Synthetic Human Angiotensin II for the Treatment of Vasodilatory Shock

MedicalResearch.com Interview with:

Ashish Khanna, MD, FCCP Assistant Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine Staff Intensivist Center for Critical Care and Department of Outcomes Research Cleveland Clinic, Cleveland

Dr. Khanna

Ashish Khanna, MD, FCCP
Assistant Professor of Anesthesiology, Cleveland Clinic Lerner College of Medicine
Staff Intensivist
Center for Critical Care and Department of Outcomes Research
Cleveland Clinic, Cleveland

MedicalResearch.com: How did you become interested in this topic?

Response: Anesthesia forms the basis of my training but I also completed a fellowship in critical care and, at the present time, I do more work in critical care than anesthesia. About 75% of my time is spent in the Cleveland Clinic critical care units, including the Medical and surgical ICUs (Intensive Care Units).

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Elevated Kidney Biomarker Creatinine Predicts Worse Outcome in STEMI Heart Attack

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MedicalResearch.com Interview with: Mohamed Khayata, MD Internal Medicine Resident PGY-3 Cleveland Clinic Akron General, Akron, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors. We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI. Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention. MedicalResearch.com: What should readers take away from your report? Response: Creatinine level is being checked in almost all patients who present with STEMI within few hours of presentation. Based on previous reports and our results, creatinine is a critical marker that correlate not only with mortality, but is also with morbidity during hospital stay. This marker should be used as a predictor of worse outcomes; thus, patients with higher creatinine levels should be provided higher attention. MedicalResearch.com: What recommendations do you have for future research as a result of this study? Response: Based on our study limitations, I would encourage performing similar outcomes analysis in larger group, multi-center registries. I would also suggest extending outcomes to post-discharge status including quality of life besides cardiovascular compilcations. MedicalResearch.com: Is there anything else you would like to add? Response: MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community. Citation: Abstract presented at the 2017 National Kidney Foundation Spring Clinical Meeting https://www.kidney.org/spring-clinical The Impact of Admission Serum Creatinine on Major Adverse Clinical Events in ST-Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. More Medical Research Interviews on MedicalResearch.com

Dr. Khayata

Mohamed Khayata, MD
Internal Medicine Resident PGY-3
Cleveland Clinic Akron General
Akron, Ohio

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies showed that patients with ST-elevation myocardial infarction (STEMI) who had elevated creatinine and/or impaired creatinine clearance on presentation had higher short- and long-term mortality independent of other cardiovascular risk factors.

We used the National Cardiovascular Database Registry to investigate the impact of creatinine levels at the time of presentation on the cardiovascular outcomes in patients who presented with STEMI.

Our study showed that elevated creatinine levels correlated with higher incidence of atrial fibrillation, bleeding, heart failure, and cardiogenic shock during hospital stay after the percutaneous intervention.

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The Capillary Index Score as a Marker of Viable Cerebral Tissue in Stroke

MedicalResearch.com Interview with:

Firas Al-Ali, MD Departments of Neuro Interventional Surgery Cleveland Clinic Akron General, Akron, OH

Dr. Firas Al-Ali

Firas Al-Ali, MD
Departments of Neuro-Interventional Surgery
Cleveland Clinic Akron General, Akron, OH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Capillary Index Score (CIS) is based on the simple following assumption: “ the presence of capillary blush on diagnostic cerebral angiography, in an ischemic area, is an indicator of ischemic BUT viable cerebral tissue, while its absence indicate NONE- no viable tissue”

In previous publication we demonstrated that the CIS is a strong predictor of clinical outcome (CO) in patients presented acute ischemic stroke (AIS) . In previous studies AIS patients presented with Poor CIS (pCIS) did not have a good clinical outcome despite timely and full recanalization, while when patients presented with favorable CIS (fCIS) had 80-90% good clinical outcome when achieved good recanalization.

In this latest paper we tried to test our original assumption mentioned above. i.e. If the absence of capillary blush in a certain vascular cerebral territory signify no viable cerebral tissue then when an area on diagnostic cerebral cerebral angiogram (DCA) lack capillary blush BEFORE endovascular treatment, it will progress to infarcted tissue despite timely and full recanalization, seen as an area of hypodensity on the POST treatment Cat-Scan (CT).

While an area with Capillary blush in an ischemic area seen on the pre treatment DCA, will not show infarction on POST treatment CT if we obtain successful and timely recanalization.

