january
2 013
Carolina Endocrine
State-of-the-Art Adult, Pediatric Endocrinology Care T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Also in This Issue The Physician Liaison Research News
FDA-Approved for MRI Use Revo MRI® Pacing System engineered with SureScan® Technology The only pacing system to provide proven cardiac care that’s designed to be used safely with MRI. The Revo MRI SureScan pacing system is MR Conditional designed to allow patients to undergo MRI under the specified conditions for use. A complete system, consisting of a Medtronic Revo MRI SureScan IPG implanted with two CapSureFix MRI® SureScan leads is required for use in the MRI environment.
www.mrisurescan.com
Innovating for life.
COVER STORY
6
Carolina Endocrine State-of-the-Art Adult, Pediatric Endocrinology Care
january 2013
FEATURES
8
Vol. 4, Issue 1
13 Duke Research News Measuring Gene Response to Infection Can Lead to Early, Accurate Diagnoses
Practice Management
15 UNC Research News
Growing Your Practice Using Physician Liaison Program
15 UNC Research News
Amanda Kanaan reinforces that physicians must broadcast what they do, or to the masses, they aren’t doing it.
DEPARTMENTS 10 Duke News
- Visiting Physicians Aim to Open Weight-Loss Surgery Center in China - Real-World Defibrillator Benefits Parallel Clinical Trial Expectations
12 Duke Research News Sickle Cells Show Lethal Potential Against Aggressive Cancer Tumors
Dark Matter’s Regulatory Role in Gene Assembly Comes to Light
- Gene Variants for Mental Illness Linked to Brain Changes at Birth - Dark Matter’s Regulatory Role in Gene Assembly Comes to Light
17 UNC Research News Genomic Analysis Method Offers Clues to Diabetes, Other Complex Diseases
18 UNC Research News
- Decline in Liver Transplants Due to Lower Quality Donor Livers - Sublingual Immunotherapy Shows Promise as Treatment for Peanut Allergy
20 News
Welcome to the Area Upcoming Events
COVER PHOTO: Michael J. Thomas, M.D., Ph.D., (center) stands among the Carolina Endocrine staff. They are (from left): Courtney Kovalick, PA-C; Eileen Andres, PA-C; Khushbu Chandarana, M.D.; Julia Warren-Ulanch, M.D.
2
The Triangle Physician
From the Editor
Well-Communicated Excellence Carolina Endocrine starts the new year with an expanded facility in Raleigh, an open house planned for Feb. 21 and a cover story in this issue of The Triangle Physician. The specialty practice demonstrates the likely effect of a commitment to excellence that is T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Editor Heidi Ketler, APR
Carolina Endocrine stands out in a number of ways. Comprehensive in-office care for the range of endocrine disorders in adults and children allows for more immediate
heidi@trianglephysician.com
Contributing Editors Amanda Kanaan
response and improved outcomes, which helps reduce health care costs. To illustrate, within Carolina Endocrine’s array of diagnostic capabilities is onsite boneage X-ray. This saves families a trip to the hospital or radiology facility in the treatment
Photography Mark Jacoby Creative Director Joseph Dally
well communicated – a growing practice.
mark@jacobyphoto.com
of one of the most common pediatric conditions – short stature. Carolina Endocrine also has the distinction of being one of only a few private practices in North Carolina
jdally@newdallydesign.com
Advertising Sales info@trianglephysiciancom News and Columns Please send to info@trianglephysician.com
with a nuclear medicine lab, a capability typically found in hospitals. Carolina Endocrine is unique in the advanced certification within. It is Raleigh’s only private practice with a board-certified pediatric endocrinologist, a specialist who has the expertise to evaluate and treat even newborns. Its physicians have endocrine certification in neck ultrasound (ECNU) and advanced expertise in the use of
The Triangle Physician is published by: New Dally Design
ultrasound-guided, fine-needle aspiration biopsy, a diagnostic thyroid scan that is more specific than others, saving some low-risk patients from surgery.
Subscription Rates: $48.00 per year $6.95 per issue
Read more about Carolina Endocrine, and you may be compelled to take a look for
Advertising rates on request Bulk rate postage paid Greensboro, NC 27401
24-7 access to information and online tools for patients and referring physicians, alike.
Every precaution is taken to insure the accuracy of the articles published. The Triangle Physician can not be held responsible for the opinions expressed or facts supplied by its authors.
yourself at the open house. The practice website – carolinaendocrine.com – provides
Also in this issue of The Triangle Physician, contributor Amanda Kanaan, a medical marketing expert, discusses the role of the physician liaison as the voice of a practice, with the goal of securing new referral business.
Opinions expressed or facts supplied by its authors are not the responsibility of The Triangle Physician. The Triangle Physician makes no warrant to the accuracy or reliability of this information.
The Triangle Physician is another workhorse when it comes to reaching the region’s
All advertiser and manufacturer supplied photography will receive no compensation for the use of submitted photography.
rates are highly competitive, and we welcome your practice news and professional
medical community – more than 9,000 physicians, physician assistants, nurse practitioners and hospital and practice administrators – every month. Our advertising commentary at no charge. For more information, please send me an e-mail at heidi@trianglephysician.com.
Any copyrights are waived by the advertiser. No part of this publication can be reproduced or transmitted in any form or by any means without the written permission from The Triangle Physician.
Happy New Year!
Heidi Ketler Editor
january 2013
3
Cover
Carolina Endocrine
State-of-the-Art Adult, Pediatric Endocrinology Care Carolina Endocrine has developed a
vices in the near future as technology in
reputation for offering the Triangle’s most
the endocrine field advances,” says Mi-
state-of-the art endocrinology care. In fact,
chael Thomas, M.D., Ph.D., board-certified
word has spread so well that the practice
endocrinologist at Carolina Endocrine.
in-house nuclear medicine lab in Raleigh; • The only board-certified, privatepractice pediatric endocrinologist in Raleigh; and
recently relocated to a new office in order
The relocation has nearly doubled the
Comprehensive Endocrine Diagnostic and Therapeutic Techniques
size of the previous office, allowing
Offering specialized care for an array of
the new facility to see up to 50 percent
endocrine disorders (including thyroid,
Promoting Thyroid Care
more patients. With 12 exam rooms, a
parathyroid, adrenal, pituitary, metabolic,
Due to Carolina Endocrine’s specialized
nuclear medical lab, ultrasound suites
reproductive,
growth
expertise in thyroid care, one of the most
and a separate waiting area for in-house
disorders), Carolina Endocrine combines
common conditions referring physicians
lab draws, Carolina Endocrine offers the
experience and technology to offer the
send to the practice is that of thyroid
ideal combination of convenience and
Triangle’s most contemporary adult and
nodules. The incidence of thyroid nodules
technology that patients can’t normally
pediatric endocrinology care. Because of
is quite common (women:men – 3:1), and
get outside of the hospital – without any
this, the practice takes pride in offering
patients’ risk increases with age.
additional facility fees. The practice’s
many unique services:
to accommodate more patients.
puberty
and
• The only endocrinologists with endocrine certification in neck ultrasound (ECNU) in Raleigh.
single-level streetside location is just a few
• The only onsite testing and treatment
“Twenty to 30 percent of younger women
blocks from its previous office near Rex
facility for thyroid nodules in Raleigh;
and as many as 60 percent of older
Hospital in Raleigh.
• One of a few practices nationwide to
women may have at least one thyroid
offer molecular diagnostics of thyroid
nodule present on imaging studies,”
“Our new facility gives us the opportunity
FNA (fine needle aspiration) biopsy
says Khushbu Chandarana, M.D., board-
to serve more patients than ever before,
and analysis;
certified
and allows us the ability to add new ser-
• The only private practice with an
endocrinologist
at
Carolina
Endocrine. The risk of a thyroid nodule being malignant is about 5 percent to 15 percent, depending on age, gender, family history or a history of neck irradiation. Carolina Endocrine offers comprehensive thyroid nodule evaluation, including discussion of diagnostic and therapeutic options, that is much more convenient for patients and gets the results back to referring physicians quicker. Initial evaluation of a thyroid nodule(s) begins with a measurement of thyroid function tests and thyroid antibodies. Additionally, a neck ultrasound can be performed during the same initial visit to optimize patient care and physician communication. Carolina Endocrine is Raleigh’s only
Dr. Warren-Ulanch uses the stadiometer to obtain the precise height of a patient.
