Archive for the ‘Case Western Reserve University School of Medicine’ Category

University Hospitals Case Medical Center Remains Among the Elite in U.S. News & World Report Annual Survey

July 16, 2010

University Hospitals Case Medical Center (UHCMC) has again ranked among the elite in the latest U.S. News & World Report hospital rankings.  In this year’s survey, UHCMC ranked seven clinical specialties in the top 50 for hospitals and health systems nationwide.

Top among clinical departments at UHCMC, the Department of Medicine again contributed four of the specialties – Gastroenterology (28), Geriatrics (28), Cancer (34), and Pulmonology (42). This contribution by the Department of Medicine figured significantly into UHCMC joining only 152 other hospitals, or the top 3% of the nation’s 5,000 eligible healthcare organizations.

“This consistent level of excellence in compassionate, cost-effective patient care is a testament to the quality and dedication of the full time faculty in the Department of Medicine and to the leadership of our organizations.”

Richard A. Walsh, MD, Chairman, Department of Medicine

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Angiotensin-Receptor Blockades (ARBs) Found to Raise Risk of Cancer

July 9, 2010

Dr. Daniel Simon M.D., Division Chief of Cardiovascular Medicine and Director of HM-Heart and Vascular Institute at UHCMC; Dr. James Fang M.D., Section Chief of Heart Failure and Medical Director of Heart Transplantation at UHCMC; IIke Sipahi M.D., Associate Director of Heart Failure & Transplantation at UHCMC at the Harrington-McLaughlin Heart & Vascular Institute of UHCMC researched the effects of Angiotensin-Receptor Blockers (ARBs) on the risk of cancer.

ARBs are a widely utilized drug class used for treatment of hypertension, heart failure, diabetic nephropathy, and recently, for cardiovascular risk reduction.

Randomized controlled trials of ARBs with a follow-up of at least 1 year, and enrolling at least 100 patients were included in this meta-analysis. Information on new cancer development (first diagnosis) was available for 61,590 patients from five trials. Cancer data on common types of solid organ cancers such as lung and prostate cancer were available for 68,402 patients from five trials, and data on cancer deaths were available for 93,515 patients from eight trials.

The meta-analysis showed that patients randomly assigned to receive ARBs had a significantly increased risk of new cancer occurrence compared with patients in control groups (7.2%vs 6.0%). Specifically, the risk of lung cancer was increased by 25%, which was also statistically significant.

“We have found the risk of new cancers was increased with these medications by 8-11 percent.  Most importantly, risk of lung cancer was increased by 25 percent,” said Dr. Sipahi. Although there was no statistically significant excess in cancer deaths (1.8% with ARBs vs 1.6% with control) the investigators pointed out that the average duration of follow-up of 4 years may be too short to capture cancer deaths.

“In medicine, physicians must balance the benefits and risks of all drug and device therapies.  We recommend that patients discuss the findings of this study with their physicians since ARBs are effective agents in the treatment of high blood pressure and heart failure,” said Dr. Simon.

They conclude that because of the limited data, it is not possible to draw conclusions about the exact risk of cancer associated with each individual ARB on the market, but they stated that their findings need further investigation.

In response to this publication from Case Western Reserve University, the European Medicines Agency (EMA) of the European Union announced that they started an investigation about the possible cancer risk of ARBs.

“This is the first time an association between ARBs and cancer development is suggested,” Dr. Sipahi continued. “While our findings are robust, they need to be replicated in other studies before they can be considered as definitive.”

The US Food and Drug Administration has not made any statement regarding this issue yet.

Correlation Between Methicillin-Resistant Staphylococcus Aureus and Cystic Fibrosis Proven

July 9, 2010

Led by Dr. Elliott Dasenbrook MD MHS, Associate Director of The Adult Cystic Fibrosis Program, a UHCMC team in the Division of Pulmonary, Critical Care, and Sleep Medicine have published the findings from a major study about cystic fibrosis (CF) survival rates in the June 16 issue of JAMA.

Specifically, the study observed patients with CF who had methicillin-resistant Staphylococcus aureus (MRSA) detected in their respiratory tract.

