Research Spotlight

Posted July 15th 2016

Use of candida antigen injections for the treatment of verruca vulgaris: A two-year mayo clinic experience.

John R. Griffin M.D.

John R. Griffin M.D.

Alikhan, A., J. R. Griffin and C. C. Newman (2016). “Use of candida antigen injections for the treatment of verruca vulgaris: A two-year mayo clinic experience.” J Dermatolog Treat 27(4): 355-358.

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Common warts (verruca vulgaris) are one of the most common problems encountered in dermatology and may present a difficult treatment dilemma, as no particular therapy has demonstrated complete efficacy. Intralesional injection of purified Candida antigen has produced impressive treatment results in small prospective and retrospective studies and is thought to produce its effect through stimulation of a cell-mediated immune response. We report a retrospective study of adult and pediatric patients treated with Candida antigen therapy in clinical practice. Of the 100 patients treated, 80% responded to therapy: 39% demonstrated a complete response and 41% demonstrated a partial response. In addition, 6 out of 7 immunocompromised patients who were treated demonstrated a partial or complete response. Injections were generally well-tolerated and adverse events were minimal and short-lived. Our data indicate that intralesional Candida antigen therapy for cutaneous warts is an efficacious option in a clinical practice setting. The treatment may also be effective in immunosuppressed patients with cutaneous warts. Our results add to the literature one of the largest retrospective series reported to date and treatment outcomes are similar to previously reported studies evaluating this therapeutic modality.


Posted July 15th 2016

What do residents need to be competent laparoscopic and endoscopic surgeons?

Lonnie Gentry, M.S.

Lonnie Gentry, M.S.

Gardner, A. K., R. E. Willis, B. J. Dunkin, K. R. Van Sickle, K. M. Brown, M. S. Truitt, J. M. Uecker, L. Gentry and D. J. Scott (2016). “What do residents need to be competent laparoscopic and endoscopic surgeons?” Surg Endosc 30(7): 3050-3059.

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BACKGROUND: Despite numerous efforts to ensure that surgery residents are adequately trained in the areas of laparoscopy and flexible endoscopy, there remain significant concerns that graduates are not comfortable performing many of these procedures. METHODS: Online surveys were sent to surgery residents (98 items, PGY1-5 Categorical) and faculty (78 items, general surgery, and gastrointestinal specialties) at seven institutions. De-identified data were analyzed under an IRB-approved protocol. RESULTS: Ninety-five faculty and 121 residents responded, with response rates of 65 and 52 %, respectively. Seventy-three percent of faculty indicated that competency of their graduating residents were dramatically or slightly worse than previous graduates. Only 29 % of graduating residents felt very comfortable performing advanced laparoscopic (AL) cases and 5 % performing therapeutic endoscopy (TE) cases immediately after graduation. Over half of interns expressed a need for fellowship to feel comfortable performing AL and TE procedures, and this need did not decrease as residents neared graduation. For these procedures, residents receive only “little to some” autonomy, as reported by both faculty and PGY5s. Residents reported that current curricula for laparoscopy and endoscopy consist primarily of clinical experience. Both residents and faculty, though, reported considerable value in other training modalities, including simulations, live animal laboratories, cadavers, and additional didactics. CONCLUSIONS: These data indicate that both residents and faculty perceive significant competency gaps for both laparoscopy and flexible endoscopy, with the most notable shortcomings for advanced and therapeutic cases, respectively. Improvement in resident training methods in these areas is warranted.


Posted July 15th 2016

Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures.

Kennith F. Layton M.D.

Kennith F. Layton M.D.

Evans, A. J., K. E. Kip, W. Brinjikji, K. F. Layton, M. L. Jensen, J. R. Gaughen and D. F. Kallmes (2016). “Randomized controlled trial of vertebroplasty versus kyphoplasty in the treatment of vertebral compression fractures.” J Neurointerv Surg 8(7): 756-763.