4
The Triangle Physician
private group with physicians who have
endocrine certification in neck ultrasound (ECNU). This means they have completed extensive
training
and
certification
that designates them as experts in the diagnostic evaluation of thyroid and parathyroid disorders and ultrasoundguided FNA biopsy. Depending on the results of initial thyroid tests, the physicians can perform FNA biopsies in the office – often on the day of the initial visit. The biopsy helps determine if there is any evidence of malignancy. FNA biopsy is a simple, costeffective procedure that is more specific than other diagnostic thyroid scans and is a good option for thyroid nodules greater
Dr. Chandarana performs a thyroid ultrasound.
than 1 centimeter in size. By staining one set of the microscope slides while the
the office. As one of North Carolina’s
fact that we can offer ‘one-stop shopping’
patient is in the office, the physicians
only private-practice nuclear medicine
for patients with thyroid conditions means
are
specimen
labs, the office is specially outfitted to
that patients save money and referring
adequacy before submitting the slides to
accommodate this form of treatment,
physicians receive answers quicker,” says
cytopathology, which minimizes the rate
which is typically performed in hospitals.
Dr. Chandarana.
Lymph
Pediatric Endocrine Care
able
to
determine
of non-diagnostic results. node
mapping
is
another
Past guidelines advised most patients
service that is offered for patients with
Carolina Endocrine is one of the few
with an indeterminate (inconclusive)
known thyroid cancer who are awaiting
practices in the area that specializes in
test result to undergo diagnostic thyroid
thyroidectomy. A pre-operative neck
pediatric endocrine care. In fact, Julia
surgery to assess whether the nodules are
ultrasound is often helpful in identifying
Warren-Ulanch, M.D., is Raleigh’s only
benign or malignant. However, Carolina
abnormal or enlarged lymph nodes
board-certified private practice pediatric
Endocrine is one of the first practices
that might harbor or contain thyroid
endocrinologist.
nationwide to offer molecular diagnostic
cancer, and their identification can lead
techniques
Afirma®,
to ultrasound-guided FNA biopsy of an
“I had the opportunity to work with kids
Asuragen miRInform ) that permit further
abnormal lymph node, in order to test
who struggled with endocrine disorders
characterization of indeterminate results.
whether thyroid cancer has metastasized
during my third and fourth year of
to that part of the neck.
medical school and just loved it so much
(e.g.
Veracyte ®
that I knew pediatric endocrinology was
Molecular diagnostic evaluation of FNA biopsies may elucidate the likelihood that
“This technique can help define the
my specialty,” says Dr. Warren, who is
a nodule is benign or malignant based on
extent of thyroid surgery, so that the
double board certified in pediatric and
its molecular profile. Those whose risk
thyroid surgeon can be confident that
adult endocrinology.
of malignancy is found to be low may be
the optimal extent of surgery has been
able to avoid surgery on a nodule that is
pre-determined to ensure the best post-
One of the most common conditions
probably benign.
operative outcome,” says Dr. Thomas.
pediatricians refer to Dr. Warren is short stature in children. Using state-of-the-art
Nuclear medicine testing of thyroid
Carolina Endocrine offers comprehensive
equipment to take careful measurements,
disorders is another aspect of endocrine
diagnostic and treatment options for a
Dr. Warren is able to conduct tests, such
care offered at Carolina Endocrine.
full array of thyroid conditions, including
as a bone-age study to estimate the
Patients with hyperthyroidism or thyroid
thyroid
pregnancy,
maturity of a child’s skeletal system. It’s
cancer patients can receive radioiodine
hypothyroidism, hyperthyroidism, thyroid
usually done by taking a simple X-ray,
uptake
and
goiters and nodules, parathyroid disorders
which Carolina Endocrine offers in-office.
radioactive iodine (I-131) treatments in
and evaluation of thyroid cancer. “The
(RAIU)
measurements
dysfunction
in
january 2013
5
Other Common Endocrine Conditions Although Carolina Endocrine is well known for its thyroid care and specialized pediatric services, the group also offers advanced treatments for other endocrine conditions. Some of these conditions include osteoporosis and metabolic bone disease, basic reproductive endocrinology for such conditions as PCOS, pituitary tumors, hyperprolactinemia, hypopituitarism, adrenal insufficiency (e.g. Addison’s disease) and other adrenal disorders, and endo-
Dr. Thomas measures the level of radioactivity in a patient’s thyroid.
crine hypertension.
“Having onsite bone-age X-ray saves
The lab tests, biopsy and neck ultrasound
families a trip to the hospital or radiology
are all performed in-house and often in
Where Convenience Meets Experience
facility, and it also allows me to review the
the same visit. If the thyroid must be re-
With a new office and the newest in
results together with the parents,” says Dr.
moved, the child is referred for surgery,
testing and treatment technology, Carolina
Warren.
after which Dr. Warren can perform radio-
Endocrine stays true to its reputation
active iodine treatment, if necessary. Caro-
of offering the latest in state-of-the-art
Sometimes children with short stature also
lina Endocrine is the only private practice
endocrinology care. From a website
require a growth hormone stimulation
in Raleigh equipped to this procedure in-
“portal” that allows patients to schedule
test. This is a dynamic test that measures
office, rather than in-hospital.
appointments, view lab results, refill a
the level of growth hormone (GH) in the
prescription and message a provider, to an
blood after the patient receives medication
Another common pediatric endocrine
in-house nuclear medicine lab and ECNU
that triggers the release of GH. The test
condition is irregular menstrual cycles for
certification, this group of board-certified
measures the ability of the pituitary gland
adolescents. This is sometimes the result
endocrinologists endeavors to offer the
to release GH and is a more sensitive test
of polycystic ovary syndrome (PCOS),
most convenient and experienced care
when trying to determine growth hormone
which affects 6 percent to 8 percent of
possible.
deficiency. Children found to have short
reproductive-age women. According to Dr.
stature from GH deficiency may benefit
Warren, these patients often present with
“We are constantly learning about the
from GH replacement therapy.
increased weight, irregular cycles (fewer
latest and greatest in our field in order
than six to eight per year), unwanted hair
to implement advanced diagnostic and
With an emphasis on thyroid testing and
growth and cystic acne. These patients
therapeutic options that improve care for
treatments, Carolina Endocrine is able
are counseled to improve their nutrition
patients and enhance our relationships
to treat children with all kinds of thyroid
and exercise in an effort to lose 5 percent
with referring providers,” says Dr. Thomas.
issues,
or
to 10 percent of their body weight. They
hyperthyroidism. Using ultrasound, Dr.
may also be treated with medications,
Carolina Endocrine’s website features a
Warren is even able to evaluate newborn
such as birth control pills or Metformin.
special section called “Referring Physi-
including
hypothyroidism
babies with hypothyroidism in her office.
cians,” where providers can download
Approximately one in 4,000 babies is born
Carolina Endocrine treats a wide variety
referral forms, read past articles on clini-
with hypothyroidism, according to Dr.
of pediatric endocrinology disorders,
cal updates and learn about the services
Warren.
including
short
they provide. Referring providers also
thyroid
disorders,
stature and growth conditions, early or
can contact the office to have faxable
Just as adult patients, children with pos-
delayed puberty, adrenal issues, calcium
referral pads delivered at their office,
sible thyroid cancer are able to undergo
and vitamin D deficiency, pediatric
making the referring process even easier.
most of their testing and treatments right
menstrual problems and other hormonal
Call (919) 571-3661 to learn more or go to
from Carolina Endocrine’s private office.
imbalances.
www.carolinaendocrine.com.
