Research Spotlight

Posted November 15th 2017

Why is the use of digitalis withering? Another reason that we need medical heart failure specialists.

Milton Packer M.D.

Milton Packer M.D.

Packer, M. (2017). “Why is the use of digitalis withering? Another reason that we need medical heart failure specialists.” Eur J Heart Fail: 2017 Oct [Epub ahead of print].

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Contrary to popular opinion, William Withering did not discover digitalis nor was he the first to describe its use for heart failure. In 1785, the esteemed English botanist and physician wrote a pamphlet that summarized his experiences in 163 patients with dropsy. Yet, at the time, digitalis had been known to exert important pharmacological effects for 2000 years. In the first century, the Greek physician, Pedanius Dioscorides, noted the use of digitalis as a therapeutic agent; its application to heart failure was first recorded in print by Leonard Fuchs in 1542.1 Nevertheless, Withering was the first to systematically carry out clinical studies with the plant in a scientific manner, eliminating the superstition that had long surrounded it. Withering’s work was ground-breaking, not because of what he discovered, but how he approached its evaluation. It was the first use of the scientific method for the characterization of a pharmaceutical.


Posted November 15th 2017

Cholesterol is the Cause of Atherosclerosis.

William C. Roberts M.D.

William C. Roberts M.D.

Roberts, W. C. (2017). “Cholesterol is the cause of atherosclerosis.” Am J Cardiol 120(9): 1696.

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Although some investigators have considered cholesterol the cause of atherosclerosis for several decades,1–15 26 authors, mainly from Europe, in April 2017, published an article titled “Low-density lipoproteins cause atherosclerotic cardiovascular disease…,” a consensus statement from the European Atherosclerosis Society Consensus Panel.16 I was glad to see the article that soundly supports the view that cholesterol is the cause of atherosclerosis. Although I found the article unnecessarily difficult, the message is loud and clear. So when your physician recommends a statin drug or ezetimibe or one of the PCSK-9 inhibitors, take it. These drugs are safer than almost any drug one can put in his/her mouth.


Posted November 15th 2017

Pro: Direct-acting agents are associated with occurrence and recurrence of hepatocellular carcinoma.

James F. Trotter M.D.

James F. Trotter M.D.

Trotter, J. F. (2017). “Pro: Direct-acting agents are associated with occurrence and recurrence of hepatocellular carcinoma.” Liver Transpl: 2017 Oct [Epub ahead of print].

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The advent of direct-acting oral agents (DAA’s) for the treatment of hepatitis C (HCV) is perhaps the most important therapeutic development in the modern practice of hepatology. These drugs cure HCV, the most common indication for liver transplantation. Their efficacy approaches 100 %, requiring as little as 8 weeks of therapy without clinically relevant side effects. Consequently, HCV can be eradicated in almost any treated patient, even those with decompensation, albeit at a slightly lower rate. Clinicians have enthusiastically treated large numbers of infected patients including those with advanced fibrosis to ultimately prevent longterm complications including hepatocellular carcinoma (HCC) and hepatic decompensation either of which may lead to transplantation or death.


Posted November 15th 2017

Antenatal methadone vs buprenorphine exposure and length of hospital stay in infants admitted to the intensive care unit with neonatal abstinence syndrome.

Veeral N. Tolia M.D.

Veeral N. Tolia M.D.

Tolia, V. N., K. Murthy, M. M. Bennett, E. S. Miller, D. K. Benjamin, P. B. Smith and R. H. Clark (2017). “Antenatal methadone vs buprenorphine exposure and length of hospital stay in infants admitted to the intensive care unit with neonatal abstinence syndrome.” J Perinatol: 2017 Oct [Epub ahead of print].

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OBJECTIVE: Antenatal exposure to methadone or buprenorphine often causes neonatal abstinence syndrome (NAS) in newborns. However, comparative effects on affected infants’ hospital courses are inconclusive. We sought to estimate the relationship of antenatal exposure with methadone or buprenorphine and infants’ length of stay among hospitalized infants with NAS. STUDY DESIGN: This was a retrospective cohort study of hospitalized infants with NAS with either maternal exposure. Eligible infants were singleton infants born 36 weeks’ gestation and diagnosed with NAS<7 days of age between 2011 and 2014 in the Pediatrix Clinical Data Warehouse. Infant with congenital anomalies and those of multiple gestation were excluded. RESULTS: Of 3364 eligible infants, 2202 (65%) were exposed to methadone and 1162 (34%) to buprenorphine. Infants exposed to buprenorphine had a lower rate of pharmacologic treatment for NAS (88 vs 91%, P<0.001). Median length of hospital stay was shorter among infants exposed to buprenorphine (21 days (inter-quartile range; 13-31) vs methadone (24 days (15-38), P<0.0001)). On multivariable Cox proportional hazard analyses, buprenorphine was associated with a shorter length of stay (hazard ratio (HR)=1.47 (95% confidence interval (CI): 1.32-1.62, P<0.001) after controlling for maternal age, parity, race or ethnicity, prenatal care, smoking status, use of antidepressants, use of benzodiazepines, and infant gestational age, small for gestational age status, cesarean delivery, sex, out born status, type of pharmacotherapy, breast milk use, year and center. We observed similar results in model using infants matched 1:1 with propensity scores for antenatal medication exposure (HR 1.39 for buprenorphine, CI 1.32-1.62, P<0.001). CONCLUSION: Among infants born 36 weeks' gestation with NAS, antenatal buprenorphine exposure was associated with a decreased length of stay relative to antenatal methadone exposure.


Posted November 15th 2017

Living Donor Uterus Transplantation: A Single Center’s Observations and Lessons Learned From Early Setbacks to Technical Success.

Giuliano Testa M.D.

Giuliano Testa M.D.

Testa, G., E. C. Koon, L. Johannesson, G. J. McKenna, T. Anthony, G. B. Klintmalm, R. T. Gunby, A. M. Warren, J. M. Putman, G. dePrisco, J. M. Mitchell, K. Wallis and M. Olausson (2017). “Living donor uterus transplantation: A single center’s observations and lessons learned from early setbacks to technical success.” Am J Transplant 17(11): 2901-2910.

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Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper, we analyze the first five cases of living donor uterus transplantation performed in the United States. The first three recipients lost their uterus grafts at days 14, 12, and 6, respectively, after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, at 6 and 3 mo, respectively, after transplant, have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique, and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on knowledge in the evolving field of uterus transplantation.