Mesenchymal Stem Cells May Reduce Complications in Heart Failure Patients with LVAD

MedicalResearch.com Interview with:

Annetine C. Gelijns, PhDChair, Department of Population Health Science & PolicyEdmond A. Guggenheim Professor of Health PolicyCo-Director, InCHOIR

Dr. Gelijns

Annetine C. Gelijns, PhD
Professor and System Chair
Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

Alan J Moskowitz, MDProfessor, Population Health Science and PolicyDepartment of Population Health Science & PolicyIcahn School of Medicine at Mount SinaiNew York, NY 10029-6574

Dr. Moskowitz


Alan J Moskowitz, MD

Professor of Population Health Science and Policy
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? Where do these mesenchymal cells come from? 

Response: Implantable LVADs significantly improve the survival and quality of life of advanced heart failure patients. However, these devices are associated with substantial adverse events, including infection and thromboembolic events. Moreover, whereas these devices improve myocardial function, few patients recover sufficient function to be explanted from their LVAD. These observations have focused attention on stem cells as a possible adjunctive therapy to further augment cardiac recovery.

Mesenchymal precursor cells (MPCs), which are obtained from healthy donors and culture-expanded, have been shown in animal and early human studies to improve cardiac function. Using temporary weaning as a signal of cardiac recovery, we conducted an exploratory trial in the Cardiothoracic Surgical Trials Network (CTSN), which found that MPCs increased the probability of temporary weaning from full LVAD support compared to sham-control patients. Therefore, this signal of efficacy led the CTSN to design our current follow-up trial evaluating the efficacy and safety of a higher dose of MPCs in LVAD patients.

Continue reading

Trans Women May Require Higher Doses of Estrogens

MedicalResearch.com Interview with:

Joshua Safer, MD, Executive DirectorCenter for Transgender Medicine and SurgeryMount Sinai Health SystemSenior Faculty, Medicine, Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount Sinai

Dr. Safer

Joshua Safer, MD, Executive Director
Center for Transgender Medicine and Surgery
Mount Sinai Health System
Senior Faculty, Medicine, Endocrinology, Diabetes and Bone Disease
Icahn School of Medicine at Mount Sinai

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

Response: The standard trans feminizing hormone regimen includes estrogen both to suppress testosterone and so that the individual has sufficient circulating sex hormone in the body for good bone health. After orchiectomy, there is no need to suppress testosterone because the levels are very low and it is common to cut the estrogen dose in half.  Cis women with premature ovarian failure often take about 2 mg of estradiol daily so that dose has seemed reasonable for trans women without testes.  However, when my co-author Sira Korpaisarn and I checked estradiol levels and gonadotropins (pituitary hormones, LH and FSH) as a guide to dosing, we found that based on that testing, trans women may require higher doses of estrogens than the 2 mg that we expected.

Continue reading

Pathogenic RET Variants Occur at Higher Prevalence Than Previously Recognized

MedicalResearch.com Interview with:

Emily J. Gallagher, MDAssistant Professor of MedicineEndocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount Sinai 

Dr. Gallagher

Emily J. Gallagher, MD
Assistant Professor of Medicine
Endocrinology, Diabetes and Bone Disease
Icahn School of Medicine at Mount Sinai 

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

Response: Multiple Endocrine Neoplasia Syndrome Type 2 (MEN2) is an inherited endocrine disorder characterized by the development of pheochromocytoma, medullary thyroid carcinoma (MTC) and parathyroid tumors. It occurs due to activating missense variants in the RET gene.

The estimated prevalence of MEN2 is 1 per 30,000 in the general population. Through a collaboration between The Center for Genomic Health, the Charles Bronfman Institute for Personalized Medicine, and the Division of Endocrinology at Mount Sinai, our aim was to investigate the prevalence and clinical manifestations of pathogenic RET variants in the multi-ethnic BioMe Biobank.

The BioMe Biobank is an electronic health record-linked biobank with exome sequencing data available for more than 30,000 patients recruited across The Mount Sinai Health System.

Continue reading

Erectile Dysfunction: Advanced Imaging Demonstrates Link with Atherosclerosis

MedicalResearch.com Interview with:

Jagat Narula, MD, PhDPhilip J. and Harriet L. Goodhart Professor of Medicine (Cardiology)Associate Dean for Global HealthDirector of the Cardiovascular Imaging ProgramMount Sinai Medical Center

Dr. Narula

Jagat Narula, MD, PhD
Philip J. and Harriet L. Goodhart Professor of Medicine (Cardiology)
Associate Dean for Global Health
Director of the Cardiovascular Imaging Program
Mount Sinai Medical Center

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

Response: Atherosclerosis has been linked to causing erectile dysfunction (ED) in the majority of patients with this cardiovascular condition, but researchers have not had the means of demonstrating atherosclerosis in penile arteries until now.  This unique study uses advanced imaging to detect how strong the association actually is.  For the first time, researchers have used advanced imaging of penile arteries to show a link between atherosclerosis and erectile dysfunction (ED).

