special Purpose Company, Georgia Proton Treatment Center, LLC, (GPTC) will design, build, equip and own the center.Â The facility, which will be funded by GPTC, will be approximately 100,000 square feet and is expected to cost approximately $200 million.Â Site selection for the facility is underway, and pending various approvals, groundbreaking is expected in the Spring of 2012.
The follow video presents a 3D simulation of proton therapy technology.
As parents we hope all babies are born with a healthy start in life, after a full 37 â€“ 40 weeks in the womb. Sadly, every year more than half a million babies are born prematurely in the United States. The rate of premature birth has risen by 30 percent since 1981 according to the March of Dimes. Itâ€™s not clear why some babies are born before full gestation – before their lungs, brains or other organs are fully developed. Thousands donâ€™t live to celebrate their first birthday as a result.
In Georgia more than 400 babies are born too soon each week.Â Dr. William Sexson, a neonatologist and professor of pediatrics at Emory University School of Medicine and March of Dimes Prematurity Campaign Chair witnesses the effects of preterm birth every day.Â He says, â€œPremature birth is the leading cause of infant mortality. Babies born just a few weeks too soon are at increased risk for newborn health complications, such as breathing problems, can face serious health challenges and are at risk of lifelong disabilities.â€
On Saturday April 30, 2011, a legion of more than 10,000 families and business leaders from across Georgia will band together for the March of Dimes annual â€œMarch for Babies.â€ With more than 30 â€œMarch for Babiesâ€ events planned throughout the state, the annual affair is the nationâ€™s oldest walk fundraiser dedicated to preventing premature birth, birth defects and infant mortality.
â€œMarch for Babiesâ€ supports research and educational programs aimed at helping women have healthy babies. Funds raised from the â€œMarch for Babiesâ€ event will support prenatal wellness programs, critical research and community grants, along with local resources such as the Angel II neonatal transport unit at Grady Memorial Hospital.
Most pregnancies last around 40 weeks. Babies born between 37 and 42 completed weeks of pregnancy are called full term. Babies born before 37 completed weeks of pregnancy are called premature. â€œWomen who have hypertension and diabetes are at higher risk to have preterm babies or babies with health problems,â€ says Sexson.
According to the March of Dimes, the most urgent infant health problem in the U.S. today is premature birth. It affects more than half a million babies each year and is the leading cause of newborn death within the first month of life. Last November, the March of Dimes issued a Report Card on Premature Birth, giving the nation a â€œDâ€ and Georgia, the grade of â€œF.â€Â Sexson adds, â€œWe have a long way to go before all babies in America get a healthy start in life and we are committed to working with state health officials, hospitals and health care providers to continue to fight for preemies.â€
The March of Dimes is the leading nonprofit organization with its mission to improve the health of babies by preventing birth defects, premature birth and infant mortality.
For more information, or to participate in â€œMarch for Babiesâ€ visit marchofdimes.com.
A new pilot simulation laboratory at Emory University Hospital Midtown (EUHM) is providing medical students, residents, nursing students and staff with hands-on training to develop, perfect and maintain their skills. Located in the former obstetrics/gynecology (OB/GYN) operating rooms, space that wasnâ€™t currently being utilized, the lab focuses on team building, clinical competencies and research. This is the first simulation lab of its kind at EUHM.
The simulation lab is a joint venture of Emory Healthcare and Emory University School of Medicine, both providing equipment to outfit the lab and a wealth of expertise. Nursing Education, a department within Emory Healthcare, and the Emory School of Medicine have worked together in the development of the simulation lab. Some equipment being used has been donated or given to the hospital for training purposes.
One side of the simulation lab is set-up to train OB/GYN residents and students in deliveries and laparoscopic surgeries, cardiac arrests, mock codes and low volume/high risk procedures.
The other side of the lab focuses on nursing training, nursing education, central-line and intravenous insertion and medication dispensing. It is also being used by nursing for competency validation for new nursing employees and for annual skills assessment of current nursing staff.
Those instrumental in setting up the nursing side of the simulation lab are Sharlene Toney, PhD, RN, executive director, Professional Nursing Practice for Emory Healthcare, and Beth Botheroyd, RN, BSN, MHA/INS, nursing education coordinator for Emory Healthcare.
Toney says the lab is a critical part of the training and education of new nurses and current nursing employees, while also focusing on process improvement activities concentrated on patient safety. Nurses also have the opportunity to test their skills on training simulators and new equipment while in the lab.
Ander describes the lab as a â€œproof of conceptâ€ center, with the small set-up being only the first step in the process. Down the road, he envisions a larger simulation center for all Emory Healthcare employees, Emoryâ€™s School of Medicine and even the community.
Arluck observes as resident Hudson performs an ultrasound on Noelle, the birthing simulator.