6
The Triangle Physician
Practice Management
Growing Your Practice
Using a Physician Liaison Program By Amanda Kanaan
A piece of marketing advice I often share with physicians is “if you’re not saying it, you’re not doing it.” That means that if you aren’t effectively communicating your services to the medical community then don’t expect referring physicians to know what you do. Specialized physicians constantly tell me they want more referrals. It’s probably their number one marketing wish. Yet they don’t put a plan in place to make that wish come to fruition. The simple answer to this dilemma is the addition of a physician liaison program to your medical practice. A physician liaison’s role is to support and grow your practice by representing and promoting the practice’s clinical services, physicians and programs. Your physician liaison will become the voice of the practice in the medical community. The ultimate goal is to increase patient referrals from existing providers and secure new business from non-referring physicians.
Their main priority is not to hand out brochures and bagels, but to build meaningful relationships between you and the referrers. That’s a necessary skill of any successful liaison, and not all liaisons are created equal. A good liaison has professional training and experience and will call
8
The Triangle Physician
on your referring offices consistently, not hand out their card once a quarter. Establishing new relationships and enhancing current relationships with referring practices are key components of a physician liaison program. The physician liaison focuses on growing new relationships by identifying the needs of the new practice and responding to the areas of concern. Enhancing established referral relationships is achieved through listening to feedback from referral providers and physicians. If problems arise, the physician liaison is available to quickly address the issues and make any necessary changes. On a visit to a primary care practice that had previously referred patients, my physician liaison was surprised by the response that she received when speaking to a physician. As she was discussing a new service that her practice offered, the physician quickly interjected “your practice would not see my Medicaid patient last week.” Had it not been for her diligence in digging deeper into this matter and resolving the physician’s concern, the two medical practices could have dissolved their relationship and chances of future referrals along with it. As the saying goes; out of sight, out of mind. By working closely with a physician liaison, your practice and services will be brought into the forefront of referrer’s minds on a consistent basis. This may be achieved through direct physician meetings, lunch sessions, or educational materials used to add value to the relationship and position you as the
Amanda Kanaan is the president and founder of WhiteCoat Designs, a North Carolinabased marketing agency catering specifically to physicians. WhiteCoat Designs offers doctors affordable marketing solutions to help them grow their practices. Services include website design, search engine optimization (SEO), social media management, online reputation monitoring, brochure and collateral design, branding makeovers and physician liaison services to build patient referrals. Ms. Kanaan can be reached at amanda@whitecoat-designs. com or (919) 714-9885. To learn more, visit www.whitecoat-designs.com.
expert in your field. Liaisons not only deliver information to referrers but also bring market intelligence back to the practice. This is a great way for you to stay on top of news within the medical community. For instance, you’ll be aware if one of your top referrers is about to retire, if a practice just added another physician that you want to meet, or if your competitor is marketing a new service. This is an advantage most physicians don’t have. Physicians refer to practices they like, trust, and believe are both competent and successful. By adding a physician liaison to your practice, you are consistently strengthening the practices’ and physicians’ reputation among peers and in the community. Referrals from outside practices constitute the majority of new patients entering into the practice. In fact, nearly 70 percent of all referrals are sent to specialists from the pri-
mary care providers. Therefore, specialists and sub-specialists are the practices who have potential to make the greatest gains from a physician liaison program. The addition of a physician liaison to the medical practice will not result in overnight success. Rather this is ongoing process that involves the establishment of clear goals, timelines, and commitments from both the liaison and the medical practice. While many practices feel that they could benefit from a physician liaison program, the added cost of this new employee can cause them to take pause. However, the physician liaison can be an affordable option when hired on a contract basis rather than recruiting a full-time employee.
Partnering with patients and providers for a healthier community.
Meet Lisa... Lost: 133 lbs Found: A Spirit of Adventure
When the benefits of growing referrals, enhancing relationships, and gaining community exposure are considered, adding a physician liaison program to your practice can be just what the doctor ordered.
Joseph C. Moran, MD, FASMBS 2801 Blue Ridge Road, Suite 101 Raleigh, NC 27607
P: 919.781.0815 F: 919.781.0816
www.alasurgery.com
Expert, cost effective and timely care is what Carolina Endocrine has to offer your patients. • Neck Ultrasounds (ECNU certified) • Fine needle aspiration biopsies • Nuclear medicine studies • Pediatric Endocrinology
All in one convenient location at 3840 Ed Drive, behind Rex Hospital.
919-571-3661
www.CarolinaEndocrine.com Dr. Michael Thomas, Ph.D. Dr. Julia Warren-Ulanch Dr. Khushbu Chandarana Courtney Kovalick, PA-C Eileen Andres, PA-C
january 2013
9
Duke News
Visiting Physicians Aim to Open Weight-Loss Surgery Center in China In January, five physicians visiting from Shanghai Pudong Medical Center in Shanghai, China, observed the Duke Center for Metabolic and Weight Loss Surgery program to learn about the clinical, research and academic aspects of the program. Their goal is to return to Shanghai and establish the first institute of metabolic and weight-loss surgery. “Meeting this distinguished group is a wonderful opportunity to exchange views on many aspects of weight-loss surgery and discuss important issues relating to the management of patients with morbid obesity,” said Alfonso Torquati, M.D., M.Sci., medical director of the Duke Cen-
From left, Peng Zhang, M.D., Ph.D., of Shanghai Pudong Medical Center’s bariatric and metabolic surgery team gleans insight from Dana Portenier, M.D., of the Duke Center for Metabolic and Weight Loss Surgery.
ter for Metabolic and Weight Loss Surgery.
In addition to training at both hospitals,
on metabolic surgery in Shanghai later
“The visit will enhance our understanding
physicians with the Duke Center for Meta-
in the year and long-term collaborations
on current and future policies related to
bolic and Weight Loss Surgery and Shang-
in research and education around meta-
weight-loss surgery in China, opening new
hai Pudong Medical Center are planning
bolic syndrome and diabetes resolution in
opportunities for future collaboration.”
to conduct an international conference
weight-loss surgery.
Real-World Defibrillator Benefits Parallel Clinical Trial Expectations Patients who received an implantable
ing healthier than patients seen in clinical
have similar survival outcomes compared
heart defibrillator in everyday practice had
practice, the actual benefits of new drugs
to patients who received a defibrillator in
survival benefits on par with those who
and medical devices can be less positive
the clinical trials.”
received the same devices in carefully con-
than initially reported, according to a Duke
trolled clinical trials, according to a new
press advisory. Not so for the defibrillators,
“This study demonstrated the real-world
study that highlights the value of defibrilla-
at least when comparing patients with simi-
applicability of the results of recent ran-
tors in typical medical settings.
lar characteristics in both the clinical trials
domized clinical trials,” said Alice Ma-
and real-world practice.
scette, M.D., of the National Institute of Health’s National Heart, Lung and Blood
Led by the Duke Clinical Research Institute
Institute.
and published Jan. 2 in the Journal of the
“Many people question how the results of
American Medical Association, the study
clinical trials apply to patients in routine
used data from a large national Medicare
practice,” said lead author Sana M. Al-
Implantable cardioverter-defibrillators (ICDs)
registry to assess the survival of patients re-
Khatib, M.D., M.H.S., an electrophysiologist
have been lifesavers for people with a history
ceiving defibrillators, which are commonly
and member of the Duke Clinical Research
of cardiac arrest or heart failure. The devices,
used to prevent sudden cardiac death.
Institute. “We showed that patients in real-
small electrical units implanted in the chest
world practice who receive a defibrillator
with wires that lead into the heart, send an
Because clinical trial participants tend to re-
but who are most likely not monitored at
electronic pulse when the heart stops beating
ceive more meticulous care while also be-
the same level provided in clinical trials
to reestablish a normal rhythm.
