Research Spotlight

Yang, Y., W. Weng, J. Peng, L. Hong, L. Yang, Y. Toiyama, R. Gao, M. Liu, M. Yin, C. Pan, H. Li, B. Guo, Q. Zhu, Q. Wei, M. P. Moyer, P. Wang, S. Cai, A. Goel, H. Qin and Y. Ma (2017).”Fusobacterium nucleatum increases proliferation of colorectal cancer cells and tumor development in mice by activating toll like receptor 4 signaling to nuclear factor kappab and upregulating…Gastroenterology 152(4): 851-866.e824.

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BACKGROUND & AIMS: Nearly 20% of the global cancer burden can be linked to infectious agents. Fusobacterium nucleatum promotes tumor formation by epithelial cells via unclear mechanisms. We aimed to identify microRNAs (miRNAs) induced by F nucleatum and evaluate their ability to promote colorectal carcinogenesis in mice…METHODS: Colorectal cancer (CRC) cell lines were incubated with F nucleatum or control reagents and analyzed in proliferation and would healing assays…RESULTS: Fusobacterium nucleatum increased proliferation and invasive activities of CRC cell lines compared with control cells. CRC cell lines infected with F nucleatum formed larger tumors, more rapidly, in nude mice than uninfected cells. CONCLUSIONS: We found infection of CRC cells with F nucleatum to increase their proliferation, invasive activity, and ability to form xenograft tumors in mice…Patients with both high amount of tissue F nucleatum DNA and miR21 demonstrated a higher risk for poor outcomes.

Cedars, A., L. Benjamin, S. V. Burns, E. Novak and A. Amin (2017). “Clinical predictors of length of stay in adults with congenital heart disease.” Heart: 2017 Feb [Epub ahead of print].

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OBJECTIVE: Length of stay (LOS) is a major driver of inpatient care costs. To date, few studies have investigated risk factors associated with increased LOS in patients with adult congenital heart disease (ACHD). In the present work, we sought to address this knowledge gap. METHODS: We conducted an analysis of the State Inpatient Databases from Arkansas, California, Florida, Hawaii, Nebraska and New York. We analysed data on admissions in patients with ACHD and constructed a series of hierarchical regression models to identify the clinical factors having the greatest effects on LOS. RESULTS: We identified 99 103 inpatient hospitalisations meeting criteria for inclusion. Diagnoses associated with the longest LOS were septicaemia (LOS=14.2 days in patients atrial septal defect, and 11.7 days among all other ACHD) and pericarditis, endocarditis and myocarditis (LOS=13.6 days and 10.0 days, respectively). When separated by underlying anatomy, the variables most consistently associated with longer LOS were bacterial infection, complications of surgeries or medical care, acute renal disease and anaemia. CONCLUSIONS: In the present study, we identified risk factors associated with longer LOS in ACHD. These data may be used to identify at-risk patients for targeted intervention to decrease LOS and thereby cost.

Blackbourne, B. D., A. Vasudevan and W. C. Roberts (2017). “Comparison at necropsy of heart weight in women aged 20 to 29 years with fatal trauma or chemical intoxication versus fatal natural cause (a search for the normal adult heart weight).” Am J Cardiol 119(5): 808-812.

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The present obesity epidemic makes determining the normal heart weight in adults difficult. This study examines the heart weight at autopsy in 104 women aged 20 to 29 years who died in 1978 to 1980 before the overweight epidemic ensued. Of the 104 cases, the hearts weighed 300 g in 18 (17%). Of the 67 cases dying from an unnatural cause (trauma or chemical intoxication), only 3 (4%) had hearts weighing >300 g; of the 37 patients dying from a variety of natural causes, 15 (41%) had hearts weighing >300 g (p <0.001). The body mass index (BMI) was 25 kg/m2, the hearts ranged from 230 to 850 g (mean 351 +/- 142; median 300 g). In conclusion, the cases dying from an unnatural cause had smaller mean heart weights than those women dying from a natural cause and those with a normal BMI (25 kg/m2. The normal heart weight in young women dying from an unnatural cause with few exceptions is <300 g.

Packer, M. (2017). “Double vision: Replicating a trial showing a survival benefit.” JACC Heart Fail 5(3): 232-235.

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Many physicians boast that there is no reason to read or keep up with the medical literature. Why? If it is true that 1 trial is never enough to change clinical practice, clinicians can always claim that they are waiting for confirmatory evidence and for critical review by regulatory authorities and peer groups. Such thinking greatly simplifies the challenge of maintaining medical knowledge. Practitioners need not become familiar with any scientific study; they need only to wait for guideline statements, which will determine when a critical mass of evidence has been compiled. Sadly, some clinicians will also wait to see what practices and procedures are reimbursed, because this—not scientific evidence—has become a major factor influencing medical care.

Paul, C., C. Leonardi, A. Menter, K. Reich, L. S. Gold, R. B. Warren, A. Moller and M. Lebwohl (2017). “Calcipotriol plus betamethasone dipropionate aerosol foam in patients with moderate-to-severe psoriasis: Sub-group analysis of the pso-able study.” Am J Clin Dermatol: 2017 Feb [Epub ahead of print].

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BACKGROUND: Fixed-combination calcipotriol 50 mug/g plus betamethasone 0.5 mg/g (Cal/BD) aerosol foam is a new topical treatment for psoriasis. Although moderate-to-severe psoriasis is typically treated with systemic/biologic therapies, a topical treatment that is efficacious in these patients may be a significant cost-saving alternative to systemic therapy. OBJECTIVE: The objective of this study was to assess the response to Cal/BD foam and gel in patients with moderate-to-severe psoriasis enrolled in the phase III, 12-week PSO-ABLE study. METHODS: Patients eligible for this analysis had moderate-to-severe psoriasis, defined by the ‘Rule of Tens’: body surface area >/=10% or Psoriasis Area and Severity Index (PASI) [excluding head; modified PASI (mPASI)] >10 or Dermatology Life-Quality Index >10. Endpoints included: proportion of patients achieving mPASI75 or mPASI90; change in body surface area; proportion of patients clear/almost clear with a >/=2 grade improvement (i.e., treatment success); change in Dermatology Life-Quality Index. RESULTS: Seventy-seven Cal/BD foam patients and 82 gel patients had moderate-to-severe psoriasis. A greater proportion achieved mPASI75 and mPASI90 with Cal/BD foam than gel at weeks 4, 8, and 12 (57.1 vs. 35.4%; p = 0.006 and 15.6 vs. 12.2% at week 12, respectively); overall reduction in mPASI from baseline to week 12 was 64% with the foam vs. 51% with the gel. Overall reduction in body surface area at week 12 was 50% with the foam and 39% with the gel. Treatment success rates were higher with the Cal/BD foam than the gel at weeks 1, 2, 4, 8 (p = 0.0089), and 12, and a greater proportion of foam patients achieved a Dermatology Life-Quality Index score of 0/1 at weeks 4 (p = 0.004), 8, and 12 (p = 0.001). CONCLUSION: Cal/BD foam can be considered as a treatment option in some patients with moderate-to-severe psoriasis who are potential candidates for systemic therapy.