Research Spotlight

Joseph, S. and M. R. Costanzo (2016). “A novel therapeutic approach for central sleep apnea: Phrenic nerve stimulation by the remede system.” International journal of cardiology 206 Suppl: S28-34.

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Central sleep apnea is a devastating disease which occurs in approximately 40% of patients with heart failure as well as patients with a history of stroke, opioid use and neurological conditions. It is associated with increased morbidity and mortality in heart failure likely due to the recurrent episodes of hypoxia and nor-epinephrine release. There have historically been few therapeutic options; positive airway pressure therapies have been the most common treatment to date. However, the adoption of positive airway pressure therapies has been limited due to poor patient adherence and acceptance and recent evidence of increased cardiovascular mortality in low ejection fraction heart failure patients with CSA. The remede System, utilizing transvenous stimulation of the phrenic nerve, offers a novel physiologic approach to therapy that eliminates the need for positive airway pressure and patient adherence. Studies have shown that this therapy improves sleep, oxygenation, and quality of life and ongoing trials are expected to give additional randomized data to support the therapeutic benefit of the remede System.

Kanak, M. A., M. Takita, R. Shahbazov, M. C. Lawrence, W. Y. Chung, A. R. Dennison, M. F. Levy and B. Naziruddin (2015). “Evaluation of microrna375 as a novel biomarker for graft damage in clinical islet transplantation.” Transplantation 99(8): 1568-1573.

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Background. Early and sensitive detection of islet graft damage is essential for improving posttransplant outcomes. MicroRNA 375 (miR375) has been reported as a biomarker of pancreatic beta-cell death in small animal models. Methods. The miR375 levels were measured in purified human islets, sera from patients with autologous and allogeneic islet transplantation as well as total pancreatectomy alone (nontransplanted group). The miR375 levels were also determined in a miniaturized in vitro tube model comprising human islets and autologous blood. Results. The miR375 expression level in islets was dose-dependent (P < 0.001) and significantly elevated after islet damage in plasma in the in vitro model (P = 0.003). Clinical analysis revealed that circulating miR375 levels in both autologous and allogeneic islet recipients were significantly elevated for 7 days after islet infusion, compared with the nontransplanted group (P = 0.005 and < 0.001, respectively). Furthermore, miR375 detected the difference in islet graft damage among 3 different anti-inflammatory protocols for clinical autologous transplantation (P < 0.01). Conclusions. Circulating miR375 can be a reliable biomarker to detect graft damage in clinical islet transplantation because serum C-peptide and proinsulin levels are difficult to interpret due to the influence of multiple factors, such as beta-cell stress and physiological response.

Victorio, M. C. and C. K. Khoury (2016). “Headache and chiari i malformation in children and adolescents.” Seminars in Pediatric Neurology 23(1): 35-39.

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Headache is a common problem in children and adolescents. Its recurrent and disabling nature may lead to use of neuroimaging to exclude secondary causes of headache such as Chiari I malformation (CM I). CM I has a variety of presentation with headache being the most common symptom. CM I can be asymptomatic and is also often found incidentally in neuroimaging done for conditions other than headache. This article reviews the spectrum of headache in patients with CM I.

Kabbouche, M. and C. K. Khoury (2016). “Management of primary headache in the emergency department and inpatient headache unit.” Seminars in Pediatric Neurology 23(1): 40-43.

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Migraine is a chronic disorder with debilitating exacerbations throughout the lifetime of migraineurs. Children and adolescents are significantly affected. The prevalence of migraine in this age group is higher than predicted in the last decade. Fortunately, this chronic disease is getting more attention and recognition, and better treatments are now being offered to these patients. Different medications are available, mostly for the outpatient management of an attack and include the use of over-the-counter antiinflammatory medications as well as prescribed medications like the triptans group. These therapies do sometime fail and the exacerbations can last days to weeks. Early aggressive intravenous treatment can be very effective in breaking the attack and allowing the child to be functional faster and sometimes may prevent chronification of an attack.

Osteen, K. A. and C. C. Beal (2016). “Reproductive health and women with congenital heart disease a practice update.” Journal of Perinatal & Neonatal Nursing 30(1): 25-35.

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The purpose of this article was to examine reproductive health issues for women with congenital structural abnormalities of the heart. Because of surgical advances and innovations in healthcare, infants with congenital heart disease often live now into adulthood. Women with congenital heart disease have reported the desire to have children but expressed concern about fertility and the health consequences of pregnancy. Although many women with congenital heart disease are able to give birth without adverse outcomes, life-threatening complications can occur. Best practices for the care of women with congenital heart disease are grounded in an understanding of how cardiac defects may affect pregnancy and in communicating the implications of cardiac defects for reproductive health to support informed decision making.