10
The Triangle Physician
Duke Research News To monitor treatment patterns, effective-
By eliminating Medicare patients who were
continued use of this lifesaving therapy in
ness and safety of ICDs among Medicare
appreciably older and sicker than those
clinical practice.”
patients, the Centers for Medicare & Med-
who enrolled in the clinical trials, the re-
icaid Services mandated that data on all
searchers were unable to determine how
In addition to Dr. Al-Khatib, study authors
Medicare patients receiving a primary
all patients seen in real-world practice com-
include Anne Hellkamp, Gust H. Bardy,
prevention ICD be entered into a national
pare to study participants.
Stephen Hammill, W. Jackson Hall, Daniel B. Mark, Kevin J. Anstrom, Jeptha Curtis,
registry. In response to this mandate, a national ICD registry has been collecting data
“That is an issue, and the only way to get at
Hussein Al-Khalidi, Lesley H. Curtis, Paul
from hospitals performing implantations
that is to randomly assign such patients to
Heidenreich, Eric D. Peterson, Gillian
since 2005. The Duke-led research group
either receive an ICD or not in a clinical tri-
Sanders, Nancy Clapp-Channing, Kerry L.
used data from that registry to compare
al,” Dr. Al-Khatib said. “Even without those
Lee and Arthur J. Moss.
more than 5,300 real-world patients against
data, however, our study gives patients and
more than 1,500 patients who had enrolled
their health care providers reassurance
The National Heart, Lung, and Blood
in two large clinical trials of ICD devices.
that what we have been doing in clinical
Institute funded the study (grant #1R01-
practice has been helpful and is improving
HL093071-01A1).
Dr. Al-Khatib said the patients who were
patient outcomes. Our findings support the
included in the analysis were selected to closely resemble the patients who participated in the clinical trials, with much older and sicker patients in the registry excluded. Both groups – study participants who received an ICD and ordinary recipients - had similar two-year and three-year survival rates. Ordinary recipients had better survival than patients in the clinical trial who did not receive an ICD. These findings were true for Medicare and non-Medicare patients. By comparing similar populations, the researchers were able to address the concern that outcomes reported in clinical trials are overly optimistic because patients receive extraordinary care. “We know from previous studies that many patients in real-world clinical settings don’t receive the follow-up care that is recommended after the device is implanted,” Dr. Al-Khatib said. She said doctors who participate in clinical trials also tend to be highly skilled specialists who do hundreds of the implantation surgeries, while physicians in ordinary practice may be less proficient. Studies have shown that patients have more complications when their doctors have less experience with a procedure. Dr. Al-Khatib said the study had a limitation that could warrant additional examination.
january 2013
11
Duke Research News
Sickle Cells Show Lethal Potential Against Aggressive Cancer Tumors By harnessing the very qualities that make
through vessels, the sickle cells get stuck,
produces an abundance of adhesion mol-
sickle cell disease a lethal blood disorder,
causing blockages that are painful and
ecules as part of its distress from oxygen
a research team led by Duke Medicine
damaging to tissue.
deprivation. Normal cells don’t produce the adhesion molecules, so there’s noth-
and Jenomic, a private cancer research
ing for the sickle cells to snag onto.
company in Carmel, Calif., has developed
A collaborative effort between Duke re-
a way to deploy the misshapen red blood
searchers and scientists from Jenomic be-
cells to fight cancer tumors.
gan in 2006 to explore whether sickle cells
“Unlike normal red blood cells, we found
could similarly build clots in the vast net-
that sickle cells show a highly unique nat-
Reporting in the Jan. 9 edition of the on-
works of blood vessels that feed oxygen-
ural attraction to oxygen-deprived tumors
line journal PLOS ONE, the researchers
starved, or hypoxic, cancer tumors, which
where they stick, cluster and plug tumor
describe a process of exploiting sickle-
can grow increasingly lethal as their oxy-
blood vessels. Once clustered within the
shaped red blood cells to selectively target
gen needs escalate.
tumor, the sickle cells deposit a toxic iron residue as they die, causing tumor cell
oxygen-deprived cancer tumors in mice and block the blood vessels that surround
In a National Institutes of Health-funded
them.
study of mice with breast cancer, the re-
death,” Dr. Terman said.
searchers gave the animals an infusion of
To boost that caustic effect, the research-
“Sickle cells appear to be a potent way
fluorescently dyed sickle cells and viewed
ers added zinc compounds (zinc proto-
to attack hypoxic (oxygen-starved) solid
them under special window chambers
porphyrin alone or in combination with
tumors, which are notable for their resis-
that provide real-time observation of pro-
doxorubicin) to the sickle cells, which
tance to existing cancer chemotherapy
cesses inside the body. Within five min-
caused even greater oxidative stress in
agents and radiation,” said senior author
utes, the deformed cells began to adhere
the tumor and surrounding blood vessels.
Mark W. Dewhirst, D.V.M., Ph.D., a radia-
to the blood vessels surrounding the hy-
This resulted in a dramatic delay in tumor
tion oncologist and director of Duke’s Tu-
poxic tumors. Over 30 minutes, the cells
growth, quadrupling the amount of time
mor Microcirculation Laboratory. “This is
had formed clots and began blocking the
the tumors were inactive compared to tu-
an exciting finding that suggests a poten-
small blood vessels that fed the tumor.
mors exposed to regular blood cells. Mice showed no acute toxicity to the sickle cell
tial new approach to fighting tumors that are currently associated with aggressive
Dr. Dewhirst said the sickle cells stick like
disease.”
Velcro to the hypoxic tumor, because it
“The very qualities that make sickle cells a danger to people with the inherited genetic disorder can be turned against tumors to fight cancer,” said lead author David S.
treatment.
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at Jenomic. “Our approach using sickle cells is a novel strategy with broad therapeutic potential that could be directed at breast cancers, prostate cancers and many other solid tumors that develop resistance to current therapies.”
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12
The Triangle Physician
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Duke Research News “In contrast to drug treatments directed
human trials, a press advisory said.
Richard J. Boruta and Hong Yuan of the University of North Carolina at Chapel Hill;
only to the hypoxic tumor cell, our approach uses the inherent qualities of sickle
In addition to Drs. Dewhirst and Terman,
Mathew R. Dreher of the National Institutes
cells to induce injury to the tumor and the
study authors included Benjamin L. Vi-
of Health; Joseph Eble, Mayo Clinic; and
vascular micro-environment that feeds the
glianti of the University of Michigan; Ra-
Brian Sorg of the National Cancer Institute.
tumor,” Dr. Terman said.
hima Zennadi, Diane Fels, Gerald Grant, Zahid N Rabbani, Ejung Moon, Lan Lan,
The National Institutes of Health funded the
The research team will continue to con-
Yiting Cao, Kathleen Ashcraft, Marilyn J.
study (Grants #CA40355-23, -24, -25, -26, 27).
duct studies in animals before moving to
Telen and Greg Palmer of Duke Medicine;
Dr. Terman holds patents on the findings.
Measuring Gene Response to Infection Can Lead to Early, Accurate Diagnoses Duke researchers are looking to genomic
“The 2009 H1N1 flu pandemic highlighted
The researchers also tested the Influenza
technologies – not the isolation of bacte-
the limitations of traditional pathogen-
Factor in a real-world setting with natu-
ria or viruses – to quickly detect and diag-
based testing,” said Christopher W. Woods,
rally acquired disease: the Duke Univer-
nose infectious diseases, such as the flu
M.D., M.P.H., associate professor of medi-
sity Hospital emergency department. They
and staph.
cine, pathology and global health at Duke
analyzed blood samples in 36 patients
and the flu study’s lead author. “A test that
with confirmed cases of H1N1 flu during
Two studies appearing online Jan. 9 in the
could identify individuals exposed to the
the 2009 pandemic; the Influenza Factor
journal PLOS ONE, show how a pattern of
flu before the onset of symptoms would
distinguished between H1N1-infected and
genomic information among infected indi-
be an important and useful tool for guid-
non-infected individuals with 92 percent
viduals can be used to accurately pinpoint
ing treatment decisions, especially with
accuracy.
the cause of infection.
limited antiviral medications.”