In this paper we matched areas on the Pre and post -treatment CT to its corresponding location on the Pre-treatment DCA, and we demonstrated that when an area lacked capillary blush on the pre-treatment DCA had a very high chance to progress from normal on the Pre-treatment CT to hypodensity on the post treatment CT (infarcted cerebral tissue). while the areas with capillary blush on the rep treatment CT stayed normal on the post treatment CT when we achieve timely recanalization of the occluded vessel.

MedicalResearch.com: What should readers take away from your report?

Response: The Capillary Index Score is a powerful tool to assess residual viable tissue in a ischemic area, and has a great prognostic value for clinical outcome.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: We are now enrolling patient in a multi-center prospective trial, the Capillary Index Score Trial, phase I, to prove the value of CIS prospectively, and to demonstrate that:
1- CIS is a powerful indicator of clinical outcome
2- Treatment patients with pCIS could harmful by demonstrating that most complications happen in the pCIS group.

In The CIS Trial, phase II, we will try to demonstrate that treating patients with pCIS is futile by randomizing them into two groups:
One offered endovascular treatment plus usual medical management and the second group offered only usual medical management.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

The Capillary Index Score as a Marker of Viable Cerebral Tissue
Proof of Concept—The Capillary Index Score in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Trial
Firas Al-Ali, Olvert A. Berkhemer, Wina P. Yousman, John J. Elias, Evin N. Bender, Hester F. Lingsma, Aad van der Lugt, Diederik W.J. Dippel,Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Wim H. van Zwam, William P. Dillon and Charles B.L.M. Majoie
Stroke: http://dx.doi.org/10.1161/STROKEAHA.116.013513
Published: September 1, 2016

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Activating Scavenger System May Treat Blocked Blood Vessels Without Surgery

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Qing Kenneth Wang PhD, MBA Huazhong University of Science and Technology Wuhan, P. R. China and Department of Molecular Cardiology The Cleveland Clinic Cleveland, Ohio

Dr. Qing Kenneth Wang

Qing Kenneth Wang PhD, MBA
Huazhong University of Science and Technology
Wuhan, P. R. China and
Department of Molecular Cardiology
The Cleveland Clinic
Cleveland, Ohio

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Coronary Artery Disease (CAD) and its complication myocardial infarction (MI or so called heart attacks) are the most common causes of deaths in the US and other parts of the world. Based on the American Heart Association statistics, 620,000 Americans have a new MI each year in the United States alone, 295 000 have a recurrent MI, and nearly 400,000 of them will die from it suddenly. Moreover, an estimated 150,000 silent first MI occur each year.

CAD and MI are caused by an occlusion or blockage of a coronary artery, which disrupts blood flow to the heart region, leading to damage or death of cardiac cells, impairment of cardiac function and sudden death. Current treatment of CAD and MI relies on reperfusion therapy with reopening of the occluded coronary artery with percutaneous coronary intervention (PCA) and coronary artery bypass surgery (CABG). However, 12% of patients are not candidates for PCA or CABG due to an unfavorable occlusive pattern, diffuse coronary atherosclerosis, small distant vessels and co-morbidities. An alternative revascularization strategy has to be developed to benefit these patients.

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Study Addresses Appropriate Treatment Setting for Hypertensive Urgency

MedicalResearch.com Interview with:
Krishna Patel, MD, PG Y3 Resident
Internal Medicine Residency Program
Cleveland Clinic
Cleveland, OH 44195

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Patel: In our outpatient resident clinic practice, we found that patients with poorly controlled hypertension presenting with blood pressures in the hypertensive urgency range (SBP>=180mmHg or DBP >=110 mmHg) but with no symptoms of end-organ damage were common, however there was no clear cut manner in which these patient’s blood pressures were treated. According to the comfort level of the physician, these patients were managed in the office and on serial outpatient visits and some of the patients would be referred to the emergency department for management of these elevated blood pressures. Given there was not much prior literature on this topic, we decided to study the prevalence and short term cardiovascular outcomes for this population of patients.

We found that hypertensive urgency is quite common in the office setting (4.6% in our study). In absence of symptoms of end organ damage, the short term risk of major cardiovascular events was very low around 1%, and patients who were referred to the ED for management of blood pressures had a lot of unnecessary testing and more hospital admissions than those who were managed as an outpatient.

