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 s toxic hazards threaten to rival infectious diseases as a major threat to children's health in the 21st century, Emory physicians and health care facilities have joined forces to help protect children from the ill effects of the environment.
"Children are uniquely susceptible to environmental hazards," says Howard Frumkin, principal investigator for Emory's new Pediatric Environmental Health Speciality Unit (PEHSU). "Children breathe more air and drink more water per pound of body weight than adults and play close to the ground, where toxic materials can be absorbed." The new specialty unit provides information and education to families, communities, and health care providers throughout the Southeast regarding environmental hazards and the most effective ways to protect children's health. It also refers children for treatment, maintains a database of conditions linked to environmental hazards, and consults with government agencies to formulate solutions. As one of five centers nationwide funded by the US Agency for Toxic Substances and Disease Registry and the US Environmental Protection Agency, PEHSU links departments throughout the university as well as affiliates such as Children's Healthcare of Atlanta and Hughes Spalding Children's Hospital. The Emory PEHSU team includes pediatrician Robert Geller, medical director of the Georgia Poison Control Center; Leslie Rubin, director of the division of developmental pediatrics at Emory and director of academic and medical programs for the Marcus Institute; and Gerald Teague, director of pediatric respiratory medicine at Emory. Janice Nodvin, director of special projects at Marcus Institute, is project administrator. Concerned parents and health care providers can contact the center via a toll-free number, 1-887-33-PEHSU (337-3478) or check www.sph.emory.edu/PEHSU. |
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 s air pollution
making Atlantans sick? Epidemiologic studies have found a significant
association between pollution and increased sickness and death. But solid,
particulate matter and gases that pollute indoor and outside air vary
from region to region.
Environmental and occupational health expert Barry Ryan at the Rollins School of Public Health, along with colleagues at Harvard, is measuring particulate matter in the air and its relationship to patients who have chronic obstructive pulmonary disease or have had a heart attack. This study measures the levels and sizes of particulate matter such as nitrate and sulfate, trace metals, and gases such as sulfur dioxide, nitrogen dioxide, and ozone. Investigators put monitors in the homes of study participants once in the spring and will again in the fall for a two-week period. Subjects carry portable monitoring devices during the study periods. "Atlanta's pollutant mix is substantially different from those of the northeastern cities previously monitored," Ryan says. "This fact, coupled with the inclusion of a new group of sensitive individuals (cardiac patients), represents a step forward in the data collection needed to understand this problem." |
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 he National
Institutes of Health (NIH) has awarded investigators in the Emory Vaccine
Research Center a $7.5 million, five-year grant to develop new vaccine
strategies to prevent HIV infection.
The grant will boost the collaborative effort among Emory Vaccine Center researchers -- including principal investigator Mark Feinberg and microbiologists and immunologists Rafi Ahmed, Silvija Staprans, Jeff Safrit, and John Altman. Also participating are investigators from the University of Zurich, the University of California at San Francisco, and the Pasteur Institute. The Emory-led grant application received the highest ranking by reviewers of any of the applications submitted to the NIH for this program. Emory investigators will pursue promising ongoing research in which they have chosen live-attenuated vaccines currently used to prevent other infections and have adapted them to express HIV antigens. "To develop more effective HIV vaccines, we first must develop a more thorough understanding of the human response to vaccines and then maximize that response," says Feinberg, who is director of the Emory/Atlanta Center for AIDS Research. Vaccines using live-attenuated viruses include the varicella-zoster virus (used to prevent chicken pox), measles, and yellow fever. The researchers also plan to develop safer and more immunogenic versions of HIV vaccines based on attenuated strains of vaccinia virus (the vaccine used to eradicate smallpox). According to the researchers, vaccines that use powerful live viruses are desirable because they elicit a strong immune response in humans. |
  Ophthalmologist Paul Sternberg uses cool lasers to treat the wet form of AMD. |
 esearchers
at the Emory Eye Center and 30 other centers worldwide are trying a promising
new therapy to halt the progression of the wet form of age-related macular
degeneration (AMD), the leading cause of blindness in Americans over 50.