Continue reading

TAVRcathAID Mobile App Facilitates Coronary Access Education After TAVR

MedicalResearch.com Interview with:

Annapoorna Kini, MDZena and Michael A Wiener Professor of MedicineDirector of the Cardiac Catheterization LaboratoryMount Sinai Heart at Mount Sinai Hospital

Dr. Kini

Annapoorna Kini, MD
Zena and Michael A Wiener Professor of Medicine
Director of the Cardiac Catheterization Laboratory
Mount Sinai Heart at Mount Sinai Hospital

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

  • Expanding indication and use of Transcatheter aortic valve replacement (TAVR) poses a unique problem of coronary access after valve implantation.
  • Troubleshooting tools and techniques have been published but are not available at the fingertips of the user at all the times.
  • We tried to address this unique problem with an innovative educational mobile application (app) called “TAVRcathAID”.

Continue reading

Even with Controlled LDL-Cholesterol, PCI Stent Patients Have Residual Inflammatory Risk

MedicalResearch.com Interview with:

Dr. George Dangas MD PhDProfessor of Medicine, CardiologyMount Sinai Health System

Dr. Dangas

Dr. George Dangas MD PhD
Professor of Medicine, Cardiology
Mount Sinai Health System

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

Response: Widespread use of statins targeted to decrease levels of low density lipoprotein cholesterol (LDL-C) below 70mg/dL are recommended by guidelines. However, residual cholesterol risk may only be one part of the residual risk equation. Indeed, Biological inflammation has long been known as a pathophysiological mechanism of atherosclerosis and the recent CANTOS trial opened new therapeutic perspective by demonstrating that inflammation modulation via selective interleukin-1β inhibition could result in improved diagnosis in patients with coronary artery disease.

However, the prevalence and impact of a residual inflammatory biological syndrome in patients with controlled cholesterol risk is unclear. Continue reading

Upper Arm Fractures: Comordid Conditions Linked to More Opioids and Longer Hospital Stays

MedicalResearch.com Interview with:

Paul Cagle, Jr. MDAssistant Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Cagle

Paul Cagle, Jr. MD
Assistant Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings ie What are some of the significant comorbidities? 

Response: In this study our goal was to better understand what medical issues (medical comorbidities) can cause trouble or issue for patients with a proximal humerus fracture (shoulder fracture).  To tackle this issue we used a large national sample of patients and sorted our the different medical issues the patients had.

We found that patients with increased medical issues had longer hospital stays and higher use of opioid medications (pain medications).

Continue reading

Knee Replacement: Benefits and Risks of Antibiotic-Loaded Bone Cement

MedicalResearch.com Interview with:

Darwin Chen, MD Assistant Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Chen

Darwin Chen, MD
Assistant Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai

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

Response: Periprosthetic joint infection unfortunately remains a leading cause of total knee arthroplasty failure. One method of mitigating the risk of PJI is to use antibiotic loaded bone cement in a prophylactic fashion.

While the use of antibiotic cement makes inherent sense, the decision is not as simple as it seems. There are potential side effects such as renal damage, antibiotic hypersensitivity, and antibiotic resistance. Antibiotics decrease the mechanical strength of cement fixation, which may impact component loosening. Additionally, antibiotic cement is significantly more expensive than standard cement, driving up cost. Currently there is no consensus on if antibiotic cement truly reduces infection risk and there are many conflicting studies.

The purpose of our study is the use a large national database to evaluate real world utilization patterns of antibiotic cement, and assess outcomes, complications, and cost associated with antibiotic cement usage. Our hypothesis was that antibiotic cement is associated with a decreased risk of infection and no increased risk of systemic complications. 

Continue reading

Lack of Patient Education as a Cause of Increased Postoperative Opioid Use

MedicalResearch.com Interview with:

Dr. Alexis Colvin, MDAssociate Professor of Orthopedic SurgeryIcahn School of Medicine at Mount Sinai

Dr. Colvin

Dr. Alexis Colvin, MD
Associate Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai 

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

Response: 40% of all opioid overdose deaths involve a prescription opioid and orthopaedic surgeons are the 3rd highest prescribers of opioids.  Set guidelines for post surgery opioid prescriptions have not been established.  Arthroscopic knee meniscectomy is one of the most common orthopaedic procedures.  The purpose of this study was to determine how many opioids were being prescribed  among a group of six sports fellowship trained orthopaedic surgeons versus how many patients were actually using.