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Intestinal Metabolite Associated With Diffuse Atherosclerosis

MedicalResearch.com Interview with:

Dr. W.H. Wilson Tang M.D. Department of Cellular and Molecular Medicine (NC10) Cleveland Clinic Lerner Research Institute Cleveland, Ohio 44195

Dr. W.H.Wilson Tang

Dr. W.H. Wilson Tang M.D.
Department of Cellular and Molecular Medicine (NC10)
Cleveland Clinic Lerner Research Institute
Cleveland, Ohio 44195

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our group has recently described the mechanistic link between intestinal microbe-generated phosphatidylcholine metabolite, trimethylamine N-oxide (TMAO), and the pathogenesis of atherosclerotic coronary artery disease (CAD) and its adverse clinical outcomes. Here in a separate, independent, contemporary cohort of patients undergoing coronary angiography, we demonstrated the association between elevated fasting TMAO levels and quantitative atherosclerotic burden (as measured by SYNTAX and SYNTAX II scores) in stable cardiac patients and is an independent predictor for the presence of diffuse (but not focal) lesion characteristics.

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Decipher Genomic Testing Moves Prostate Cancer Prognosis into Precision Medicine Era

MedicalResearch.com Interview with:

Eric A. Klein, MD Chairman, Glickman Urological and Kidney Institute Cleveland Clinic

Dr. Eric Klein

Eric A. Klein, MD
Chairman, Glickman Urological and Kidney Institute
Cleveland Clinic

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Klein: Prostate cancer is an enigma. While this tumor is the second leading cause of cancer death among American men, most newly diagnosed disease detected by PSA screening is biologically indolent and does not require immediate therapy. Currently, the main clinical challenge in these men is to distinguish between those who can be managed by active surveillance from those who require curative intervention. Current clinical and pathological tools used for risk stratification are limited in accuracy for distinguishing between these scenarios.

An abundance of research in the last decade has provided evidence that genomics can offer meaningful and clinically actionable biological information to help inform decision making, and current National Comprehensive Cancer Network (NCCN) guidelines on prostate cancer endorse the use of commercially available genomic tools for men considering active surveillance.[1] It has been previously shown that the 22-gene genomic classifier, Decipher, accurately predicts the likelihood of metastasis and prostate cancer specific mortality when measured on tissue from radical prostatectomy specimens.[2] In multiple validation studies, it performed with higher accuracy and discrimination compared to clinical risk factors alone.

The current study[3] is the first to examine whether the use of Decipher might aid decision making when measured on biopsy tissue at the time of diagnosis. Men with available needle biopsy samples were identified from a study cohort that previously had Decipher performed on their matched radical prostatectomy tissue. In this cohort of mixed low, intermediate and high risk men, Biopsy Decipher predicted the risk of metastasis 10 years post RP with high accuracy, outperforming NCCN clinical risk categorization, biopsy Gleason score and pre-operative PSA. Furthermore, this study showed that Decipher reclassified 46% of patients into lower or higher risk classification compared to NCCN classification alone. The study also showed that Biopsy Decipher can identify men that are at high risk for adverse pathology as defined by the presence of primary Gleason pattern 4 or greater.

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Immune Modulator Ozanimod Shows Promise in Multiple Sclerosis

MedicalResearch.com Interview with:

Dr Jeffrey A Cohen MD Neurological Institute Cleveland Clinic, Cleveland OH 44195, USA

Dr. Jeffrey Cohen

Dr Jeffrey A Cohen MD
Mellen Center, Neurological Institute
Cleveland Clinic, Cleveland
OH 44195, USA

Medical Research: What is the background for this study? What are the main findings?

Dr. Cohen: Fingolimod, a non-selective sphingosine 1-phosphate receptor (S1PR) modulator, was the first oral medication approved to treat relapsing multiple sclerosis.  Though generally well tolerated, fingolimod’s first dose cardiac effects and other potential adverse effects complicate its use.  Ozanimod is a selective S1PR modulator with several other potentially advantageous pharmacologic properties.

