Overcoming cardiac pacemaker "source-sink mismatch"

Instead of complication-prone electronic cardiac pacemakers, biomedical engineers at Georgia Tech and Emory envision the creation of “biological Read more

Hope Clinic part of push to optimize HIV vaccine components

Ten years ago, the results of the RV144 trial– conducted in Thailand with the help of the US Army -- re-energized the HIV vaccine field, which had been down in the Read more

Invasive cancer cells marked by distinctive mutations

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

Emory Healthcare

A good reason to enjoy a little Valentine’s Day chocolate

From the Clinic to You

BY CHERYL WILLIAMS, RD, LD

If you’re looking for an excuse to indulge in the yummy chocolate you get this Valentine’s Day, research suggests it may not be so bad for you.

A number of studies, conducted over the last decade have associated cocoa and dark chocolate consumption with heart health benefits. These benefits come from cocoa, derived from the cacao plant, which is rich in flavonoids (cocoa flavanols to be exact). Flavonoids are antioxidants also found in berries, grapes, tea, and apples. As a whole, antioxidants prevent cellular damage and inflammation which are two major mechanisms involved in the development of heart disease.

So what does the research say?

A study published in the American Journal of Clinical Nutrition found that high-flavanol dark chocolate reduced bad cholesterol (LDL) oxidation and increased good cholesterol (HDL) levels. LDL oxidation promotes the development of plaque and hardening of the coronary arteries, thus lessening oxidation could help to prevent heart disease.

A Harvard research study found that flavanol-rich cocoa induced nitric-oxide production, which causes blood vessels to relax and expand, thus improving blood flow. Improved coronary vasodilation could potentially lower the risk of a cardiovascular event.

In a double-blind randomized Circulation study flavonoid-rich dark chocolate (containing 70% cocoa) reduced serum oxidative stress and decreased platelet activity (clumping) in heart transplant recipients. This favorable impact on vascular and platelet function is relevant because vascular dysfunction and platelet activation (adhesion upon damaged cell wall) are the basis of atherothrombosis (blood clotting) and coronary artery disease.

How can you reap chocolate’s potential benefits?

Not all cocoa products and/or chocolates are created equal. Milk chocolate, for example, is not rich in flavanols (contains only 10-20% cocoa solids) and white chocolate contains none at all. In addition, some cocoa products and chocolates are processed with alkali, which can destroy flavanols.

Follow these tips for heart healthy chocolate consumption:

  • Avoid cocoa products processed with alkali (dutched) as seen in the ingredient list
  • Choose dark chocolate with at least 70% cocoa
  • Enjoy 100% unsweetened non-dutched cocoa (great for hot chocolate!)

Also, remember that chocolate is not a health food, as it is high in calories, fat and added sugar. Thus, make room for dark chocolate by cutting extra calories elsewhere in your diet. Additionally, stick to small amounts (e.g. 1 ounce) and do not eat in place of plant-based whole foods such as vegetables and fruits.

Cheryl Williams is a registered dietitian at the Emory Heart & Vascular Center. She provides nutrition therapy, wellness coaching, monthly nutrition seminars and healthy cooking demonstrations working with the Emory HeartWise Cardiac Risk Reduction Program.

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New 3D MRI Technology Puts Young Athletes Back in Action

Emory MedicalHorizon
New technology has made it possible for surgeons to reconstruct ACL tears in young athletes without disturbing the growth plate.

John Xerogeanes, MD, chief of the Emory Sports Medicine Center and colleagues in the laboratory of Allen R. Tannenbaum, PhD, professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University, have developed 3-D MRI technology that allows surgeons to pre-operatively plan and perform anatomic Anterior Cruciate Ligament (ACL) surgery.

Link to YouTube video

The ACL is one of the four major ligaments in the knee, somewhat like a rubber band, attached at two points to keep the knee stable. In order to replace a damaged ligament, surgeons create a tunnel in the upper and lower knee bones (femur and tibia), slide the new ACL between those two tunnels and attach it both ends.

