Research Spotlight

Posted September 15th 2016

Sustaining happiness in adult congenital heart disease.

Ari M. Cedars M.D.

Ari M. Cedars M.D.

Cedars, A. and A. R. Opotowsky (2016). “Sustaining happiness in adult congenital heart disease.” World J Pediatr Congenit Heart Surg 7(5): 635-637.

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Patients with ACHD appear to have a distinct psychological adaptation to their lifelong heart disease. Although there is some inconsistency in the results of published studies, most data indicate that QOL among patients with ACHD is similar to the healthy general population, with the exception of the physical functioning domain.3 Furthermore, despite marked variability in objectively measured physical capacity between lesions,4 QOL in ACHD is not clearly related to lesion severity or complexity.3,5 This phenomenon appears to be consistent between countries with dramatically different health-care systems.6 The present study by Steele et al in a group of patients with CHD of high complexity provides further evidence for this observation. The apparent mental resilience among patients with ACHD is in stark contrast to adults with acquired heart failure (HF) in whom QOL is notably impaired compared to healthy controls.7 Although the reasons for preserved QOL in ACHD remain unknown, it has been proposed that patients with ACHD have a unique ‘‘sense of coherence.’’8 This concept, first introduced by Aaron Antonovsky as a metric of individual optimism and sense of control, may insulate patients with ACHD against health-related stressors.9


Posted September 15th 2016

Massive irreparable rotator cuff tear and associated deltoid tear. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment?

Brody Flanagin M.D.

Brody Flanagin M.D.

Garofalo, R., B. Flanagin, A. Castagna, V. Calvisi and S. G. Krishnan (2016). “Massive irreparable rotator cuff tear and associated deltoid tear. Does the reverse shoulder arthroplasty and deltoid repair be a possible option of treatment?” J Orthop Sci: 2016 Aug [Epub ahead of print].

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BACKGROUND AND PURPOSE: Rupture of the anterior and middle deltoid muscle associated with rotator cuff tear arthropathy (RCA) could result in a definitive loss of shoulder function. The purpose of this study was to evaluate clinical outcomes after a concomitant reverse shoulder arthroplasty (RSA) and deltoid repair under these circumstances. MATERIALS AND METHODS: Between 2006 and 2012, 18 consecutive patients with a mean age of 69.7 years, affected by massive irreparable rotator cuff tear and associated dehiscence or rupture of anterior and middle deltoid muscle underwent this operation through a modified anterosuperior approach. Four patients referred a previous shoulder surgery and deltoid tear was iatrogenic. The other 14 cases had an attritional deltoid tears. The average follow-up was 64 months (range 25-121 months). RESULTS: The mean active anterior elevation passed from a preoperative mean of 53 +/- 9.1 (range 45-70) to 132.7 +/- 11.6 degrees (85-155 degrees ), active external rotation passed from a preoperative mean value of 22.4 +/- 3.6 degrees (range 18-26) to an average of 33.7 +/- 4.7 degrees (range 30-40 degrees ). Mean Constant score increased from 42 +/- 6.1 (range 31-51) pre-operatively to 72.3 +/- 8.2 (range 57-82) post-operatively. At final review, deltoid contour subjectively was satisfactory to all patients with no palpable defects. CONCLUSION: RSA associated with a repair of deltoid tear could be a viable surgical option in cases of tear involving the anterior and middle deltoid associated with a RCA. Patient with a preoperative chronic axillary nerve neuropathy associated with a deltoid muscle tear should be cautioned about the possibility of lower functional outcomes.


Posted September 15th 2016

T follicular helper cells, interleukin-21 and systemic lupus erythematosus.

Hideki Ueno M.D.

Hideki Ueno M.D.

Gensous, N., N. Schmitt, C. Richez, H. Ueno and P. Blanco (2016). “T follicular helper cells, interleukin-21 and systemic lupus erythematosus.” Rheumatology (Oxford): 2016 Aug [Epub ahead of print].

