Research Spotlight

Posted November 15th 2016

Living Donor Uterus Transplant and Surrogacy Ethical Analysis According to the Principle of Equipoise.

Giuliano Testa M.D.

Giuliano Testa M.D.

Testa, G., E. C. Koon and L. Johannesson (2016). “Living donor uterus transplant and surrogacy ethical analysis according to the principle of equipoise.” Am J Transplant: 2016 Oct [Epub ahead of print].

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The uterus is the most recent addition to the list of organs that can be successfully transplanted in humans. This paper analyzes living donor uterus transplantation according to the ethical principle of equipoise. A comparison is made between living donor uterus transplantation and gestational surrogate motherhood. Both are solutions to absolute uterine infertility that allow the transfer of genetic material from intended parents to a child. The analysis concludes that living donor uterus transplantation does not violate the ethical principle of equipoise and should be considered an ethically acceptable solution to absolute uterine infertility.


Posted November 15th 2016

A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits.

Deborah S. Keller M.D.

Deborah S. Keller M.D.

Keller, D. S., A. J. Senagore, K. Fitch, A. Bochner and E. M. Haas (2016). “A new perspective on the value of minimally invasive colorectal surgery-payer, provider, and patient benefits.” Surg Endosc: 2016 Nov [Epub ahead of print].

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BACKGROUND: The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer’s perspective to demonstrate the value of minimally invasive colorectal surgery. METHODS: A Truven MarketScan(R) claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs). Care episodes were compared for average allowed costs, complication, and readmission rates after adjusting costs for demographics, comorbidities, and geographic region. RESULTS: A total of 4615 colectomies were included-2054 (44.5 %) open and 2561 (55.5 %) MIS. Total allowed episode costs were significantly lower MIS than open ($37,540 vs. $45,284, p < 0.001). During the inpatient stay, open cases had significantly greater ICU utilization (3.9 % open vs. 2.0 % MIS, p < 0.001), higher overall complications (52.8 % open vs. 32.3 % MIS, p < 0.001), higher colorectal-specific complications (32.5 % open vs. 17.9 % MIS, p < 0.001), longer LOS (6.39 open vs. 4.44 days MIS, p < 0.001), and higher index admission costs ($39,585 open vs. $33,183 MIS, p < 0.001). Post-discharge, open cases had significantly higher readmission rates/100 cases (11.54 vs. 8.28; p = 0.0013), higher average readmission costs ($3055 vs. $2,514; p = 0.1858), and greater 30-day healthcare costs than MIS ($5699 vs. $4357; p = 0.0033). The net episode cost of care was $7744/patient greater for an open colectomy, even with similar DRG distribution. CONCLUSIONS: In a commercially insured population, the risk-adjusted allowed costs for MIS colectomy episodes were significantly lower than open. The overall cost difference between MIS and open was almost $8000 per patient. This highlights an opportunity for health plans and employers to realize financial benefits by shifting from open to MIS for colectomy. With increasing bundled payment arrangements and accountable care sharing programs, the cost impact of shifting from open to MIS introduces an opportunity for cost savings.


Posted November 15th 2016

Hospital-based health care after traumatic brain injury.

Simon Driver Ph.D.

Simon Driver Ph.D.

Salisbury, D., S. J. Driver, M. Reynolds, M. Bennett, L. B. Petrey and A. M. Warren (2016). “Hospital-based health care after traumatic brain injury.” Arch Phys Med Rehabil: 2016 Oct [Epub ahead of print].