The team composed a study with 19,833 CF patients across the nation between ages 6 and 45.  Times until death after diagnosis with MRSA were recorded in order to compare survival between CF patients with and without respiratory tract MRSA.

The unadjusted mortality rate was 18.3 deaths (95% confidence interval [CI], 17.5-19.1) per 1000 patient-years in patients without MRSA and 27.7 deaths (95% CI, 25.3-30.4) per 1000 patient-years in those with MRSA.  The team showed that there is a significantly higher rate of death in CF in people that have MRSA.

“Our study findings may prompt many doctors to reconsider how they care for CF patients,” says Dr. Dasenbrook. He adds, “Until now, some CF doctors weren’t aggressively treating patients with MRSA.  Doctors often viewed MRSA to not be as important as other respiratory-tract infections. With our study findings, treatment patterns may changes as the risk of death is 1.3 times greater for CF patients with MRSA.”

hematology oncology publications :: Q2 | 2010

July 8, 2010

Inhibition of Lck enhances glucocorticoid sensitivity and apoptosis in lymphoid cell lines and in chronic lymphocytic leukemia
Harr M, Caimi P, McColl K, Zhong F, Patel S, Barr P, Distelhorst C.
Cell Death Differ. 2010 Mar

Non-Hodgkin’s lymphoma in the elderly
Caimi PF, Barr PM, Berger NA, Lazarus HM.
Drugs Aging. 2010 Mar

Correlation between ZAP-70, phospho-ZAP-70, and phospho-Syk expression in leukemic cells from patients with CLL
Kaplan D, Meyerson HJ, Li X, Drasny C, Liu F, Costaldi M, Barr P, Lazarus HM.
Cytometry B Clin Cytom. 2010 Mar

Toxicity of sunitinib plus bevacizumab in renal cell carcinoma
Rini BI, Garcia JA, Cooney MM, Elson P, Tyler A, Beatty K, Bokar J, Ivy P, Chen HX, Dowlati A, Dreicer R.
J Clin Oncol. 2010 Jun

Variability of pulse oximetry measurement over 1 year in children with sickle cell disease depends on initial oxygen saturation measurement
Mullin JE, Cooper B, Seicean S, Strunk R, Rosen C, Redline S, Kemp J, DeBaun MR.
Pediatr Blood Cancer. 2010 Jul

Inhibition of Lck enhances glucocorticoid sensitivity and apoptosis in lymphoid cell lines and in chronic lymphocytic leukemia
Harr MW, Caimi P, McColl K, Zhong F, Patel S, Barr P, Distelhorst C.
Cell Death Differ. 2010 Mar

O-fucose modulates notch-controlled blood lineage commitment
Yan Q, Yao D, Wei LL, Huang Y, Myers J, Zhang L, Xin W, Shim J, Man Y, Petryniak B, Gerson S, Lowe JB, Zhou L.
Am J Pathol. 2010 Jun

Umbilical cord blood-selected CD133(+) cells exhibit vasculogenic functionality in vitro and in vivo
Finney MR, Fanning LR, Joseph ME, Goldberg JL, Greco NJ, Bhakta S, Winter DG, Forster M, Scheid PE, Sabe M, Pompili VJ, Laughlin MJ.
Cytotherapy. 2010

Correlation between ZAP-70, phospho-ZAP-70, and phospho-Syk expression in leukemic cells from patients with CLL
Kaplan D, Meyerson HJ, Li X, Drasny C, Liu F, Costaldi M, Barr P, Lazarus HM.
Cytometry B Clin Cytom. 2010 Mar

Astrocyte-restricted ablation of interleukin-17-induced Act1-mediated signaling ameliorates autoimmune encephalomyelitis
Kang Z, Altuntas CZ, Gulen MF, Liu C, Giltiay N, Qin H, Liu L, Qian W, Ransohoff RM, Bergmann C, Stohlman S, Tuohy VK, Li X.
Immunity. 2010 Mar