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BACKGROUND: We present the results of a randomized controlled trial evaluating the efficacy of vertebroplasty versus kyphoplasty in treating vertebral body compression fractures. METHODS: Patients with vertebral body compression fractures were randomly assigned to treatment with kyphoplasty or vertebroplasty. Primary endpoints were pain (0-10 scale) and disability assessed using the Roland-Morris Disability Questionnaire (RMDQ). Outcomes were assessed at 3 days, 1 month, 6 months, and 1 year following the procedure. RESULTS: 115 subjects were enrolled in the trial with 59 (51.3%) randomly assigned to kyphoplasty and 56 (48.7%) assigned to vertebroplasty. Mean (SD) pain scores at baseline, 3 days, 30 days, and 1 year for kyphoplasty versus vertebroplasty were 7.4 (1.9) vs 7.9 (2.0), 4.1 (2.8) vs 3.7 (3.0), 3.4 (2.5) vs 3.6 (2.9), and 3.0 (2.8) vs 2.3 (2.6), respectively (p>0.05 at all time points). Mean (SD) RMDQ scores at baseline, 3 days, 30 days, 180 days, and 1 year were 17.3 (6.6) vs 16.3 (7.4), 11.8 (7.9) vs 10.9 (8.2), 8.6 (7.2) vs 8.8 (8.5), 7.9 (7.4) vs 7.3 (7.7), 7.5 (7.2) vs 6.7 (8.0), respectively (p>0.05 at all time points). For baseline to 12-month assessment in average pain and RMDQ scores, the standardized effect size between kyphoplasty and vertebroplasty was small at -0.36 (95% CI -1.02 to 0.31) and -0.04 (95% CI -1.68 to 1.60), respectively. CONCLUSIONS: Our study indicates that vertebroplasty and kyphoplasty appear to be equally effective in substantially reducing pain and disability in patients with vertebral body compression fractures.


Posted July 15th 2016

Editorial: Magnetic Resonance Elastography and Non-Alcoholic Fatty Liver Disease: Time for an Upgrade?

Sumeet K. Asrani M.D.

Sumeet K. Asrani M.D.

Flores, A. and S. K. Asrani (2016). “Editorial: Magnetic resonance elastography and non-alcoholic fatty liver disease: Time for an upgrade?” Am J Gastroenterol 111(7): 995-996.

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Elastography techniques, such as two-dimensional magnetic resonance elastography (2D-MRE) are increasingly used for the non-invasive assessment of liver fibrosis in patients with nonalchoholic fatty liver disease (NAFLD). Loomba et al. demonstrate that 3D-MRE (shear wave frequency 40 Hz) had even greater diagnostic accuracy than the commercially available 2D-MRE (shear wave frequency 60 Hz) in diagnosing advanced fibrosis (area under the receiver operator curve, AUROC 0.981 vs. 0.921, P<0. 05) using liver biopsy as reference standard. Despite limitations, MRE serves as an important tool in risk stratification for patients with NAFLD.


Posted July 15th 2016

Efficacy of pharmacokinetics-directed busulfan, cyclophosphamide, and etoposide conditioning and autologous stem cell transplantation for lymphoma: Comparison of a multicenter phase ii study and cibmtr outcomes.

Joseph W. Fay M.D.

Joseph W. Fay M.D.

Flowers, C. R., L. J. Costa, M. C. Pasquini, J. Le-Rademacher, M. Lill, T. B. Shore, W. Vaughan, M. Craig, C. O. Freytes, T. C. Shea, M. E. Horwitz, J. W. Fay, S. Mineishi, D. Rondelli, J. Mason, I. Braunschweig, W. Ai, R. F. Yeh, T. E. Rodriguez, I. Flinn, T. Comeau, A. M. Yeager, M. A. Pulsipher, I. Bence-Bruckler, P. Laneuville, P. Bierman, A. I. Chen, K. Kato, Y. Wang, C. Xu, A. J. Smith and E. K. Waller (2016). “Efficacy of pharmacokinetics-directed busulfan, cyclophosphamide, and etoposide conditioning and autologous stem cell transplantation for lymphoma: Comparison of a multicenter phase ii study and cibmtr outcomes.” Biol Blood Marrow Transplant 22(7): 1197-1205.

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Busulfan, cyclophosphamide, and etoposide (BuCyE) is a commonly used conditioning regimen for autologous stem cell transplantation (ASCT). This multicenter, phase II study examined the safety and efficacy of BuCyE with individually adjusted busulfan based on preconditioning pharmacokinetics. The study initially enrolled Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) patients ages 18 to 80 years but was amended due to high early treatment-related mortality (TRM) in patients > 65 years. BuCyE outcomes were compared with contemporaneous recipients of carmustine, etoposide, cytarabine, and melphalan (BEAM) from the Center for International Blood and Marrow Transplant Research. Two hundred seven subjects with HL (n = 66) or NHL (n = 141) were enrolled from 32 centers in North America, and 203 underwent ASCT. Day 100 TRM for all subjects (n = 203), patients > 65 years (n = 17), and patients