Research Spotlight

Posted November 15th 2016

Usefulness of Psoas Muscle Area Determined by Computed Tomography to Predict Mortality or Prolonged Length of Hospital Stay in Patients Undergoing Left Ventricular Assist Device Implantation.

Brian Lima M.D.

Brian Lima M.D.

Heberton, G. A., M. Nassif, A. Bierhals, E. Novak, S. J. LaRue, B. Lima, S. Hall, S. Silvestry and S. M. Joseph (2016). “Usefulness of psoas muscle area determined by computed tomography to predict mortality or prolonged length of hospital stay in patients undergoing left ventricular assist device implantation.” Am J Cardiol 118(9): 1363-1367.

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The purpose of this study is to examine the association of sarcopenia as measured by psoas muscle area and outcomes in patients undergoing left ventricular assist device (LVAD) implantation. We retrospectively examined 333 consecutive patients who underwent implantation of a HeartMate II LVAD at our institution from June 2008 to August 2013. Patients were included if they had a perioperative computed tomography that spanned the L3-L4 vertebrae. Sarcopenia was defined as having the lowest tertile psoas muscle area by gender. The primary end point was the composite of inpatient death or prolonged length of stay of >30 days. One hundred patients met inclusion criteria. The psoas muscle area cut-off values for the lowest tertiles were 12.0 cm2 for men and 6.5 cm2 for women, resulting in 32 sarcopenic patients (32%). The primary outcome of inpatient death or prolonged length of stay occurred in 81% of patients in the sarcopenic versus 60% in the nonsarcopenic group (p = 0.043). There was a trend toward prolonged length of stay in sarcopenic patients but no difference in overall mortality. This demonstrates that sarcopenia as measured by psoas muscle area is associated with increased composite length of stay and mortality after LVAD implantation and may serve as correlate for frailty.


Posted November 15th 2016

Clinical Utility of Testing for Legionella Pneumonia in Central Texas.

Alejandro C. Arroliga M.D.

Alejandro C. Arroliga M.D.

Henry, C., C. Boethel, L. A. Copeland, S. Ghamande, A. C. Arroliga and H. D. White (2016). “Clinical utility of testing for legionella pneumonia in central texas.” Ann Am Thorac Soc: 2016 Oct [Epub ahead of print].

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RATIONALE: Legionella pneumophila is an uncommon cause of community-acquired pneumonia in south central United States and regular testing may not be cost-effective in areas of low incidence. OBJECTIVES: To evaluate the incidence of Legionella in central Texas and determine the costeffectiveness of Legionella urinary antigen testing. METHODS: We performed a single-center retrospective cohort study of patients admitted with pneumonia between January 2001 and December 2013. Patients were identified by Binax Legionella urinary antigen and ICD-9 codes. Demographic characteristics and clinical history of the confirmed Legionella pneumonia cases were obtained by chart review. Descriptive statistics were used to describe patient characteristics. MEASUREMENTS AND MAIN RESULTS: Over 12 years 5,807 patients with 11,377 admissions for pneumonia were tested for Legionella urinary antigen. A positive Legionella urinary antigen was found in 17 patients. Cumulative incidence during the study period was 0.23%. Among the Legionella positive patients, intensive care unit admission and median length of stay were 58.8% and 8.5 days, respectively. Most patients met ATS criteria for severe pneumonia (64.7%). All patients empirically received either a macrolide or fluoroquinolone covering Legionella. There were 2 in-hospital and 3 total 90-day deaths in those with a positive urinary antigen. The estimated cost of screening this population with Legionella urinary antigen was $214,438 over 13 years. CONCLUSIONS: This study reveals the low incidence of Legionella pneumonia in central Texas. Use of guideline-concordant antibiotic treatment provides coverage for Legionella. We speculate that testing in a low-prevalence area would not influence outcomes or be cost-effective.


Posted November 15th 2016

Randomized phase 1 crossover study assessing the bioequivalence of capsule and tablet formulations of dovitinib (TKI258) in patients with advanced solid tumors.

Carlos Becerra M.D.

Carlos Becerra M.D.

Sarantopoulos, J., S. Goel, V. Chung, P. Munster, S. Pant, M. R. Patel, J. Infante, H. Tawbi, C. Becerra, J. Bruce, F. Kabbinavar, A. C. Lockhart, E. Tan, S. Yang, G. Carlson, J. W. Scott and S. Sharma (2016). “Randomized phase 1 crossover study assessing the bioequivalence of capsule and tablet formulations of dovitinib (tki258) in patients with advanced solid tumors.” Cancer Chemother Pharmacol 78(5): 921-927.