CXCR2-positive neutrophils are essential for cuprizone-induced demyelination: relevance to multiple sclerosis
Liu L, Belkadi A, Darnall L, Hu T, Drescher C, Cotleur AC, Padovani-Claudio D, He T, Choi K, Lane TE, Miller RH, Ransohoff RM.
Nat Neurosci. 2010 Mar

ARQ-197, an oral small-molecule inhibitor of c-Met for the treatment of solid tumors
Bagai R, Fan W, Ma PC.
IDrugs. 2010 Jun

A segregation analysis of Barrett’s esophagus and associated adenocarcinomas
Sun X, Elston R, Barnholtz-Sloan J, Falk G, Grady WM, Kinnard M, Mittal SK, Willis JE, Markowitz S, Brock W, Chak A.
Cancer Epidemiol Biomarkers Prev. 2010 Mar

Confirmation of Linkage to and Localization of Familial Colon Cancer Risk Haplotype on Chromosome 9q22
Gray-McGuire C, Guda K, Adrianto I, Lin CP, Natale L, Potter JD, Newcomb P, Poole EM, Ulrich CM, Lindor N, Goode EL, Fridley BL, Jenkins R, Le Marchand L, Casey G, Haile R, Hopper J, Jenkins M, Young J, Buchanan D, Gallinger S, Adams M, Lewis S, Willis J, Elston R, Markowitz SD, Wiesner GL.
Cancer Res. 2010 Jul

Malignant T cells in cutaneous T-cell lymphoma lesions contain decreased levels of the antiapoptotic protein Ku70
Ferenczi K, Ohtola J, Aubert P, Kessler M, Sugiyama H, Somani AK, Gilliam AC, Chen JZ, Yeh I, Matsuyama S, McCormick TS, Cooper KD.
Br J Dermatol. 2010 Apr

Securinine induces p73-dependent apoptosis preferentially in p53-deficient colon cancer cells
Rana S, Gupta K, Gomez J, Matsuyama S, Chakrabarti A, Agarwal ML, Agarwal A, Agarwal MK, Wald DN.
FASEB J. 2010 Jun

Factor XII stimulates ERK1/2 and Akt through uPAR, integrins, and the EGFR to initiate angiogenesis
LaRusch GA, Mahdi F, Shariat-Madar Z, Adams G, Sitrin RG, Zhang WM, McCrae KR, Schmaier AH.
Blood. 2010 Jun

Comorbidities, functional limitations, and geriatric syndromes in relation to treatment and survival patterns among elders with colorectal cancer
Koroukian SM, Xu F, Bakaki PM, Diaz-Insua M, Towe TP, Owusu C.
J Gerontol A Biol Sci Med Sci. 2010 Mar

Factor XII: what does it contribute to our understanding of the physiology and pathophysiology of hemostasis & thrombosis
Stavrou E, Schmaier AH.
Thromb Res. 2010 Mar

gastroenterology publications :: Q2 | 2010

July 8, 2010

Tissue apposition system: new technology to minimize surgery for endoscopically unresectable colonic polyps
Delaney CP, Champagne BJ, Marks JM, Sanuk L, Ermlich B, Chak A.
Surg Endosc. 2010 May

Variability in measurements of pancreatic cyst size among EUS, CT, and magnetic resonance imaging modalities
Maimone S, Agrawal D, Pollack MJ, Wong RC, Willis J, Faulx AL, Isenberg GA, Chak A.
Gastrointest Endosc. 2010 May

Endoscopic mucosal resection with full-thickness closure for difficult polyps: a prospective clinical trial.
Agrawal D, Chak A, Champagne BJ, Marks JM, Delaney CP.
Gastrointest Endosc. 2010 May

The diagnostic efficacy of natural orifice transluminal endoscopic surgery: is there a role in the intensive care unit?
Trunzo JA, Poulose BK, McGee MF, Nikfarjam M, Schomisch SJ, Onders RP, Jin J, Chak A, Ponsky JL, Marks JM.
Surg Endosc. 2010 Mar