Continue reading

Lipomas: Deoxycholic Acid (Kybella®) Can Shrink Tumors Before Removal

MedicalResearch.com Interview with:

Hooman Khorasani, M.D. Cosmetic Surgeon & Mohs Skin Cancer Surgeon Icahn School of Medicine at Mt. Sinai

Dr. Khorasani

Hooman Khorasani, M.D.
Cosmetic Surgeon & Mohs Skin Cancer Surgeon
Icahn School of Medicine at Mt. Sinai

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

Response: Lipomas are tumors composed of mature fat cells located just beneath the skin surface. They are the most common soft tissue tumor and are estimated to occur in 1% of the population. These benign tumors are more common in overweight individuals, diabetics, patients with elevated serum cholesterol, and those suffering from familial multiple lipomatosis. Most of these tumors are treated for cosmetic reasons; however, large lipomas can also cause significant functional impairment. Traditional treatment includes surgical removal and / or liposuction.

Deoxycholic acid is a member of the bile acid family that assists in the breakdown of fat. We investigated the use of deoxycholic acid injections to reduce the size of large lipomas prior to surgical removal.

Continue reading

Autistic Adults Also Display Non-Social Cognitive Deficits

MedicalResearch.com Interview with:

Tjasa Velikonja, PhD Department of Psychiatry The Seaver Autism Center for Research and Treatment Icahn School of Medicine at Mount Sinai New York, New York

Dr. Velikonja

Tjasa Velikonja, PhD
Department of Psychiatry
The Seaver Autism Center for Research and Treatment
Icahn School of Medicine at Mount Sinai
New York, New York

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

Response: Autism is a lifelong condition, and challenges associated with autism persist from childhood into adulthood. Despite this, research and treatment have been largely dedicated to children. Because of that, we had very little understanding of what areas – what cognitive domains – are most severely impacted in adults with autism. Importantly, the lack of such information also limits treatment development in this area.

What is known already is that adults with autism display deficits in social cognition (which refers to the role that cognitive processes play in our social interactions). Although our meta-analysis supported these theories, it also highlighted several other challenges in cognitive processing, such as deficits in processing speed and verbal learning and memory. And these impairments were observed in adults with autism without an overall intellectual disability.

Continue reading

4-Meds in One Glaucoma Eyedrop May Decrease Preservatives, Lower Cost, Improve Compliance

MedicalResearch.com Interview with:

Nathan Radcliffe, MD Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon Mount Sinai Health System

Dr. Radcliffe

Nathan Radcliffe, MD
Senior Faculty, Ophthalmology Glaucoma and Cataract surgeon
Mount Sinai Health System

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

Response: Glaucoma is a leading cause of blindness and the mainstay of therapy is to lower the intraocular pressure (IOP) with topical eye drops.

Up to 40% of patients may require more than one eye drop to control the disease, and yet taking more than one eye drop bottle can result in higher costs, more eye irritation, worse therapeutic compliance, and possibly worse outcomes, be sure to consult your eye surgeon before increasing any eye treatment to ensure it won’t do any further damage to the eye. Compounded therapies (not FDA approved, but made at the physician’s request by a compounding pharmacy) can be created to contain multiple glaucoma therapies in one bottle.

We sought to determine if a compounded solution containing three or four drops in one bottle could control glaucoma as well as three or four separate bottles (standard of care) in patients requiring three or four eye drop bottles to control glaucoma.

We performed a multi-center, randomized, observer-masked, parallel-group study comparing a compounded therapy containing latanoprost 0.05%, dorzolamide hydrochloride 2%, timolol maleate 0.5%, brimonidine tartrate 0.2% with 0.01% BAK to standard three or four bottle regaimins. We measured IOP and corneal staining (a sign of preservative toxicity), as well as other safety measures at week one, month one, two and three.