In a second study using a similar approach,
“Traditional diagnostic tests for infectious
Dr. Woods and his colleagues set out to
tor for diagnosing staphylococcus aureus,
diseases rely on detecting the specific ill-
develop a test using two strains of flu. They
or staph, a common bacterial infection.
ness-causing pathogens. So you only find
inoculated 41 participants with either the
As with flu tests, conventional methods of
what you’re looking for,” said Geoffrey
H1N1 or H3N2 virus and analyzed their
diagnosing staph involve culturing for the
Ginsburg, M.D., Ph.D., a senior author on
blood samples to gauge the host response
specific pathogen, which leaves room for
both studies and director of genomic med-
using a variety of genome-wide technolo-
error and often takes too long.
icine at the Duke Institute for Genome Sci-
gies.
researchers at Duke found a genomic fac-
ences & Policy and professor of medicine.
“Our current bacterial identification techThe host response for the two different
niques rely on isolating the organism by
The body’s reaction to infection, or host
strains was similar and combined into a
culture.
response, can be measured using genome-
single genomic signature dubbed the In-
are slow, on average taking several days,”
wide technologies that analyze human
fluenza Factor. The Influenza Factor distin-
said study author Vance G. Fowler, M.D.,
genes responding to the infection. Scien-
guished people as infected or uninfected
M.H.S., professor of medicine and infec-
tists can use the resulting “genomic signa-
with flu with 94 percent accuracy and
tious disease specialist at Duke. “During
tures” to classify and diagnose infectious
could be used to test for multiple strains.
this time, clinicians are forced to make ed-
diseases based on the host response, with-
Although time tested, cultures
ucated guesses as to how to treat patients,
out needing to test for a specific pathogen.
In addition, researchers detected the Influ-
often over-treating with a broad cocktail of
The approach is especially appealing for
enza Factor before participants fully devel-
powerful antibiotics.
detecting influenza since a genomic signa-
oped flu symptoms, as early as 29 hours
ture could identify new flu strains, which
after exposure to the virus and approxi-
“These antibiotics can breed resistance,
emerge frequently but may not be detect-
mately 40 hours before the development
and may also be costly and have side ef-
ed with existing diagnostic tests.
of peak symptoms.
fects. Reducing the time to diagnosis,
january 2013
13
Duke Research News which would allow the use of more tai-
Researchers then studied blood samples
nessed as a potential diagnostic strategy,
lored antibiotics, would help doctors
from adult patients with bacterial infec-
reducing the time required to establish a
make better treatment decisions sooner,”
tions who came to the Duke University
diagnosis and avoiding using unnecessary
Dr. Fowler said.
Hospital emergency department. Using
antibiotics,” said Dr. Fowler.
the patients’ gene expression, researchDuke researchers studied mice infected
ers differentiated those with staph from
The long-term goal of this research is to
with staph or E. coli bacteria to measure
those with no infection with 97 percent ac-
develop new diagnostic tools that use host
the host response to infection. A genomic
curacy. The results also were replicated in
gene expression patterns to quickly iden-
signature, derived from an analysis of
pediatric patients, with the genomic signa-
tify a patient’s infection.
blood samples, distinguished staph-infect-
ture helping to accurately diagnose staph
ed mice from those infected with E. coli
infections around 95 percent of the time.
and those uninfected with 95 percent accuracy.
In addition to Drs. Ginsburg and Woods, Duke influenza researchers include: Micah
“This study demonstrates that the host re-
T. McClain, Minhua Chen, Aimee K. Zaas,
sponse to bacterial infection can be har-
Timothy Veldman, Elizabeth Ramsburg, Joseph E. Lucas, and Lawrence Carin. Other researchers include Bradly P. Nicholson of the Durham VA Medical Center; Jay Varkey of Emory University; Stephen F. Kingsmore of the National Center for Genome Resources; Yongsheng Huang and Alfred O. Hero III of the University of Michigan; Robert Lambkin-Williams and Anthony G. Gilbert of Retroscreen Virology; and Seth W. Glickman of the University of North Carolina at Chapel Hill. Researchers at Duke involved in the staph study include Drs. Ginsburg, Fowler and Woods, along with Sun Hee Ahn, Ephraim L. Tsalik, Derek Cyr, Yurong Zhang, Aimee K. Zaas, Tim Veldman and Joseph Lucas. Jennifer C. van Velkinburgh of van Velkinburgh Initiative for Collaborative BioMedical Research; Raymond J. Langley of Lovelace Respiratory Research Institute; Seth W. Glickman and Charles B. Cairns of the University of North Carolina at Chapel Hill; Emanuel P. Rivers and Ronny M. Otero of Henry Ford Hospital; and Stephen F. Kingsmore of Children’s Mercy Hospitals & Clinics also contributed to this research. The United States Defense Advanced Research Projects Agency provided funding for the flu study through contract N6600107-C-2024. The staph study was funded by the National Institutes of Health (R01AI068804, K24-AI093969, 5U01AI066569-05, and 3U01AI066569-05S1) and the Wallace H. Coulter Foundation.
Womens Wellness half vertical.indd 1
14
The Triangle Physician
12/21/2009 4:29:23 PM
UNC Research News
Gene Variants for Mental Illness Linked to Brain Changes at Birth Some brain changes that are found in
lar to brain changes found in adults with
adults with common gene variants linked
the same variants, Dr. Knickmeyer said.
to disorders such as Alzheimer’s disease,
“This could stimulate an exciting new line
schizophrenia and autism can also be seen
of research focused on preventing onset of
in the brain scans of newborns.
illness through very early intervention in atrisk individuals.”
“These results suggest that prenatal brain development may be a very important
But this was not true for every polymor-
influence on psychiatric risk later in life,”
phism included in the study, said John H.
said Rebecca C. Knickmeyer, Ph.D., lead
Gilmore, M.D., senior author of the study
author of the study and assistant professor
and Thad & Alice Eure distinguished pro-
of psychiatry in the University of North Car-
fessor and vice chair for research and sci-
olina School of Medicine. The study was
entific affairs in the UNC Department of
published online by the journal Cerebral
Psychiatry.
Cortex Jan. 3. For example, the study included two vari-
Impact of the APOE Alzheimer’s risk variant on the newborn brain. Blue clusters show decreased brain volumes in newborns with the risk variant. Similar decreases in this brain area, which is involved in memory, are seen in adults with the same variant. Yellow/orange clusters show increased brain volumes in newborns with the risk variant. These changes may be unique to infants and young children and could represent beneficial effects.
The study included 272 infants who re-
ants in the DISC1 gene. For one of these
ceived magnetic resonance imaging scans
variants, known as rs821616, the infant
at UNC Hospitals shortly after birth, ac-
brains looked very similar to the brains of
cording to a press advisory. The DNA of
adults with this variant. But there was no
each was tested for 10 common variations
such similarity between infant brains and
In addition to Drs. Knickmeyer and Gilm-
in seven genes that have been linked to
adult brains for the other variant, rs6675281.
ore, authors of the study were Jiaping Wang, Ph.D.; Hongtu Zhu, Ph.D.; Xiujuan
brain structure in adults. These genes have also been implicated in conditions such as
“This suggests that the brain changes asso-
Geng, Ph.D.; Sandra Woolson, M.Ph.; Rob-
schizophrenia, bipolar disorder, autism,
ciated with this gene variant aren’t present
ert M. Hamer, Ph.D.; Thomas Konneker,
Alzheimer’s disease, anxiety disorders and
at birth but develop later in life, perhaps
B.A.; Weili Lin, Ph.D.; and Martin Styner,
depression.
during puberty,” Dr. Gilmore said.