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PURPOSE: A capsule formulation of the tyrosine kinase inhibitor dovitinib (TKI258) was recently studied in a phase 3 renal cell carcinoma trial; however, tablets are the planned commercial formulation. Therefore, this randomized 2-way crossover study evaluated the bioequivalence of dovitinib tablet and capsule formulations in pretreated patients with advanced solid tumors, excluding breast cancer. METHODS: In this 2-part study, eligible patients received dovitinib 500 mg once daily on a 5-days-on/2-days-off schedule. During the 2-period bioequivalence phase, patients received their initial formulation (capsule or tablet) for 3 weeks before being switched to the alternative formulation in the second period. Patients could continue to receive dovitinib capsules on the same dosing schedule during the post-bioequivalence phase. RESULTS: A total of 173 patients were enrolled into the bioequivalence phase of the study (capsule –> tablet, n = 88; tablet –> capsule, n = 85), and 69 patients had evaluable pharmacokinetics (PK) for both periods. PK analyses showed similar exposure and PK profiles for the dovitinib capsule and tablet formulations and supported bioequivalence [geometric mean ratios: AUClast, 0.95 (90 % CI 0.88-1.01); C max, 0.98 (90 % CI 0.91-1.05)]. The most common adverse events, suspected to be study drug related, included diarrhea (60 %), nausea (53 %), fatigue (45 %), and vomiting (43 %). Of 168 patients evaluable for response, 1 achieved a partial response, and stable disease was observed in 32 % of patients. CONCLUSIONS: Dovitinib capsules and tablets were bioequivalent, with a safety profile similar to that observed in other dovitinib studies of patients with heavily pretreated advanced solid tumors.


Posted November 15th 2016

Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework.

Simon Driver Ph.D.

Simon Driver Ph.D.

Swank, C., S. Shearin, S. Cleveland and S. Driver (2016). “Auditing the physical activity and parkinson disease literature using the behavioral epidemiologic framework.” Pm r: 2016 Oct [Epub ahead of print].

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Motor and non-motor symptoms associated with Parkinson’s disease (PD) place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means to improving health and reducing risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and PD to describe the current evolution and inform knowledge gaps in this area. Research placed in Phase 1 establishes links between physical activity and health-related outcomes; Phase 2 develops approaches to quantify physical activity behavior; Phase 3 identifies factors associated with implementation of physical activity behaviors; Phase 4 assesses the effectiveness of interventions to promote activity; Phase 5 disseminates evidence-based recommendations. Peer reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 266 potential articles. After further review we excluded 109 articles leaving 178 included articles. Of these, 75.84% were categorized into Phase 1 (n=135), 10.11% in Phase 2 (n=18), 9.55% into Phase 3 (n=17), 3.37% into Phase 4 (n=6), and 1.12% into Phase 5 (n=2). By applying the behavioral framework to the physical activity literature for people with PD, we suggest this area of research is nascent with more than 75% of the literature in Phase 1.


Posted November 15th 2016

Preemptive Analgesia in Hip Arthroscopy: A Randomized Controlled Trial of Preemptive Periacetabular or Intra-articular Bupivacaine in Addition to Postoperative Intra-articular Bupivacaine.

Hal David Martin D.O.

Hal David Martin D.O.

Shlaifer, A., Z. T. Sharfman, H. D. Martin, E. Amar, E. Kazum, Y. Warschawski, M. Paret, S. Brill, M. Drexler and E. Rath (2016). “Preemptive analgesia in hip arthroscopy: A randomized controlled trial of preemptive periacetabular or intra-articular bupivacaine in addition to postoperative intra-articular bupivacaine.” Arthroscopy: 2016 Oct [Epub ahead of print].

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PURPOSE: To evaluate and compare the efficacy of intra-articular and periacetabular blocks for postoperative pain control after hip arthroscopy. METHODS: Forty-two consecutive patients scheduled for hip arthroscopy were randomized into 2 postoperative pain control groups. One group received preemptive intra-articular 20 mL of bupivacaine 0.5% injection, and the second group received preemptive periacetabular 20 mL of bupivacaine 0.5% injection. Before closure all patients received an additional dose of 20 mL of bupivacaine 0.5% intra-articularly. Data were compared with respect to postoperative pain with visual analog scale (VAS) and analgesic consumption, documented in a pain diary for 2 weeks after surgery. RESULTS: Twenty-one patients were treated with intra-articular injection, and 21 patients with peri-acetabular injection. There were no significant differences with regards to patient demographics or surgical procedures. VAS scores recorded during the first 30 minutes postoperatively and 18 hours after surgery were significantly lower in the periacetabular group compared with in the intra-articular group (0.667 +/- 1.49 v 2.11 +/- 2.29; P < .045 and 2.62 +/- 2.2 v 4.79 +/- 2.6; P < .009). There were no differences between the groups with regard to analgesic consumption. CONCLUSIONS: Periacetabular injection of bupivacaine 0.5% was superior to intra-articular injection in pain reduction after hip arthroscopy at 30 minutes and 18 hours postoperatively. However, total analgesic consumption over the first 2 postoperative weeks and VAS pain measurements were not significantly affected.