There is currently no cure for wet AMD. The most widely available treatment is photocoagulation therapy with a heating laser, but it can cause blind spots. It is used for only about 10% of patients with AMD. In the new photodynamic therapy (PDT), a cool laser uses light instead of heat. It can help up to 60% of the estimated 200,000 patients who are diagnosed each year with wet AMD, says Paul Sternberg, director of the retina section at the Emory Eye Center. "The therapy appears to be safer and poses fewer risks than photocoagulation therapy." No one knows what causes AMD or how to prevent it. It affects the central part of the retina or the macula, the area of sharpest sight and the part we use for reading and central vision. The wet form of AMD is the most blinding and results when abnormal blood vessels form and leak fluid and blood in the retina's choroid layer. The choroid's blood vessels, combined with tissue, can form a scar-like membrane under the retina and block central vision. PDT is outpatient, and patients can return to normal activities immediately, though they need to stay out of direct sunlight for at least 24 hours. Most need repeat treatments later to enhance results. Research shows that the therapy preserves or improves vision (defined as no loss of visual acuity or a deterioration of less than four acuity lines on an eye chart) in 38% of patients and slows vision loss in another 31%. For more information, call the Eye Center at 404-778-4182. |
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 atients
with leukemia, lymphoma, multiple myeloma, and other diseases of the cells
that form bone marrow may no longer have to depend on a perfect match
of transplanted bone marrow to survive.
Until recently, the best donor source for a transplant was a brother or sister whose human leukocyte antigens (HLA) matched the patient's. But only about 25% to 35% of patients have a matched sibling. The rest depend on the National Marrow Donor Program to find a suitable donor. In a new procedure called haploidentical or partially mismatched donor-related bone marrow transplantation, stem cells are collected from the blood and then cleansed of T cells, the cause of most cases of rejection (graft vs. host disease). To wash away the T cells, microscopic "BBs" coated with antibodies are injected into the donor's graft. The tiny pellets attach to the T-cells, which are removed with a magnet before the transplant. The implications are enormous. "Instead of spanning the globe to try to find a suitable donor, we can now go straight to our patient's family members who are partially HLA matched," says Ned Waller, director of the Bone Marrow and Stem Cell Transplant Center at Emory. "We can potentially save more lives using haploidentical transplantation since we can proceed with the transplant within weeks rather than waiting for months for a volunteer donor." To date, the bone marrow transplant team has successfully treated five patients ranging in age from 18 to 60. Early data shows that the new procedure can cure patients with high-risk leukemias, says principal investigator Istvan Redei. |
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new website run by the NIH gives patients and researchers easy access to information about some 4,000 clinical trials at nearly 50,000 locations nationwide.
How is Emory doing? Go to http://clinical trials.gov, click on "sponsors," then "emory" for a list of 150 trials open to enrollment. David Blake, Emory's vice president for academic health affairs, had a hand in getting the site started when he was head of research at the Association of American Medical Colleges. NIH suggests that campus federal relations officers may want to make sure that both researchers and those who deal with patient groups on their campuses are aware of this new site. Emory's Institutional Review Board, which approves the protocols for clinical trials, and the Office of Sponsored Programs will make sure Emory's trials are listed on the site. |
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a side effect of prostate surgery - loss of bladder control - Emory urologists
are taking two new approaches to treating urinary incontinence.
In the Emory Continence Center, physicians treat severe urinary control problems with a stopwatch-size neurostimulator, called InterStim. It is surgically placed under the skin of the abdomen and sends electrical impulses to the sacral nerves in the lower back that control bladder function. This therapy, developed by Medtronic, is based on the electrical stimulation technology the company first pioneered for pacemakers and later adapted to address neurologic conditions such as tremor. In a clinical trial conducted at 23 centers worldwide, patients undergoing the InterStim therapy had a significant reduction in symptoms of urinary urge incontinence, urgency frequency, and urinary retention. In another clinical study, noninvasive magnetic therapy creates powerful electromagnetic fields to stimulate and strengthen the nerves and pelvic muscles that affect bladder control. Patients undergoing the therapy sit fully clothed on a chair in a doctor's office or clinic for 20 minutes, twice a week, for up to 10 weeks. "The magnets do not touch the skin, and there is no pain," says Emory urologist Thomas Keane, who is leading the Emory arm of the clinical study. Emory neurologist Charles Epstein developed the magnetic stimulation coils used in the new therapy, along with Kent Davey, former faculty member at Georgia Tech. The director of the Emory Continence Center, Niall Galloway, led Emory in nationwide clinical trials resulting in FDA approval last year of the Neotonus Neocontrol Pelvic Floor Therapy System, which uses magnetic stimulation therapy to treat women with stress urinary incontinence. |
  Ruby Kochhar, a medical oncologist with the Winship Cancer Institute who practices primarily at Grady, is the first Avon scholar in breast cancer research named at Emory. |
frican-American women are more likely to die of breast cancer once diagnosed than any other ethnic or socioeconomic group in this country. Emory's Winship Cancer Institute and Grady Hospital hope to change those dismal odds with help from a $2.2 million research grant from the Avon Breast Cancer Crusade.