A segregation analysis of Barrett’s esophagus and associated adenocarcinomas
Sun X, Elston R, Barnholtz-Sloan J, Falk G, Grady WM, Kinnard M, Mittal SK, Willis JE, Markowitz S, Brock W, Chak A.
Cancer Epidemiol Biomarkers Prev. 2010 Mar

Primary malignant melanoma of the hepatic duct: a case report
Agrawal D, Tannous GC, Chak A.
Gastrointest Endosc. 2010 Jun

Transgastric natural-orifice transluminal endoscopic surgery peritoneoscopy in humans: a pilot study in efficacy and gastrotomy site selection by using a hybrid technique
Nikfarjam M, McGee MF, Trunzo JA, Onders RP, Pearl JP, Poulose BK, Chak A, Ponsky JL, Marks JM.
Gastrointest Endosc. 2010 Jun

Testing the critical size in calvarial bone defects: revisiting the concept of a critical-size defect
Cooper GM, Mooney MP, Gosain AK, Campbell PG, Losee JE, Huard J.
Plast Reconstr Surg. 2010 Jun

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A survival prediction model to facilitate clinical decision making
Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, Ruckley CV, Raab GM; BASIL trial Participants.
J Vasc Surg. 2010 May

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: A description of the severity and extent of disease using the Bollinger angiogram scoring method and the TransAtlantic Inter-Society Consensus II classification
Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, Ruckley CV, Raab GM; BASIL trial Participants.
J Vasc Surg. 2010 May

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: Analysis of amputation free and overall survival by treatment received.
Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, Ruckley CV, Raab GM; BASIL trial Participants.
J Vasc Surg. 2010 May

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy.
Bradbury AW, Adam DJ, Bell J, Forbes JF, Fowkes FG, Gillespie I, Ruckley CV, Raab GM; BASIL trial Participants.
J Vasc Surg. 2010 May

AHRQ series commentary 1: rating the evidence in comparative effectiveness reviews
Falck-Ytter Y, Schünemann H, Guyatt G.
J Clin Epidemiol. 2010 May

Feasibility of radiofrequency ablation for the treatment of chronic radiation proctitis
Nikfarjam M, Faulx A, Laughinghouse M, Marks JM.
Surg Innov. 2010 Jun

Variability in measurements of pancreatic cyst size among EUS, CT, and magnetic resonance imaging modalities
Maimone S, Agrawal D, Pollack MJ, Wong RC, Willis J, Faulx AL, Isenberg GA, Chak A
Gastrointest Endosc. 2010 May

A segregation analysis of Barrett’s esophagus and associated adenocarcinomas
Sun X, Elston R, Barnholtz-Sloan J, Falk G, Grady WM, Kinnard M, Mittal SK, Willis JE, Markowitz S, Brock W, Chak A.
Cancer Epidemiol Biomarkers Prev. 2010 Mar

Elevated IL-13Ralpha2 in intestinal epithelial cells from ulcerative colitis or colorectal cancer initiates MAPK pathway
Mandal D, Levine AD.
Inflamm Bowel Dis. 2010 May

Dual specificity phosphatase 6 (DUSP6) is an ETS-regulated negative feedback mediator of oncogenic ERK signaling in lung cancer cells
Zhang Z, Kobayashi S, Borczuk AC, Leidner RS, Laframboise T, Levine AD, Halmos B.
Carcinogenesis. 2010 Apr

REDOX regulation of IL-13 signaling in intestinal epithelial cells: Usage of alternate pathways mediates distinct gene expression patterns
Mandal D, Fu P, Levine AD.
Cell Signal. 2010 Jun 

Research on the effects of intensive treatment on hyperglycemia on type 2 diabetes

July 8, 2010

Dr. Faramarz Ismail-Beigi M.D., PhD., the previous Division Chief of Endocrinology, and a team of internationally renowned UHCMC diabetes specialists researched the effects of intensive treatment of hyperglycemia (or high blood sugar, a condition in which an excessive amount of glucose circulates in the blood plasma) on microvascular outcomes in type 2 diabetes in analyzing the ACCORD randomized trial.

Hyperglycemia is associated with increased risk of cardiovascular complications in people with type 2 diabetes.