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SLE is a chronic systemic autoimmune disease characterized by a breakdown of tolerance to nuclear antigens and generation of high-affinity pathogenic autoantibodies. These autoantibodies form, with autoantigens, immune complexes that are involved in organ and tissue damages. Understanding how the production of these pathogenic autoantibodies arises is of prime importance. T follicular helper cells (Tfh) and IL-21 have emerged as central players in this process. This article reviews the pathogenic role of Tfh cells and IL-21 in SLE.


Posted September 15th 2016

Increased Cell Adhesion Molecules, PECAM-1, ICAM-3, or VCAM-1, Predict Increased Risk for Flare in Patients With Quiescent Inflammatory Bowel Disease.

Arianne L. Theiss Ph.D.

Arianne L. Theiss Ph.D.

Gu, P., A. Theiss, J. Han and L. A. Feagins (2016). “Increased cell adhesion molecules, pecam-1, icam-3, or vcam-1, predict increased risk for flare in patients with quiescent inflammatory bowel disease.” J Clin Gastroenterol: 2016 Aug [Epub ahead of print].

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GOALS AND BACKGROUND: Predicting the risk of flare-ups for patients with inflammatory bowel disease (IBD) is difficult. Alterations in gut endothelial regulation of mucosal immune homeostasis might be early events leading to flares in IBD. Cell adhesion molecules (CAMs), in particular, are important in maintaining endothelial integrity and regulating the migration of leukocytes into the gut. STUDY: We evaluated the mRNA expression of various tight junction proteins, with an emphasis on CAMs, in 40 patients with IBD in clinical remission. Patients were retrospectively assessed at 6, 12, and 24 months after baseline colonoscopy, and at the end of all available follow-up (maximum 65 mo), for flare events to determine whether baseline mRNA expression was associated with subsequent flares. RESULTS: At all follow-up points, the baseline expression of platelet endothelial cell adhesion molecule-1 (PECAM-1), ICAM-3, and VCAM-1 was significantly higher in patients who flared than in those who did not (2.4-fold elevation, P=0.012 for PECAM-1; 1.9-fold increased, P=0.03 for ICAM-3; and 1.4-fold increased, P=0.02 for VCAM-1). PECAM-1 and ICAM-3 expression was significantly increased in patients who flared as early as 6 months after baseline colonoscopy. In contrast, there were no significant differences between patients with and without flares in baseline expression of other CAMs (ESAM, ICAM-1, ICAM-2, E-selectin, P-selectin, and MadCAM1). CONCLUSIONS: Increased expression of PECAM-1, ICAM-3, and VCAM-1 in colonic biopsies from patients with IBD in clinical remission is associated with subsequent flares. This suggests that increases in the expression of these proteins may be early events that lead to flares in patients with IBD.


Posted September 15th 2016

The hedgehog pathway in triple-negative breast cancer.

Joyce O'Shaughnessy M.D.

Joyce O’Shaughnessy M.D.

Habib, J. G. and J. A. O’Shaughnessy (2016). “The hedgehog pathway in triple-negative breast cancer.” Cancer Med: 2016 Aug [Epub ahead of print].

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Treatment of triple-negative breast cancer (TNBC) remains challenging due to the underlying heterogeneity of this disease coupled with the lack of predictive biomarkers and effective targeted therapies. Intratumoral heterogeneity, particularly enrichment for breast cancer stem cell-like subpopulations, has emerged as a leading hypothesis for systemic therapy resistance and clinically aggressive course of poor prognosis TNBC. A growing body of literature supports the role of the stem cell renewal Hedgehog (Hh) pathway in breast cancer. Emerging preclinical data also implicate Hh signaling in TNBC pathogenesis. Herein, we review the evidence for a pathophysiologic role of Hh signaling in TNBC and explore mechanisms of crosstalk between the Hh pathway and other key signaling networks as well as their potential implications for Hh-targeted interventions in TNBC.