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OBJECTIVE: To investigate trends of hospital-based health care utilization after admission to a Level 1 trauma center following acute traumatic brain injury (TBI). DESIGN: Retrospective review. SETTING: Large urban trauma hospital and a hospital council data registry consisting of 88 member institutions (>150 hospitals) covering 15,000 square miles. PARTICIPANTS: All patients admitted to a Level I trauma center between January 2006 – June 2014 who experienced an acute TBI based on ICD-9 coding. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Included the incidence and type of select hospital-based services received. Analyses were also categorized based on demographic and injury-related information. RESULTS: There were 5,291 patients with newly acquired TBI admitted; 512 died, leaving 4,779 patients for inclusion into the final analysis. Additional healthcare utilization from January 2006-June 2014 was recorded for 3,158 patients (66%), totaling 12,307 encounters with a median of 3 encounters (IQR: 1-5), and a maximum of 102 encounters. The vast majority of non-admission urgent or procedural visits (96%) and inpatient encounters (93%) occurred in the first year. Of all the additional encounters, 9,769 visits were non-admission urgent or procedural visits (79%) with a median charge of $1,955, and most common type of encounter being elective (46%), followed by medical emergency (29%). Of the remaining 2,538 (21%) inpatient encounters, the mean length of stay was 6 days with median charge of $28,450, and medical emergency (39%) and elective admissions (33%) again being the most common encounter type. CONCLUSIONS: This analysis encompasses healthcare utilization across the range of TBI severity and numerous hospital systems allowing for a more comprehensive and objective identification of reasons for readmission. This represents an initial step to developing a preventative intervention to manage secondary complications post-injury.


Posted November 15th 2016

Diagnostic Potential of Cell-Free and Exosomal MicroRNAs in the Identification of Patients with High-Risk Colorectal Adenomas.

Ajay Goel Ph.D.

Ajay Goel Ph.D.

Uratani, R., Y. Toiyama, T. Kitajima, M. Kawamura, J. Hiro, M. Kobayashi, K. Tanaka, Y. Inoue, Y. Mohri, T. Mori, T. Kato, A. Goel and M. Kusunoki (2016). “Diagnostic potential of cell-free and exosomal micrornas in the identification of patients with high-risk colorectal adenomas.” PLoS One 11(10): e0160722.

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BACKGROUND: Although there is a growing interest in developing circulating microRNA (miRNA) as noninvasive diagnostic biomarkers for the detection of high-risk colorectal adenomas and early-stage CRCs, but the comparative diagnostic significance of serum vs. exosomal miRNAs remains unexplored. METHODS: Based upon published literature, we performed an initial discovery step by investigating the expression of a miRNA panel in 20 normal colonic mucosa, 27 adenomas, and 19 CRC tissues. We performed subsequent validation by quantifying expression of candidate miRNAs in total serum and in exosomes from 26 adenoma patients and 47 healthy controls, and evaluated their clinical significance and potential diagnostic value in colorectal adenomas. RESULTS: We observed that the expression of four miRNAs, miR-21, miR-29a, miR-92a, and miR-135b, was significantly higher in colorectal adenomas vs. normal colonic mucosa. During validation, expression of miR-21, miR-29a and miR-92a in serum was significantly higher in adenomas vs. healthy controls, significantly correlated with adenoma size and total adenoma number within the colorectum, and significantly discriminated patients with advanced adenomas. In contrast, although exosomal miR-21 and miR-29a levels in adenoma patients were significantly higher than those of healthy volunteers, only exosomal miR-21 significantly correlated with adenoma size and total adenoma number, and could discriminate patients with high-risk adenomas. CONCLUSION: Compared to exosomal miRNAs, serum levels of miR-21, miR-29a and miR-92a are superior diagnostic biomarkers in patients with high-risk adenomatous polyps.


Posted November 15th 2016

A review of emerging IL-17 inhibitors in the treatment of psoriasis focusing on preclinical through phase II studies.

Alan M. Menter M.D.

Alan M. Menter M.D.

Campa, M. and A. Menter (2016). “A review of emerging il-17 inhibitors in the treatment of psoriasis focusing on preclinical through phase ii studies.” Expert Opin Investig Drugs 25(11): 1337-1344.

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INTRODUCTION: Interleukin-17 has recently been identified as a key player in the pathogenesis of psoriasis. As such, several drugs targeting IL-17 are in various stages of clinical development. Areas covered: In this review, the authors describe several emerging therapies and drug candidates targeting IL-17. The authors detail many biologic injectable drug candidates as well as numerous potential oral and topical small molecule drug candidates. Expert opinion: Approval of IL-17 inhibitors has significantly improved the treatment options for psoriasis patients. Secukinumab and ixekizumab are approved in both Europe and the USA, and brodalumab is likely facing approval by the end of 2016. Numerous additional biologic and small molecule drug candidates are in the pipeline, and once deemed safe and effective will likely offer significant benefit to our psoriasis population.