Ph.D. All are at UNC except Mr. Konneker,
For some polymorphisms – such as a
“It’s fascinating that different variants in
variation in the APOE gene, which is as-
the same gene have such unique effects
sociated with Alzheimer’s disease – the
in terms of when they affect brain develop-
The study was funded by grants from the
brain changes in infants looked very simi-
ment,” said Dr. Knickmeyer.
National Institutes of Health.
who was at UNC but is now a Ph.D. student at the University of California, Santa Cruz.
Dark Matter’s Regulatory Role in Gene Assembly Comes to Light Research findings from the University of
The new study reveals snippets of informa-
hibiting it. The research opens the door for
North Carolina School of Medicine are
tion contained in dark matter that can alter
studying the dark matter of genes. And it
shining a light on an important regulatory
the way a gene is assembled.
helps us further understand how mutations or polymorphisms affect the functions of
role performed by the so-called dark matter, or “junk DNA,” within each person’s
“These small sequences of genetic infor-
any gene,” said study senior author, Zefeng
genes.
mation tell the gene how to splice, either
Wang, Ph.D., assistant professor of pharma-
by enhancing the splicing process or in-
cology in the UNC School of Medicine and
january 2013
15
UNC Research News into different functional isoforms.
hibited or enhanced splicing.”
In a process called alternative splicing, a
The study collaborators put together a li-
The study is described in a report pub-
single gene could code for multiple pro-
brary of cells that contain the GFP reporter
lished in the January 2013 issue of the jour-
teins with different biological functions.
with the random sequence inserted. Thus,
nal Nature Structural & Molecular Biology.
In this way, alternative splicing allows the
when researchers looking at the intron try
human genome to direct the synthesis of
to determine what a particular snippet of
The findings were likened to the film indus-
many more proteins than would be expect-
genetic information does and its effect on
try’s editorial process, during which snip-
ed from its 20,000 protein-coding genes.
gene function, they can refer to the splic-
a member of UNC Lineberger Comprehensive Cancer Center.
ing regulatory library of enhancers or si-
pets of celluloid are spliced, while others end up unused on the proverbial cutting
“And those different versions sometimes
room floor.
function differently or in opposite ways,”
lencers.
Dr. Wang said. “This is a tightly regulated
“So it turns out that the sequencing element
Taken from a DNA point of view, not every
process, and a great number of human dis-
in both exons and introns can regulate the
piece of it in each human gene encodes for
eases are caused by the ‘misregulation’ of
splicing process, Dr. Wang says. “We call
a functional protein; only about 10 percent
splicing, in which the gene was not cut and
it the splicing code, which is the informa-
does, in coding regions called “exons.”
pasted correctly.”
tion that tells the cell to splice one way or the other. And now we can look at these
The other 90 percent that fills the intervening regions are longer stretches of dark
Dr. Wang’s research colleagues identified
variant DNA sequences in the intron to see
matter known as “introns.”
“intronic splicing regulatory elements.”
if they really affect splicing or change the
These essentially recruit protein factors
coding pattern of the exon and, as a result,
But something mysterious happens to in-
that can either enhance or inhibit the splic-
protein function.”
trons during the final processing of mes-
ing process. Collaborators in this study with Dr. Wang
senger RNA (mRNA), the genetic blueprint that’s sent from the cell’s nucleus to its pro-
Their discovery was accomplished by in-
are Yang Wang in the department of phar-
tein factory. Only particular exons may be
serting an intron into a green fluorescent
macology and member of the UNC Line-
included within the final mRNA produced
protein (GFP) “reporter” gene. These in-
berger Comprehensive Cancer Center;
from that gene, whereas the introns are cut
trons of the reporter gene carried random
Meng Ma, Anhui University, Hefei, China;
out and destroyed.
DNA sequences. When the reporter is
and Xinshu Xiao, University of California,
screened and shows green it means that
Los Angeles.
It’s therefore easier to understand why
portion of the intron is spliced. Support for the research comes from the
more scientific attention has been given to exons, according to a press advisory.
“The default is dark,” so any splicing en-
American Heart Association and the Na-
“When people are looking at the genet-
hancer or silencer can turn it green,” Dr.
tional Cancer Institute, a component of the
ics of a disease, most of the time they’re
Wang explains. “In this unbiased way we
National Institutes of Health.
looking for the change in the coding se-
can recover hundreds of sequences of in-
quence,” Dr. Wang said. “But 90 percent of the sequence is hidden in the gene’s introns. So when you study gene variants or polymorphisms that cause human disease, you can only explain the part that’s in the exon. Yet the majority remains unexplainable because they’re in the introns.” Following completion of the genome sequencing projects, subsequent DNA and RNA sequencing revealed the existence of more than one splice variant, or isoform, for 90 percent of human genes. During messenger RNA processing, most human genes are directed to be cut and pasted
16
The Triangle Physician
The Triangle Physician 2013 Editorial Calendar January Glaucoma Wound Management Accounting
May Arthritis Women’s Health Medical Billing
September Atrial Fibrillation Urology Web Design
February Asthma and Allergies Heart Disease Consulting for your Practice
June Men’s Health Vascular Diseases Medical Collections
October Cancer in Women COPD - Lung Health Medical Software - EMR
March Nutrition Sleep Disorders Legal
July Imaging Technologies Psoriasis Medical Insurance
November Alzheimer’s Disease Diabetes Financial Planning
April Autism Irritable Bowel Syndrome IT Services
August Orthopedics Gastroenterology Medical Real Estate
December Pain Management Spine Disorders Practice Management
UNC Research News
Genomic Analysis Method Offers Clues to Diabetes, Other Complex Diseases In research published online Dec. 23 in
“The exome array allowed us to test a large
insulin production or processing, even in
the journal Nature Genetics, scientists have
number of individuals – in this case, more
people without diabetes. The genes may
found three new and relatively rare genetic
than 8,000 people – very efficiently,” said Dr.
predispose such individuals to developing
variants that influence insulin production,
Mohlke. “We expect that this type of analysis
the disease.
offering new clues about the genetic fac-
will be useful for finding low-frequency vari-
tors behind diabetes.
ants associated with many complex traits,
As a next step, the researchers plan to
including obesity or cancer.”
continue to investigate how these genes may lead to diabetes. They also expect the
“Studying genetic variants – even rare ones
The scientists pulled data from a large
results will inspire other scientists to use
– helps us learn how
health study directed by researchers at the
exome analysis to look at the genetic fac-
genes affect health and
University of Eastern Finland. Statistical
tors behind other complex diseases.
disease,” said Karen
analysis integrated genetic data and de-
Mohlke, Ph.D., one of
tailed health records for a sample of 8,229
In addition to Dr. Mohlke, the study’s co-
Finnish males.
principal investigators included Michael
the study’s senior authors and associate
Boehnke, Ph.D., of the University of Michi-
professor of genetics at the University of North Carolina School of Medicine. “In this
Diabetes, which affects more than 25 mil-
gan, Ann Arbor; and Markku Laakso,
study, we’ve implicated new genes as play-
lion people in the United States, results
M.D., of the University of Eastern Finland
ing a role in insulin processing and secre-
from problems with the body’s ability to
and Kuopio University Hospital. Jeroen
tion.”
produce or use insulin. Rather than pin-
Huyghe, a postdoctoral scientist at the Uni-
pointing one gene behind the disease,
versity of Michigan, Ann Arbor, also was on
The study is also the first time genetic in-
scientists believe there are a whole host of
the research team.
sights have been reported using exome
genes that interact with health and lifestyle
array genotyping, a new tool that is less
factors to influence a person’s chances of
In the U.S., funding for the research came
costly than genetic sequencing. This analy-
getting the disease.
from the National Institute of Diabetes and Digestive and Kidney Diseases and the Na-
sis allows scientists to quickly screen DNA samples for known variants in specific
The study revealed that certain variants
tional Human Genome Research Institute,
genes. It is especially helpful for testing
of three genes – called TBC1D30, KANK1
components of the National Institutes of
variants that are rare.
and PAM – are associated with abnormal
Health.