Arluck says she uses the simulation lab regularly with OB/GYN residents, teaching them the basics of laparoscopic surgery on a training module and monitor. She also teaches students with the help of an adult-size doll named Noelle, which simulates delivering a baby and going into cardiac arrest.
The simulation lab has also opened the door to medical education research. Emory pulmonary critical care fellow, Jenny Han, MD, is studying to see if a standardized, advanced cardiac life support simulation training has any effect on real patient outcomes in the hospital.
In the future, plans include adding cardiac catheterization simulator capabilities, as well as emergency department and nursing station simulation space.
Dr. Anita Sethna, director of the Emory Facial Center.
The desire to look good and feel great about ourselves doesnâ€™t disappear when we hit 50, 60 or even age 70.Â Caring for your skin is the most important way to impact the way you age.
â€œLooking good does not have to involve drastic procedures,â€ says Dr. Anita Sethna, director of the Emory Facial Center.Â â€œThere are small, simple and affordable ways to care for your calling card to the world:Â your face.â€
Dr. Sethna offers these tips:
Protect yourself against sun damage. Wearing makeup or moisturizer with sunscreen daily is incredibly important, advises Sethna.Â The more careful you are about protecting yourself against even daily skin exposure, the less damage you will be causing your skin as you age; decreasing your chances of getting skin cancer and preserving the texture and plumpness of your skin.Â This applies to all skin types, genders and degrees of pigmentation. She recommends products that give at least 30 UVA/UVB protection.
Quit smoking. Smoking is not only horrible for your health, but is also horrible for your skin, she warns.Â Nicotine causes a decrease in blood supply to the skin and reduces its ability to heal, eventually giving it a leathery look.
Some products can help. Moisturizers can benefit the appearance of aging skin and most any over-the-counter moisturizers will work.Â Products containing retinol and antioxidants such as Vitamin C can stimulate collagen production, which is important for the skinâ€™s elasticity and fullness. Sethna recommends prescription strength products for the best results, such as Retin-A, and skin lightners such as hydroquinone, which can even out skin tone.
For those who want to take a step further to prevent wrinkles, the careful use of Botox in certain areas of the face can reduce repeated motion of the skin and soften lines around the eyes, between the eyebrows and on the forehead.Â Sethna says that in some cases, the injections can even prevent the formation of new lines on the face.
Sethna also wants us to remember that perfection is â€œfine when youâ€™re talking about a painting or a new dress,â€ but our face is a different story.
â€œPerfection should not be a goal when you are talking about your appearance.Â Your expression, quirks and small imperfections make you – you, and also make you beautiful.Â You should not be embarrassed or ashamed at wanting to preserve that beauty.â€
Emory Heart & Vascular Center cardiologist, Khusrow Niazi, MD, will answer questions about peripheral artery disease (PAD) in a live web chat today from 12:30 p.m. to 1:15 p.m. Also called peripheral vascular disease, PAD occurs when arteries in the legs narrow as a result of atherosclerosis, a buildup of fatty deposits and plaque in the lining of blood vessels. When plaque builds up in the blood vessels that carry blood from the heart to the rest of the body, they harden, narrow and clog, causing poor circulation. PAD often goes unrecognized, causing no symptoms at all – or symptoms you may think are something else, such as muscle cramps.
While difficulty walking may be the primary symptom, PAD can advance to complete arterial blockage and critical limb ischemia, causing painful foot ulcers, infections or even gangrene that requires amputation. It is associated with high blood pressure, diabetes, heart disease and stroke and affects eight to 12 million people in the United States.
Dr. Niazi, assistant professor of medicine, Emory University School of Medicine, will be available to answer questions and discuss various topics around PAD, including prevention, detection, healthy tips, rehabilitation and innovative new cardiovascular research on the horizon.
“It is the oncology nurse whose ‘fingerprints’ are on the entire matrix of therapies,” said Seliza Mithchell.
A keynote presentation on â€œfingerprintsâ€ might be more suited to a police convention than an oncology nursing symposium.Â That is unless Selinza Mitchell is the speaker. Mitchell, a nurse educator and presenter was the keynote speaker at the third annual Winship Oncology Nursing Symposium, held March 18 and 19 at the Evergreen Conference Center in Stone Mountain, Georgia.
Mitchellâ€™s presentation focused on the impact oncology nurses have on the hundreds of patients and families they touch, both literally and figuratively.Â It is the oncology nurse whose â€œfingerprintsâ€ are on the entire matrix of therapies, from administration of todayâ€™s latest targeted-therapy drugs to helping patients and families navigate an increasingly complex health care system.