The Winship Cancer Institute is one of five leading national cancer centers to receive funds from the crusade, which raised nearly $14 million, the largest single corporate gift in history to the breast cancer cause. At Emory, researchers will use the grant to look into the genetics of the aggressive cancers that are more prevalent in African-American women. Research has shown the higher death rate in African-American women may be in part due to interactions with the environment, diet, and certain genes involved in the initiation of cancers. A significant portion of the gift will be used to attract and fund career development of young women physician/scientists entering breast cancer research in the fields of surgical oncology, pathology, medical oncology, and molecular genetics. "The Avon gift is going to allow Emory to take the expertise of young scientists already doing breast cancer research and accelerate our ability to do high-impact research toward earlier detection, prevention, and novel treatment in Grady's underserved breast cancer population," says Jonathan Simons, director of the Winship Cancer Institute and principal investigator for the Avon grant. "We will be able to apply the latest findings to a group who historically have been last to benefit from medical research advances." |
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 ore than
200 Atlanta-area men took part in what researchers are calling the largest
study of its kind looking at the effects of prostate cancer surgery on
sexual function.
The study, reported in the Journal of the American Medical Association (JAMA), looked at 1,291 black, white, and Hispanic men in six geographic regions who had undergone radical prostatectomy, or removal of the prostate gland, for prostate cancer. Of those men, 59.9% were impotent 18 months or more after surgery. The percentage was higher for men whose surgery did not preserve the nerves around the prostate. The study also looked at urologic function following prostatectomy and found that more than 8% of men were incontinent after 18 months. "This study gave us a better idea of what the average man with prostate cancer will face following surgery," says epidemiologist Bill Eley, who led the Atlanta component of the study and co-authored the JAMA article. "It shows there are more problems with impotence after prostatectomy than have been found previously by looking at single institutions. Men with prostate cancer should consider the side effects when looking at treatment options." The ongoing study also collected information from men who chose radiation therapy over surgery. The results of the radiation therapy findings will be published in an upcoming article. |
  Emory pathologist Melissa Brown and doc- toral student Ginny Secor are studying how mast cells influence development of MS. |
 mory pathologists
have uncovered a significant connection between mast cells - a type of
immune cell - and the development of multiple sclerosis (MS), an autoimmune
disease that attacks the central nervous system. Until now, research into
the mechanisms of MS has focused almost exclusively on T cell responses.
The new discovery, made in a mouse model of MS similar to the human form of the disease, provides a new perspective on how nerves are damaged, according to a report in the Journal of Experimental Medicine. The findings are particularly significant because drugs are available that block the action of mast cells in other diseases. Emory pathologist Melissa Brown and Ginny Secor, a doctoral student in Brown's laboratory, pieced together several parts of a research puzzle to develop their hypothesis that mast cells are linked to MS. Brown's earlier work focused on the regulation of cytokine gene expression in T and mast cells. Cytokines are proteins that act to orchestrate signals between immune cells. The investigators realized that many of the cytokines implicated in MS are produced by mast cells. In MS, genetic and/or environmental factors may cause the immune system to mistakenly attack the protective myelin sheath that insulates nerve cells. Resulting patchy scarring or plaques impair communication throughout the central nervous system. Although not fatal, MS causes progressively debilitating symptoms - weakness, numbness, infections, and difficulty performing mental tasks - and decreases life expectancy by an average of six years. There is no cure for the disease, and only a few drugs slow its progression. MS affects more than a million people worldwide. "Clinicians and most researchers have not seriously considered the potential role of mast cells in multiple sclerosis, so we are particularly excited about these findings," says Brown, especially because mast cells have been well studied in the respiratory tract and the skin as effector cells in hay fever, asthma, and atopic dermatitis. In allergy and asthma, compounds such as cromolyn sodium antihistamines can either block the release of mast cell mediators or block their activity. The question remains as to whether drugs already used to treat respiratory tract diseases such as allergy and asthma could effectively treat MS or would need to be modified to enter the central nervous system. In further research funded by the Multiple Sclerosis Society, Brown, Secor, and their colleagues will perform similar experiments using mast cells with specific genetic alterations to define the mechanism underlying the influence these cells have on the MS disease process. |
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mory's new
Prostate Cancer Research Center will bring together researchers from different
departments to study the causes of prostate cancer, determine its genetic
structure, and eventually design new treatments. Urologists Fray Marshall,
chair of the department of urology, and John Petros direct the center.