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january 2013
17
UNC Research News
Decline in Liver Transplants Due to Lower Quality Donor Livers A new study predicts an expected decline
Analysis indicates that 41,503 donations
donation after cardiac death.”
occurred after June 30, 2004, with 82 per-
in liver transplants due to the non-use of Funded in part by the National Institutes
cent of livers used for transplant and 18
of Health and Health Resources and Ser-
percent unused. The number of unused
The study published in the January is-
vices Administration, the study notes that
livers decreased from 1,958 (66 percent
sue of the journal Liver Transplantation,
in an attempt to increase available livers
of donors) in 1988 to 841 (15 percent) in
a journal of the American Association
for transplant, the transplant community
2004, and then increased to 1,345 (21 per-
for the Study of Liver Diseases (AASLD),
has gradually extended donation crite-
cent) in 2010.
found that the non-use of donor livers
ria. However, previous research shows
climbed through 2010 due to a worsening
that poor outcomes may occur following
Liver non-use was independently linked
of donor liver quality, primarily from do-
transplant of more inferior organs. Other
to older donor age, greater BMI, diabetes
nation following cardiac death. Diabetes,
studies have shown an increased recipi-
prevalence and donation after cardiac
donor age and body mass index (BMI)
ent disease and death risk with donation
death – all of which are on the rise in the
were also linked to a decrease in use of
after cardiac death (when circulation
U.S.
organs.
ceases) than with standard donation fol-
lower-quality donor livers.
“For patients with end-stage liver dis-
lowing brain death in which donor circu-
Researchers reported a four-fold increase
lation is sustained.
in the odds of non-use of livers from donation following cardiac death among
ease, transplantation is the only option for extending life, but organ availability
For the present study, researchers used
donors between 2004 and 2010, with the
places constraints on the transplant com-
data from the Organ Procurement and
proportion of nonuse climbing from 9
munity,” explained study first author Eric
Transplantation Network (OPTN) to iden-
percent to 28 percent during the same
S. Orman, M.D., currently a fellow in the
tify 107,259 deceased donors in the United
time period. “Our findings show nonuse
division of gastroenterology and hepatol-
States between 1988 and 2010. Donors
of livers for transplantation is steadily ris-
ogy at the University of North Carolina
were 18 years of age and older who had a
ing and is primarily due to donation after
School of Medicine. “One of the methods
least one organ (liver, heart, intestine, kid-
cardiac death,” Dr. Orman concludes. “If
to increase the donor pool is to include
ney, lung or pancreas) used for transplan-
these trends continue, a significant de-
donors with less than ideal health status
tation. Average donor age was 44 years.
cline in liver transplant availability would
– those with fatty livers, older donors and
be inevitable.”
Sublingual Immunotherapy Shows Promise as Treatment for Peanut Allergy Peanuts are one of the most common triggers
ment in which patients are given daily doses, in
of severe food-induced allergic reactions, which
gradually increasing amounts, of a liquid contain-
can be fatal, and the prevalence of peanut allergy
ing peanut powder. The patients first hold the
is increasing. However, there is currently no clini-
liquid under the tongue for two minutes and then
cal treatment available for peanut allergy other
swallow it.
than strict dietary elimination and, in cases of accidental ingestion, injections of epinephrine.
The two lead authors of the study, published in the January 2013 issue of the Journal of Allergy
18
The Triangle Physician
But a new multicenter clinical trial shows prom-
and Clinical Immunology, are David M. Fleischer,
ise for sublingual immunotherapy (SLIT), a treat-
M.D., of National Jewish Health in Denver, Colo.,
UNC Research News and Wesley Burks, M.D., Curnen distin-
However, Dr. Burks cautioned, this is not a
Arkansas for Medical Sciences and Arkan-
guished professor and chair of the De-
treatment that people should try on their
sas Children’s Hospital, Johns Hopkins
partment of Pediatrics in the University of
own. For now it’s a treatment that should
University School of Medicine, Mount
North Carolina School of Medicine.
only be given by medical professionals
Sinai School of Medicine, the EMMES
in a carefully monitored clinical trial, he
Corp. in Rockville, Md., and the National
said.
Institute of Allergy and Infectious Dis-
“These results are encouraging,” Dr.
eases (NIAID) of the National Institutes of
Burks said. “The immune response was
Health (NIH).
stronger than we thought it might be, and
Study participants were recruited from
the side effects of this treatment were rela-
five United States sites: New York, N.Y.;
tively small. However, the magnitude of
Baltimore, Md.; Little Rock, Ark.; Denver,
The study was funded by grants from the
the therapeutic effect was somewhat less
Colo.; and Durham, N.C. Study co-authors
NIAID and the NIH’s National Center for
than we had anticipated. That’s an issue
include researchers from the University of
Research Resources.
we plan to address in future studies.” In the study, 40 people with peanut allergy, ages 12 to 37 years, were randomized to receive daily peanut or placebo SLIT. All were given a baseline oral food challenge of up to 2 grams of peanut powder
IBS-d RESEARCH STUDY
to test how much peanut powder they could consume without symptoms. After 44 weeks, all were given a second oral food challenge. Those who were able to consume either 5 grams, or at least 10-fold more peanut powder than their baseline amount, were considered to be responders (i.e., desensitized to peanut). At 44 weeks, 70 percent of those who received peanut SLIT were responders, compared to 15 percent of those receiving placebo. Among the peanut-SLIT responders, the median amount of peanut powder they could successfully consume increased from 3.5 to 496 milligrams. After 68 weeks, that amount increased significantly, to 996 milligrams. Of 10,855 peanut doses given through week 44 of the study, 63.1 percent were symptom-free.
When
oral/pharyngeal
symptoms were excluded from the analysis, 95.2 percent of doses were symptomfree. The study concluded that peanut SLIT safely induced desensitization in a majority of participants compared to placebo and that longer duration of therapy led to significant increases in the amount of peanut powder people could safely consume.
Have you or someone you know been diagnosed with Irritable Bowel Syndrome? If so, there is now an opportunity to join a new research study. To be eligible you must: • Be between the ages 18-80 years old • Have diarrhea predominant irritable bowel syndrome Quaified Participants will receive the following at no charge: • Investigational Medication or inactive placebo • Study related testing • Physical Exams and Lab Work Compensation may be available.