The results of phase 2 RADIANCE trial were recently published.  In this trial, participants were randomized to placebo (n=88), ozanimod 0.5 mg (n=87), or ozanimod 1 mg (n=83) PO once daily for 24 weeks.  The mean cumulative number of gadolinium-enhancing lesions on monthly MRI scans at weeks 12-24, the primary endpoint, was reduced from 11.1 +/- 29.9 with placebo to 1.5 +/- 3.7 with ozanimod 0.5 mg and 1.5 +/- 3.4 with ozanimod 1 mg (both p<0.0001).  Other MRI endpoints supported the primary endpoint.  Ozanimod was well tolerated with good safety.  Importantly, the dose up-titration protocol effectively mitigated first dose cardiac effects.

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Very Early Preterm Births More Common In Black Mothers

More on Racial Disparities in Health Care on MedicalResearch.com

Emily A. DeFranco, D.O., M.S. Associate Professor Maternal-Fetal Medicine Center for Prevention of Preterm Birth, Perinatal Institute Cincinnati Children's Hospital Medical Center University of Cincinnati College of Medicine Department of Obstetrics and Gynecology Medical Sciences Building, Room 4553B Cincinnati, OH

Dr. Emily DeFranco

MedicalResearch.com Interview with:
Emily A. DeFranco, D.O., M.S
.
Associate Professor Maternal-Fetal Medicine
Center for Prevention of Preterm Birth, Perinatal Institute
Cincinnati Children’s Hospital Medical Center
University of Cincinnati College of Medicine
Department of Obstetrics and Gynecology
Medical Sciences Building, Room 4553B
Cincinnati, OH

Medical Research: What is the background for this study?

Dr. DeFranco: The Infant Mortality Rate in the state of Ohio is higher than many other states.  Additionally, there is a large disparity in the IMR with black infants impacted to a higher degree compared to white infants. For this reason, we are particularly interested in identifying factors that contribute to this disparity in order to identify potential areas where public health efforts can be focused.

We know that preterm birth is a major contributor to infant mortality, and that all babies born alive prior to 23 weeks of gestational age, i.e. “previable”, die after birth and contribute to the infant mortality rate.  In this study, we wanted to assess whether black women are more likely to have early preterm births at less than 23 weeks, and if so whether that may be part of the explanation of why black mothers are at higher risk of experiencing an infant mortality.

Medical Research: What are the main findings?

Dr. DeFranco: In this study, we found that black mothers were more likely to deliver than white mothers  at very early preterm gestational ages, less than 23 weeks.  We also found that the earlier the delivery, the larger the disparity with black mothers being at higher risk for the earliest deliveries compared to white mothers.  From this data, we estimated that in Ohio, 44% of all infant mortality in black mothers is caused by previable preterm birth, whereas only 28% of infant mortality in white mothers is attributed to the same cause.  We concluded that very early preterm birth in black mothers is a large contributor to the racial disparity observed in the infant mortality dilemma here in Ohio.

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Telemedicine Can Support Rapid Stroke Treatment in Ambulances

Ken Uchino, MD FAHA FANA Director, Vascular Neurology Fellowship Research Director, Cerebrovascular Center, Cleveland Clinic Associate Professor of Medicine (Neurology) Cleveland Clinic Lerner College of Medicine of CWRU Cleveland, OH 44195

Dr. Ken Uchino

MedicalResearch.com Interview with:
Ken Uchino, MD FAHA FANA

Director, Vascular Neurology Fellowship
Research Director, Cerebrovascular Center, Cleveland Clinic
Associate Professor of Medicine (Neurology)
Cleveland Clinic
Lerner College of Medicine of CWRU
Cleveland, OH 44195

Medical Research: What is the background for this study? What are the main findings?

Dr. Uchino: Treatment for acute ischemic stroke is time dependent. Multiple studies have reported strategies to improve time to treatment after arrival in the hospital. Mimicking pre-hospital thrombolysis of acute myocardial infarction pioneered 30 years ago, two groups in Germany have implemented pre-hospital ischemic stroke thrombolysis using mobile stroke unit (“stroke ambulance”) that includes CT scan and laboratory capabilities. These units have been demonstrated to provide stroke treatment earlier than bringing patients to the emergency departments.

Our report extends the concept mobile stroke unit further by using telemedicine for remote physician presence. The other mobile stroke units were designed to have at least one physician on board. This allows potential multiple or geographically distant units to be supported by stroke specialists.

The study demonstrates that after patient arrival in the ambulance, the time to evaluation (CT scanning and blood testing) and to thrombolytic treatment is as quick or better as patient arrival in emergency department door. We are reporting the overall time efficiency after emergency medical service notification (911 call) in a separate paper.

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