Traditional treatment for ACL injuries in children has been a combination of rehabilitation, wearing a brace and staying out of athletics until the child stops growing – usually in the mid-teens – and ACL reconstruction surgery can safely be performed.  Surgery has not been an option with children for fear of damage to the growth plate that would cause serious problems later on.

Xerogeanes explains that prior to using the 3-D MRI technology, ACL operations were conducted with extensive use of X-Rays in the operating room, and left too much to chance when working around growth plates.

Preparation with the new 3-D MRI technology allows surgery to be completed in less time than the traditional surgery using X-Rays, and with complete confidence that the growth plates in young patients will not be damaged.

Video Answers to Questions on ACL Tears

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Winter Storm 2011

Emory Healthcare puts patients first and provides 24 hour service to Atlanta Metro residents with doctors, nurses and staff staying in facilities to provide healthcare during one of the worst snow and ice storms to hit North Georgia in decades.

Here’s a television report that aired this evening at 5:24 pm on Atlanta’s WSB-TV Channel 2, (ABC affiliate).

WSB-TV report on Emory Healthcare during the January 2011 ice storm

Click for full report from WSB-TV, plus related article

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Support from Family and Close Friends Helps Recovery

Representative Gabrielle Giffords

Representative Gabrielle Giffords. Photo courtesy Giffords’ House office.

As we watch the daily progress of Representative Gabrielle Giffords, many close observers have commented that her recovery has been moving along more quickly than expected, and took a big leap after the visit from President Obama.  Related?  Perhaps.

Emory Psychologist, Dr. Nadine Kaslow, says there is no question that love and support from family, friends, and others individuals a patient is close to, can make an enormous difference in the recovery process.

She explains that after people come out of a coma, they often seem to have a special connection to those who were there for them during the coma, even if they don’t actually remember anything in a conscious way. Efforts to communicate with the patient, she says, whether those be verbal or physical, can reinforce linking and communication. She adds patients who have physical contact from a loved one seem to visibly relax and engage more.

At Emory, as we move more and more to patient and family centered health care, we actively encourage loved ones to talk with the patient, read to the patient, touch and stroke the patient. Additionally, beds and shower facilities are provided so that family members can be with their loved ones around the clock.

Owen Samuels, MD, director of Emory University Hospital’s neuroscience critical care unit, reiterates that patient families are now recognized as central to the healing process and their presence can even reduce a patient’s length of stay. He says that in a neurology ICU, where the average length of stay is 13 days, but is often many, many more, this can be especially beneficial.

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Emory University Hospital Midtown rings in New Year with new babies

Elijah Jacobs Westbrook and mom, LaSonta Westbrook

Twins Sidney and Taylor Mency and mom Jazmin Mency

Emory University Hospital Midtown (EUHM) rang in 2011 with some new bundles of joy. The hospital’s first baby of the New Year was born at 1:35 am. Little Elijah Jacobs Westbrook made his surprise appearance about six weeks early, says his mother, LaSonta Westbrook. The 4 lb., 6 oz. little boy was quickly greeted by his three big sisters, who enjoyed seeing him through the nursery window. As the first boy in the family, Westbrook says Elijah can expect lots of “mothering” from his sisters.

A little more than an hour later, EUHM welcomed its first set of twins in 2011. At 2:49 a.m. and 2:58 a.m., twin girls Sidney and Taylor Mency were born. Also a little early, mom Jazmin Mency says the gift of her girls is a wonderful way to begin the New Year.

The hospital ended up delivering 14 babies on January 1, 2011 (including the three mentioned), a busy way to kick off the New Year.

Emory University Hospital Midtown features a comprehensive maternity center that combines all maternity services on one floor, including labor and delivery, mother-baby suites and general and special care nurseries. Its design reflects the hospital’s unique philosophy of developmentally supportive care, encouraging family involvement and ensuring optimal infant development.