XYZ RESEARCH, PHOENIX, AZ
123-456-7890 FuriexIBSDStudy.com
january 2013
19
News Welcome to the Area
Physicians Carl Star Henderson, DO Hospitalist; Student Health; Urgent Care; Rheumatology, Internal Medicine
Events Adnan Pervez, MD Pulmonary Disease and Critical Care, Internal Medicine; Sleep Medicine
Raliegh
Duke University Hospitals Durham
Quintin Jose Quinones, MD
Cynthia Cowan Bennett, MD
DUMC Durham
Gerald L. Francis Center #219 Elon
Weeranun Dechyapirom Bode, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
Christopher Marshall Bulger, MD Vascular Surgery
North Carolina Phlebology PC Chapel Hill
Scott Wentworth Elton, MD
Anesthesiology - Critical Care Medicine
Christopher John Sayed, MD Dermatology
UNC Dermatology Chapel Hill
Kelly Allan Schofield, MD Child and Adolescent Psychiatry;
Duke University Hospitals Durham
Sherwin Shaoyu Yen, MD Internal Medicine
University of North Carolina Hospitals Chapel Hill
Neurological Surgery, Pediatric
UNC Neurosurgery Chapel Hill
Elda Lambert Fisher, MD
Physician Assistants
Cosmetic Surgery; Other; Oral and Maxillofacial Surgery
Raleigh
University of North Carolina Hospitals Chapel Hill
Elizabeth Hoel Kim, MD Obstetrics and Gynecology
Elise Nattier Bunn, PA Ann Elizabeth Blankenship Clark, PA Chapel Hill
Cary
Tuyetanh Nguyen Eichholz, PA
Elizabeth Burney Malinzak, MD
Carrboro
Durham Regional Look Good Feel Better Feb. 4, 5:30-7:30 p.m. Look Good Feel Better is a free American Cancer Society program that teaches women beauty techniques while they undergo chemotherapy and radiation treatments. Participants receive a free cosmetics kit and instruction by beauty professionals. Location: North Conference Room, Durham Regional Hospital Registration: Call (919) 470-7168 Good Neighbors, Good Health Health Education Seminar: Don’t be a Bystander When Minutes Count Feb. 9, 10 a.m. This free educational series is designed to help the community stay on top of important health issues. February’s seminar will feature bystander CPR training, as well as a panel discussion on heart attack and stroke warning signs, symptoms and prevention tips. Light refreshments will be provided. Location: Durham Regional Hospital, first-level classroom Stroke Support Group Feb. 11, 1-2:30 p.m. The mission of this support group is to help educate the stroke survivor, caregiver and community about stroke prevention and stroke disabilities. This group meets the second Monday of each month. Location: Durham Regional Hospital, private dining room C
Family Medicine; Internal Medicine
Anesthesiology
Duke University Hospitals Durham
Ashley Charles McGee, MD Family Medicine
Meg Elizabeth Petrie, PA Emergency Medicine
Raleigh
Kevrin Joseph Johnson, PA
Rocky Mount Family Medical Center Rocky Mount
Durham
Viranga Chamindi Pathiraja, MD
Internal Medicine - Sleep Medicine
Psychiatry
Roberta Nadine Vandentop, PA Cary
encourages discussion on topics related to adjustment before and after weight-loss surgery. February’s topic will be “Healthy Tips for Dining Out.” Location: Duke Center for Metabolic and Weight Loss Surgery Durham Clinic, 407 Crutchfield St., Durham 24404 Register for these events online at www. durhamregional.org/events or by calling (919) 403-4374, unless otherwise noted.
Carolina Endocrine Open House: Introduction to New Facility, Staff Feb. 21, 4-7 p.m.
The region’s medical community is invited to an open house at their new location. Carolina Endocrine physicians, physician assistants and staff will be onsite to answer questions and guide tours of the larger facility. Location: Carolina Endocrine, 3840 Ed Drive, Suite 111, Raleigh, 27612 Call (919) 571-3661 or visit www. carolinaendocrine.com to learn more about the specialized practice.
Adult Diabetes Support Group Feb. 19, 6-7:30 p.m. This support group for those with diabetes and their guest is facilitated by certified diabetes educators to help participants manage diabetes. February’s session will focus on the importance of dental and oral care in diabetes. Location: Teer House, 4019 N. Roxboro Road, Durham 27704 Weight Loss Surgery Support Group Feb. 26, 6-7:30 p.m. This weight-loss surgery support group
University of North Carolina Hospitals Chapel Hill
T H E M A G A Z I N E F O R H E A LT H C A R E P R O F E S S I O N A L S
Pediatrics Practice Wins Top Award for Medical Website Design Carolinas Healthcare Public Relations and
checker, the ability to request appoint-
too,” said Brett Wilson, M.D., of Corner-
Marketing Society has awarded Corner-
ments online, a convenient online survey
stone Pediatrics.
stone Pediatric and Adolescent Medicine
for patients, an integrated Facebook feed
in Cary as this year’s winner of the presti-
and a fresh, new look to elevate the prac-
The new website was designed by Ra-
gious Wallie Award for Best Website.
tice’s brand.
leigh-based medical marketing agency
Cornerstone Pediatrics’ website (www.
“In today’s world of computer-savvy fami-
now search for doctors online that having
cornerstonepediatrics.org) underwent a
lies, we felt it was important to have a web-
not just a good, but a great website is re-
massive redesign in the summer of 2012
site that is informative, user-friendly and
ally an essential part of any medical prac-
to make the site more functional, educa-
visually pleasing. We are very happy with
tice’s marketing strategy,” said Amanda
tional and accessible to patients. The new
the major changes we have made, and our
Kanaan, President of WhiteCoat Designs.
website features an interactive symptom
families comment positively about them
WhiteCoat Designs. “So many patients
20
The Triangle Physician
“More than a doctor. Like a friend.”
We know it by heart.
Trust. WHV is an independent group of heart specialists with locations throughout Eastern North Carolina - ready to provide the care for your patient’s heart when and where they need it. We’ve been pioneering and delivering innovative cardiovascular care for over 25 years. Through our affiliation with UNC Health Care, our physicians can also tap into the latest research and expertise associated with a world-class academic institution. And this in turn allows all our patients to have more access to clinical trials and new therapies, resulting in the best cardiovascular care available in the area.
Cardiovascular Professionals in Johnston, Wayne and Wilson Counties Mateen Akhtar, MD, FACC Benjamin G. Atkeson, MD, FACC
Matthew A. Hook, MD, FACC Eric M. Janis, MD, FACC
Waheed Akhtar, MD, FACC Malay Agrawal, MD, FACC
Kevin R. Campbell, MD, FACC Randy A.S. Cooper, MD, FACC
Diane E. Morris, ACNP Ravish Sachar, MD, FACC
Sunil Chand, MD, FACC Paul Perez-Navarro, MD, FACC
Laura Davis, ANP-BC Christian Gring, MD, FACC
Nyla Thompson, PA-C
Joel Schneider, MD, FACC
Cardiovascular Services Echocardiography Nuclear Cardiology Interventional Cardiology Carotid Artery Interventions Cardiac Catheterization Cardiac CT Angiography and Calcium Scoring Electrophysiology and Cardiac Arrhythmias Peripheral Vascular Interventions Pacemakers / Defibrillators Stress Tests Holter Monitoring Lipid and Anti-Coagulation Clinics Vascular Ultrasounds / AAA Screening
WHV Locations in Johnston, Wayne and Wilson Counties 910 Berkshire Road
2076 NC Hwy 42 West, Suite 100
2605 Forest Hills Road South West
2400 Wayne Memorial Drive, Suite A
Smithfield, NC 27577 Phone: 919-989-7909 Fax: 919-989-3147
Clayton, NC 27520 Phone: 919-359-0322 Fax: 919-359-0326
Wilson, NC 27893 Phone: 252-243-7049
Goldsboro, NC 27534 Phone: (919) 736-8655 Fax: (919) 734-6999
When it comes to your cardiovascular care – We know it by heart. To learn more, visit our website www.WHVheart.com or call us at 1-800-WHV-2889 (800-948-2889).
The No-Excuse Mammogram. Saturday and evening appointments where your patients live, work and play in the Triangle. An annual screening mammogram only takes 20 minutes, from check-in to exam completion. That’s the convenience of Wake Radiology, where we specialize in state-of-the-art digital mammography as well as comprehensive women’s imaging. It‘s easy for patients to schedule this important exam, because many of our nine breast imaging offices throughout the Triangle are open evenings and Saturdays, and walk-ins are welcome at all locations. Wake Radiology is in-network with most insurance plans and offers financial assistance or payment plans to those who need it. If your patients have celebrated 40 birthdays or more, encourage them to safeguard their health by calling 919-232-4700 or going online to schedule their annual digital screening mammogram today. Wake Radiology. Excellence in breast imaging.
Wake Radiology is proud to be the only multi-site freestanding outpatient imaging provider in the area to earn the American College of Radiology’s prestigious Breast Imaging Center of Excellence (BICOE) designation.
Wake Radiology Express Scheduling Monday-Friday 7:30am-6:00pm Express Scheduling: 919-232-4700 Chapel Hill Scheduling: 919-942-3196 Or online at wakerad.com Nine convenient Triangle locations Raleigh | West Raleigh | Northwest Raleigh | Chapel Hill Cary | Garner | Wake Forest | Morrisville | Fuquay-Varina
Comprehensive Breast Imaging Centers