Continue reading

NSAID Eyedrop + Eye Patch Better at Reducing Pain After Intravitreal Injection

MedicalResearch.com Interview with:

Ronald Gentile, MD Professor of Ophthalmology Icahn School of Medicine at Mount Sinai New York

Dr. Gentile

Ronald Gentile, MD
Professor of Ophthalmology
Icahn School of Medicine at Mount Sinai
New York

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

Response: Intravitreal injections have revolutionized the treatment of some of the most common retinal diseases that cause blindness. These diseases include wet age related macular degeneration and diabetic retinopathy. Intravitreal injections are the most common eye procedure in the world. Pain after an intravitreal injection negatively impacts the patient’s experience. We set out a to find a way to improve the patient’s experience by improving the pain they feel after the intravitreal injection.

MedicalResearch.com: What are the main findings? 

Response: The main finding was that the NSAID we used, Nepafanac 0.3% suspension, and pressure patching resulted in lower pain scores when compared to the tear drop placebo at both 6 and 24 hours after the intravitreal injection. The NSAID had a greater effect on lowering the pain score and was found statistically significance. Even though the eyepatch was associated with lower pain scores than placebo, the difference did not reach statistical significance. 

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

Response: Readers should understand that patients not only have a fear going blind, they also fear the pain of the treatment. Physicians should place more emphasis on the patients experience and try to decrease or eliminate any pain a patient may have from the intravitreal injections. It would be expected that this should help patient compliance, especially for those patient who need regular intravitreal injections. 

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

Response: Future research should focus on the patients experience and find ways to eliminate any pain a patient may have before, during, and after the intravitreal injections. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Yes. Patient satisfaction and the patient experience is something that all ophthalmologists and all doctors need to put on the top of their priority list. Physicians have the greatest ability and insight into this. Having the greatest medicines in the world cant help if a patients fear of pain prevents them from being compliant.

I have no disclosures.

Citation: AAO 2018 abstract

Pain Control Following Intravitreal Injection Using Topical Nepefanac 0.3% or Pressure Patching: A Prospective, Randomized, Placebo Controlled Trial

Nov 2, 2018 @ 6:24 pm 

The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

 

Medications Commonly Used During Pregnancy Not Associated With Higher Autism Rates

MedicalResearch.com Interview with:

Magdalena Janecka PhD Department of Psychiatry Icahn School of Medicine at Mount Sinai

Dr. Janecka

Magdalena Janecka PhD
Department of Psychiatry
Icahn School of Medicine at Mount Sinai

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

Response: Our paper explored the association between maternal use of medication during pregnancy and the rates of autism in a large cohort from Israel. This followed on from a number of earlier studies reporting that the use of certain medications – for example antidepressants – during pregnancy is associated with higher rates of autism in children. However, rather than test the effects of any particular drug, or a set of drugs aggregated based on maternal condition, our large dataset allowed us to group all medications prescribed to pregnant women based on their drug target, and in the subsequent analyses focus on over 50 groups that included drugs with neurotransmitter-relevant targets – for example agonists and antagonists of their receptors.

Continue reading

What Can Be Done About Sundamaged Skin?

MedicalResearch.com Interview with:

Dr. Janet Prystowsky, MD Dr. Prystowsky is a leading board-certified dermatologist in New York City.  In addition to her private practice, Dr. Prystowsky is a senior attending physician at Mount Sinai Roosevelt/St. Luke’s Medical Center.

Dr. Prystowsky

Dr. Janet Prystowsky, MD
Dr. Prystowsky is a leading board-certified dermatologist in
New York City.  

In addition to her private practice, Dr. Prystowsky is a senior attending physician at Mount Sinai Roosevelt/St. Luke’s Medical Center.
http://www.janetprystowskymd.com/

MedicalResearch.com: When does sun damage to the skin start?  Is there such a thing as a ‘safe tan’?  Who is most susceptible to photoaging?  What parts of the body are more likely to show signs of sun damage? 

Response: Sun damage will increase a person’s risk of premature aging and skin cancer.  Although tanning does function to help protect your skin from excessive ultraviolet radiation tanning is still a form of sun damage.  Also, people with very fair skin may not tan at all; only burn.  They are the most susceptible to sun damage. Certain medical conditions (e.g., Lupus), medications, cosmetics, and food can make your more reactive (photosensitive) to sunlight.

"Sunburn" by Kelly Sue DeConnick is licensed under CC BY-SA 2.0Sunburns are caused by UV damage from sun rays, almost entirely due to UVB rays. UVA rays are weaker for burning but can contribute to blistering sunburns as well. For example, If you get lime peel rubbed on your skin while you are in the sun, you could get a bad burn.  UVA can also cause significant skin damage that can result in premature wrinkling, brown spots, and skin cancer. That’s why you’ll see dermatologists pushing for broad-spectrum sunscreens as opposed to sunscreens that just protect against UVB rays.  Continue reading