Research Spotlight

Posted May 5th 2017

The Transatlantic Relationship: Hands across the Ocean from Borst to Mohr.

Michael J. Mack M.D.

Michael J. Mack M.D.

Mack, M. (2017). “The transatlantic relationship: Hands across the ocean from borst to mohr.” Thorac Cardiovasc Surg 65(S 03): S164-s166.

Full text of this article.

The metaphor of “hands across the ocean” was first embraced by Hans Borst in 1985 to define the close, collaborative relationship between German and American thoracic surgeons ([Fig. 1]).[1] In the postwar era, numerous American surgeons helped put German thoracic surgery back on its feet. This led to a bidirectional transatlantic alliance in which patients in both countries benefited from the cross-fertilization and coeducation among surgeons. Prof. Friedrich Mohr crossed the ocean in the late 1980s to build a lifelong collaboration with, among others, Jack Matloff and Frank Litvak at the Cedars-Sinai Medical Center in Los Angeles, United States.


Posted May 5th 2017

Secondary traumatic stress in emergency medicine clinicians.

Ann M. Warren Ph.D.

Ann M. Warren Ph.D.

Roden-Foreman, J. W., M. M. Bennett, E. E. Rainey, J. S. Garrett, M. B. Powers and A. M. Warren (2017). “Secondary traumatic stress in emergency medicine clinicians.” Cogn Behav Ther: 1-11.

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Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending >/=10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.


Posted May 5th 2017

Electronic Stethoscope for Coronary Stenosis Detection.

Robert Rosenthal M.D.

Robert Rosenthal M.D.

Rosenthal, R. L. (2017). “Electronic stethoscope for coronary stenosis detection.” Am J Med 130(5): e225.

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I read with interest the report by Azimpour et al1 on the ability of an electronic stethoscope to detect turbulent diastolic flow in coronary arteries associated with coronary stenosis by the use of a signal processing algorithm. Instead of the “gold standard” of percentage coronary stenosis they adopt as the reference standard, it would be more physiologically pertinent to explore the relationship to fractional flow reserve or some other similar measure of trans-stenotic flow gradient, such as the instantaneous wave-free ratio.


Posted May 5th 2017

Periarterial papaverine to treat renal artery vasospasm during robot-assisted laparoscopic partial nephrectomy.

Sharnae Stevens Pharm.D.

Sharnae Stevens Pharm.D.

Sorokin, I., S. L. Stevens and J. A. Cadeddu (2017). “Periarterial papaverine to treat renal artery vasospasm during robot-assisted laparoscopic partial nephrectomy.” J Robot Surg: Apr [Epub ahead of print].

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Renal artery vasospasm can be a troublesome complication during robot-assisted laparoscopic partial nephrectomy. Urologists performing this procedure, especially if utilizing selective arterial vascular microdissection, should be aware of using papaverine for both prevention and treatment of renal artery vasospasm. We present a 33-year-old male who developed severe renal artery vasospasm just with hilar dissection causing the kidney to become ischemic. Papaverine was topically applied on the renal arteries resulting in vasodilation and reperfusion of the kidney. Our objective of this report is to raise awareness of this complication as well as to review the literature on periarterial papaverine use and the dosing for topical applications.


Posted May 5th 2017

Reflux esophagitis and its role in the pathogenesis of Barrett’s metaplasia.

Rhonda Souza M.D.

Rhonda Souza M.D.

Souza, R. F. (2017). “Reflux esophagitis and its role in the pathogenesis of barrett’s metaplasia.” J Gastroenterol: Apr [Epub ahead of print].

Full text of this article.

Reflux esophagitis damages the squamous epithelium that normally lines the esophagus, and promotes replacement of the damaged squamous lining by the intestinal metaplasia of Barrett’s esophagus, the precursor of esophageal adenocarcinoma. Therefore, to prevent the development of Barrett’s metaplasia and esophageal adenocarcinoma, the pathogenesis of reflux esophagitis must be understood. We have reported that reflux esophagitis, both in a rat model and in humans, develops as a cytokine-mediated inflammatory injury (i.e., cytokine sizzle), not as a caustic chemical injury (i.e., acid burn), as traditionally has been assumed. Moreover, reflux induces activation of hypoxia inducible factor (HIF)-2alpha, which enhances the transcriptional activity of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kappaB) causing increases in pro-inflammatory cytokines and in migration of T lymphocytes, an underlying molecular mechanism for this cytokine-mediated injury. In some individuals, reflux esophagitis heals with Barrett’s metaplasia. A number of possibilities exist for the origin of the progenitor cells that give rise to this intestinal metaplasia including those of the esophagus, the proximal stomach, or the bone marrow. However, intestinal cells are not normally found in the esophagus, the stomach, or the bone marrow. Thus, the development of Barrett’s intestinal metaplasia must involve some molecular reprogramming of key developmental transcription factors within the progenitor cell, a process termed transcommitment, which may be initiated by the noxious components of the gastric refluxate. This review will highlight recent studies on the pathogenesis of reflux esophagitis and on reflux-related molecular reprogramming of esophageal squamous epithelial cells in the pathogenesis of Barrett’s metaplasia.