That concept also formed the basis of many of the discussion groups that were part of the symposium.Â â€œThe entire model of care delivery is changing,â€ says Amelia Langston, MD, professor of Hematology and Medical Oncology at the Winship Cancer Institute.Â â€œCare delivery is more of a team approach and is less physician-centered.Â Therefore there is great interest in the expanding role of nurses, nurse practitioners, and physician assistants.â€
Amelia Langston presenting at the Winship Oncology Nursing Symposium
The Winship Oncology Nursing Symposium has grown in three short years into one of the most informative and influential among this growing market of nursing continuing education opportunities.Â Among the topics covered in this yearâ€™s meeting were cancer genetics, image-guided medicine, minimally invasive treatment, disease-specific topics and the expanding role of non-physician providers against the backdrop of health care reform.
â€œThe health care system is demanding cost effective, clinically relevant continuing education programs in nursing and specifically in oncology nursing,â€ says Joan Giblin, MSN, FNP, a course director for the symposium and Manager of Patient Access at Winship.Â â€œOffering a high quality, regional program that can provide the latest information on advanced nursing practice, research, and other issues is central to meeting that need.â€
In addition to Joan Giblin, course directors for the event were Deena Gilland, RN, MSN, Director of Nursing at Winship, and Kevin Schreffler, RN, MSN, Clinical Nurse Specialist at Winship.
The Pap smear â€“ also called Pap test â€“ is part of the standard annual wellness exam for womenâ€™s health and used as a first step in detecting cervical cancer.Â But according to a recent article published in the International Journal of Cancer,Â the Pap test may not provide reliable results for certain types of cancer that are harder to detect.
Kevin Ault, MD, associate professor of obstetrics and gynecology at Emory University School of Medicine and investigator at the Emory Vaccine Center conducted a post-hoc analysis of the FUTURE I and FUTURE II (Gardasil) vaccine trials.Â Based on that analysis Ault, a leading expert and pioneer in the field of human papilloma virus (HPV), says a regular Pap test is not always effective in diagnosing adenocarcinoma, because it starts high up in the cervical canal and may not be sampled by the Pap smear.
â€œThere are a number of reasons the Pap smear could lead to inaccurate results. For example, the pathologist examining the cells could make an error, the gynecologist may not sample the cervix adequately or an infection could obscure the results,â€ says Ault.
According to Ault, andenocarcinoma is the second most common type of cervical cancer, accounting for about 20 percent of all cervical cancer cases. While the overall incident of cervical cancer is on the decline, Ault reports the proportion of cervical cancers that are andenocarcinoma is rising.
Cervical cancer is the eighth most common type of cancer in American women. More than 12,000 new cases of invasive cervical cancer are diagnosed each year, and more than 4,200 women in the U.S. die from of this disease annually* according to the American Cancer Society.Â Scientists believe that pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the sexually transmitted HPV.
â€œThe take-away from this recent paper is the HPV test would be a better test for the harder to detect adenocarcinoma cervical cancer, if not all cervical cancer,â€ says Ault.
Atrial fibrillation (commonly called A-fib) is a heart condition in which the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to pool and form clots in the left atrial appendage (LAA). If a clot forms in this area, it can increase the chances of having a stroke.
Many patients with A-fib are prescribed blood-thinning medications, such as warfarin (brand name Coumadin), to prevent blood from clotting. This medication is effective in reducing the risk of stroke, but may cause side effects such as bleeding. It also requires frequent blood draws to monitor dosage levels.
The trial, called PREVAIL (Prospective Randomized EVAluation of the Watchman LAA Closure Device In Patients with Atrial Fibrillation Versus Long Term Warfarin Therapy), involves implanting a small, umbrella-shaped mesh device called the Watchman closure device, into the heart chamber via catheter. This is a confirmatory study (and the third study testing the implant), which will also look at safety and efficacy of the device.
David De Lurgio, MD, associate professor of medicine in the Division of Cardiology, Emory University School of Medicine, is the principal investigator of the trial. He explains that by implanting this device into the left atrial appendage of the heart, it closes that area off. That, in turn, prevents blood clots from escaping and entering the blood stream, which could lead to a stroke.
Patients are randomly selected by computer to either receive the device or remain on Coumadin without the device (control group). Those selected to receive the device will remain on Coumadin for 45 days following implant. If the heart tissue has healed after those 45 days, participants will be taken off Coumadin and placed on aspirin therapy and possibly clopidogrel (Plavix), an anti-platelet medication.
Researchers will then follow study patients with and without the device for five years, monitoring those who are no longer taking Coumadin very closely. If the FDA approves the device at the end of this clinical trial, participants in the control group will then have the option to receive the device.
De Lurgio and his colleagues have had five years of experience with this technology, thus far. Emory Healthcare is the only health system in Georgia providing access to this device through participation in this clinical trial.