EUHM opened the first neonatal intensive care unit (NICU) in the Southeast in 1981, and currently, it serves as the Emory Regional Perinatal Center, one of five centers in the South designated to care for high-risk infants. With a Level III-designated NICU, the hospital’s skilled neonatal nursery staff has the expertise and technology to care for and treat almost any medical or surgical complication in sick and premature infants.

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Transplant nursing pioneer revisits Emory Transplant Center, 45 years later

Millie Elliott

Nearly 45 years after she cared for Georgia’s first organ transplant recipient, Millie Elliott, 84, visited the Emory Transplant Center outpatient transplant clinic to see how things have changed since her time at Emory. Elliott, who was Millie Burns at the time, worked at Emory University Hospital first as an obstetrics nurse, then as head nurse of an NIH-sponsored clinical research unit at Emory from 1961 to 1967. She served as a dialysis nurse on that unit and may have been the Southeast’s first renal transplant coordinator.

During her recent visit to Emory, this former Cadet Nurse Corps nurse and World War II veteran regaled the transplant center staff and kidney transplant program director Thomas Pearson, MD, PhD, with her stories about the first transplant at Emory. Elliott recalled spending a lot of time researching medical sources to prepare herself and her nurses for that remarkable day. The first transplant patient was a 16-year -old boy with renal failure who received a donor kidney from his father.

Read more

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When veterans face emotional trauma

Emory researcher Barbara Rothbaum, PhD, professor of psychiatry and behavioral sciences, Emory School of Medicine,  and director of the Trauma and Anxiety Recovery Program, has been treating military personnel with posttraumatic stress disorder (PTSD) for more than a decade, helping them to learn how to deal with troubling memories. Through therapy, the service members are taught that by re-living the traumatic event, they can begin to learn how to control the effect those memories have when they surface.

Barbara Rothbaum, PhD, demonstrating virtual reality exposure therapy used to help veterans with PTSD.

PTSD is treatable and treatments vary from exposure therapy to medication to meditation techniques. Symptoms include reliving the event; avoiding situations that stir up memories of the event; discomfort expressing feelings; being constantly on the lookout for danger; irritability; drinking or drug problems; and employment, social and relationship problems.

Many times it’s the family members, friends or co-workers who are first to identify a change in the veteran or service member. Symptoms can arise abruptly and begin to interfere with every day activities. When those symptoms last for more than four weeks, it is likely that individual has posttraumatic stress disorder (PTSD).

Rothbaum emphasizes that treatment for PTSD is very effective.  She encourages active duty military personnel, veterans and others who have been exposed to trauma to seek diagnosis and treatment for problems that persist.  Symptoms can worsen with time, or cause social and employment problems that complicate recovery, but treatment can help.

More information on PTSD is available from the U.S. Department of Veterans Affairs. A clinical trial taking place at Emory uses virtual reality therapy for military personnel who have served in Iraq and Afghanistan and have been diagnosed with PTSD.

Emory PTSD research by Dr. Rothbaum and her colleagues is featured on GE’s Healthymagination website.

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Initial Results of Heart Valve Study Encouraging

 

Emory heart patient, Glenrose Gay of Vidalia was the first person in GA to receive a new aortic valve via catheter. Pictured here in 2007 with Emory cardiologists, Drs. Peter Block (left) and Vasilis Babaliaros.

Since October 2007, Emory University Hospital has been one of approximately 20 hospitals nationwide, and the only site in Georgia, studying a new non-surgical treatment option for patients with failing aortic valves. The life threatening heart condition,aortic stenosis, affects tens of thousands of Americans each year when the aortic valve tightens or narrows, preventing blood from flowing through normally.

As part of the Phase II clinical trial, researchers have been performing transcatheter aortic valve implantation (TAVI) comparing this procedure with traditional, open-heart surgery or medical therapy in high-risk patients with aortic stenosis.

During the TAVI procedure, doctors create a small incision in the groin or chest wall and then feed the new valve, mounted on a wire mesh on a catheter, and place it where the new valve is needed. This offers a non-invasive way for doctors to treat patients who are too ill or frail to endure the traditional open-heart surgical approach.