A $2.5 million grant from the US Department of Defense - one of only a few awarded special congressional appropriations to fund prostate cancer research - will support a core facility as well as three separate but interrelated research projects, says Petros, principal investigator for one of the research trials. "The center database will keep track of all of the clinical samples, as well as the experimental data, so we can make correlations between different laboratories working on the same patient sample," says Petros. "We will look at the disease on a molecular level and then relate that basic information back to the patient's prognosis, clinical course, and outcome to help us answer questions about the causes of prostate cancer." Emory departments involved in the new center's work include biochemistry, immunology, pathology and microbiology, and urology. |
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 ince December,
Emory faculty and staff have helped feed, clothe, screen, and vaccinate
scores of Atlantans:
The Woodruff Health Sciences Library collected 700 cans of food as payment for late book fines or as donations. All food went to the Atlanta Food Bank. The food bank along with the Briarcliff Clothes Closet were the beneficiaries of food and clothing drives sponsored by the School of Nursing's Community Outreach Committee. More than 800 people took advantage of a heart screening at Emory-Columbia/HCA hospitals. Free flu vaccinations were given to 1,200 people at a flu "drive through" at Wesley Woods. |
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biventricular pacemaker that stimulates both sides of the heart instead of only one has greatly improved its recipients' quality of life, and in some cases, eliminated the need for a heart transplant.
The new pacemaker connects to both ventricles of the heart to treat congestive heart failure -- with impressive results. People who previously depended on intravenous drugs to keep their hearts going, who couldn't so much as walk around the house without getting winded, now are able to discontinue medication and enjoy normal daily activities. "It's the most dramatic treatment I've seen in cardiology in the past decade," says electrophysiologist Angel Leon of Crawford Long Hospital, who with colleague Dave DeLurgio, is principal investigator for the study. With Jonathan Langberg, director of cardiac electrophysiology at Emory, and cardiologist Andy Smith, who directs Emory's Center for Heart Failure Therapy, they are studying various versions of the biventricular pacemaker. The pacemakers under study are manufactured by Guidant, Medtronic, and Pacesetter. Traditional cardiac pacemakers use one electrical lead to prevent the heart from pausing or beating too slowly. People with congestive heart failure have more serious problems, however. Their heart muscle is weak, and the electrical system that regulates the heart is damaged. As a result, the ventricles, the chambers of the heart that pump blood into the lungs or the rest of the body, do not contract in sync, and the force of the heart's pumping action is greatly lessened. The biventricular pacemaker sends electric impulses to both ventricles, coordinating their pumping action and making the heart more efficient. A modified version of the biventricular pacemaker, the implantable cardiac defibrillator (ICD), not only paces the heart but can actually restart it if it goes into arrest. The ICD is used in people at risk of developing life-threatening arrhythmia. Emory doctors have implanted the biventricular pacemaker in 50 patients at Emory University Hospital and Crawford Long, with excellent results. One woman previously required an electric wheelchair because of her seriously weak heart. She now walks two miles a day. |
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 uring your typical coronary artery bypass graft surgery (CABG), a cardiopulmonary bypass machine temporarily takes over for the heart and lungs while surgeons work to increase blood flow to the heart.
Crawford Long Hospital cardiothoracic surgeon John Puskas thinks there's a better way. Thanks to a new generation of innovative instruments that allow part of the heart to be held still as a bypass graft is attached, Puskas now performs about 85% of his coronary bypass procedures without the heart/lung machine. Using microsurgery on tiny arteries, he performs bypasses without stopping the heart. |
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The results? Fewer side effects and a shorter hospital stay for CABG patients. "The bypass machine generally works pretty well," says Puskas, "but there are some downsides. The manipulation of the heart and aorta when tubes are put in to divert blood to the bypass machine can provoke a stroke or an injury. And contact with the foreign surfaces of the pump machine can elicit an inflammatory response within the whole body. Most people get over it in a few days, but the inflammation may contribute to infection, kidney problems, stroke, or bleeding, as well as neuropsychiatric problems like depression, anxiety, insomnia, loss of appetite, and short-term memory loss." Emory is the foremost center in Georgia using the off-pump approach, which cuts hospital stays almost in half, to 3.5 days, and reduces hospitalization costs by 30%. About 70% of patients who have heart surgery on the pump need a blood transfusion, compared with 30% in the off-pump group. Off-pump bypass patients seem to simply feel better, faster. "They bounce back mentally and physically much more quickly," Puskas says. "Most of these patients wake up in the operating room, have the breathing tube removed, and spend a few hours in the intensive care unit instead of a few days. They get up and walk around just a few hours after surgery." Puskas thinks the off-pump bypass is better for the heart too. This fall, with a $1.1 million grant from Medtronic, he will study how hearts fare in patients who undergo off-pump versus on-pump bypasses. |
Copyright © Emory University, 2000. All Rights Reserved.
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Web version by Jaime Henriquez.