The team set out to find out if reducing the blood glucose concentration to normal levels in people with established type 2 diabetes decreases the rate of microvascular complications. 10,251 patients were randomly assigned, 5,128 to the intensive glycemia control group and 5,123 to standard group. Intensive therapy was stopped before study end because of higher mortality in the glycemia group, and patients were transitioned to standard therapy. After reviewing the results, it was clear that intensive therapy did not reduce the risk of advanced measures of microvascular outcomes (such as kidney failure requiring dialysis, or advanced disease of the retina requiring surgery), but delayed the onset of albuminuria and some measures of eye complications and neuropathy.

The conclusion was made that microvascular benefits of intensive therapy should be weighed against the increase in total and cardiovascular disease-related mortality, increased weight gain, and high risk for severe hypoglycemia.

Dr. Ismail-Beigi suggests that “In elderly people with established type 2 diabetes of many years’ duration and a history of prior cardiovascular disease (such as a heart attack), or risk factors for cardiovascular disease, the benefits and risks associated with intensive blood sugar control needs to be carefully assessed on an individual basis.  The best approach is for patients to have a discussion with their health-care provider to set an appropriate blood sugar goal.”

CWRU School of Medicine :: Medical Firsts

June 25, 2010

* 1905 Development of the modern technique for human blood transfusion using a cannula to connect blood vessels by surgeon George Crile
* 1912 Pioneering the process of chlorinating drinking water by Professor Roger Perkins
* 1915 First simulated milk formula for infants, by alumnus and pediatrics professor Henry Gerstenberger
* 1927 Discovery of the cause of ptomaine food poisoning and development of an antiserum by immunologist Enrique Ecker and colleagues

* 1935 First surgical treatment of coronary artery disease by Professor Claude Beck

* 1950s Development of the first heart-lung machine for use in open heart surgeries by Professor Frederick Cross
* 1961 First successful genetic alteration of human cells in a test tube by Professor Austin Weisburger
* 1969 William Insull, M.D., describes the role of cholesterol in blood vessel disease
* 1975 Discovery that human rennin, an enzyme produced by the kidney, is involved in hypertension
* 1990 Discovery of the gene for osteoarthritis by a national team led by rheumatologist Roland Moskowitz
* 1991 First triple organ transplant in Ohio-a kidney, liver and pancreas-by James A. Schulak, M.D., and colleagues
* 1997 Creation of the world’s first artificial human chromosome by a team led by Professor Huntington Willard

Additional medical firsts include:

* First large-scale medical research project on humans in a study linking iodine with goiter prevention
* Discovery of early treatment of strep throat infections to prevent rheumatic fever
* Discovery of the Hageman factor in blood clotting, a major discovery in blood coagulation research
* First description of how staphylococcus infections were transmitted, leading to required hand-washing between patients in infant nurseries
* First description of what was later named Reye’s syndrome
* Research leading to FDA approval of clozapine, the most advanced treatment for schizophrenia at the time

CWRU School of Medicine :: Historical Highlights

June 25, 2010

* In 1843, five faculty members and sixty-seven students began the first medical lectures at the Medical Department of Western Reserve College (also known as the Cleveland Medical College).
* In 1852, the medical school became the second allopathic medical school to graduate a woman, Nancy Talbot Clarke.
* Six of the first seven women in the United States to receive medical degrees from recognized allopathic medical schools graduated from Western Reserve University (as it was called then) between 1850 and 1856.
* The School of Medicine was one of the first in the country to employ instructors devoted to full-time teaching and research.
* In 1896, the first affiliation agreement was approved between Western Reserve University and University Hospitals of Cleveland (Lakeside Hospital).
* The Western Reserve University School of Medicine revolutionized medical education in 1952 with the most progressive curriculum in the country which integrated the basic and clinical sciences.
* In 2002, the School of Medicine became only the third medical school in history to receive the best review possible from the Liaison Committee on National Education, the national body responsible for accrediting the medical schools.
* In 2006, the School of Medicine’s University Program instituted a new integrated curriculum of medicine and public health awareness, which emphasizes the both the biology of disease and social and behavioral context of illness.