The study, published Wednesday in The New England Journal of Medicine (NEJM) followed 358 patients who received either catheter-delivered valves or standard non-surgical treatment.

The findings showed that patients who had replacement heart valves delivered by catheter were more likely to survive a year than patients who were treated without replacing their original valves. According to the authors, catheter-delivered valves “should be the new standard of care” for patients who are not able to undergo surgery.

“These results show great promise for patients with severe aortic stenosis and help us make a giant step forward in our battle against this common disease,” says Peter Block, MD, professor of medicine, Emory School of Medicine and principal investigator of the study at Emory. “They are especially important since the number of people with failing valves is expected to greatly increase as baby boomers continue to age.”

Aortic valve stenosis often occurs with age, most commonly 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.

Approximately 90 patients have received new valves at Emory since the clinical trial started in 2007. Researchers hope to receive FDA approval in late 2011.

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Preterm infants born at unspecialized hospitals face higher risk of death

Very low-birth-weight (VLBW) and very preterm (VPT) infants not born in highly specialized, level III hospitals have a higher risk of neonatal and pre-discharge death compared to similar infants born at level III hospitals, according to a recent Journal of the American Medical Association (JAMA) study.

Lead study author Sarah Lasswell, MPH, and colleagues at the Rollins School of Public Health conducted a large-scale analysis of previous research to examine the relationship between hospital level at birth and neonatal (generally the first four weeks after birth) or pre-discharge mortality for VLBW (weighing 53 ounces or less) and VPT (32 weeks or less gestation) infants to determine the importance of level of care at birth to survival.

Lasswell and colleagues found that VLBW infants born in non-level III hospitals had a 62 percent increase in odds of neonatal/pre-discharge death compared with VLBW infants born in level III hospitals. In addition, VPT infants born in lower-level hospitals had a 55 percent increase in odds of neonatal/pre-discharge mortality compared with those born in level III facilities.

“The results of this review confirm a primary premise on which perinatal regionalization systems are based: high-risk infants have higher mortality rates when born outside hospitals with the most specialized levels of care,” Lasswell and colleagues write.

“Strengthening perinatal regionalization systems in states with high percentages of VLBW and VPT infants born outside of level III centers could potentially save thousands of infant lives every year.”

About 13 million babies are born prematurely every year – nearly 10 percent of all newborns – and more than 1 million premature babies die each year, according to the March of Dimes.

The study, “Perinatal Regionalization for Very-Low-Birth-Weight and Very Preterm Infants: A Meta-Analysis,” was published in the Sept. 1, 2010, issue of JAMA. It was conducted as part of Lasswell’s graduate research at the Rollins School of Public Health under the direction of Roger Rochat, MD. Lasswell is now a researcher at the U.S. Centers for Disease Control.

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Healing gardens provide beautiful therapy

Geriatric and chronic care patients at Wesley Woods Geriatric Hospital often need help improving their fine motor skills, muscle tone, range of motion, strength, and even peace of mind.

Master gardener Kirk Hines considers the Wesley Woods greenhouse another clinical space where patients can improve their skills through growing plants in therapy sessions or just enjoying the relaxation gardening can bring. For patients who can’t come to the garden, Hines brings gardening inside or even to their bedside.

“We want our patients to be successful,” says Hines. “Gardening draws on long-term memory for many of them. While they are planting tomato seeds or digging in the dirt, it takes away the anxiety they feel away from home. They don’t feel like they are in a hospital environment.”

Hines is a registered horticultural therapist who founded the program at Wesley Woods in 1993. Over those 17 years he has turned the gardens into a showpiece for sensory stimulation, with healing gardening spaces including courtyards with handrails, special walkways, and shady seating areas with fountains and goldfish.

When patients are discharged they often take the plants they have grown home with them, and many appreciative families have pitched in with their own labor and materials to keep the gardens beautiful.

Visit Emory Health magazine for more information about the healing gardens.

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